Induction of Labor

Indications: 

Post-dates (42+wks) 
Late Term (41+ wks)
Elective 39+wks 
Diabetes
Hypertension 
Many more - check out ACOG Medically indicated delivery 


39week induction
ARRIVE Trial - Multicenter RCT showing benefit to 39wk IOL over expectant management to ~41wks 
Included 

Primips 
No medical indications for IOL prior to 40+5

 
Results 

IOL group had LOWER c-section rate than expectant group 
Neonatal composite outcome had a trend (not statistically significant) toward lower neonatal compilations in IOL group 

Conclusion

IOL at 39wks is as safe as expectant management without increased risks
Many pregnant people are now offered a 39wk IOL rather than waiting for spontaneous labor 


The IOL Process: 
 
Evaluate and Prep:

Full H&P
Ultrasound for position - Vertex
VE for cervical exam: dilation/effacement/Station, also position and consistency 
Calculate Bishops Score → help determine mode of IOL


Options for IOL: if biship score <8 for prime or <6 for multip, ripen first! 

Mechanical cervical ripening (balloon)
Chemical cervical ripening (misoprostol or cervidil) 
Best yet--both! 

 
Contractions (pitocin) 

Prime: Pitocin alone if Biship 8 or higher
Mulitp: Pitocin alone if bishop 6 or higher&n