gynecology and obstetrics
Induction of Labor
Indications
Induction of labor can be Medically indicated (eg, for Preeclampsia and Eclampsia or Elective (to control when delivery occurs) Before elective induction, gestational age must be determined. Commonly, elective induction has been avoided at 39 weeks because of lack of evidence for perinatal benefit and concern about a higher frequency of cesarean deliveries and other adverse outcomes. This practice may be changing, partly because a 2018 study showed that induction of low-risk women at 39 weeks reduced the frequency of cesarean deliveries (but not perinatal adverse outcomes) compared with expectant management ( Indications reference ). Contraindicationsto induction include having or having had the following: Fundal uterine surgery Open maternal-fetal surgery (eg, myelomeningocele closure) Myomectomy involving entry into the uterine cavity Prior classical (vertical) Technique in the thickened, muscular portion of the uterus Active Genital Herpes None Placenta Previa or Fetal Presentation, Position, and Lie (Including Breech Presentation) (eg, transverse lie, umbilical cord presentation, certain types of fetopelvic disproportion) Multiple prior uterine scars and breech presentation are relative contraindications. 