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Thischaptershouldbecitedasfollows:
SanchezRamos,L,Kaunitz,A,Glob.libr.women'smed.,
(ISSN:17562228)2009DOI10.3843/GLOWM.10130

Thischapterwaslastupdated:
April2009

InductionofLabor
LuisSanchezRamos,MD

Professor,DivisionofMaternalFetalMedicine,UniversityofFloridaHealthScienceCenter,Jacksonville,
Florida,USA

AndrewM.Kaunitz,MD

ProfessorandAssistantChair,DepartmentofObstetricsandGynecology,UniversityofFloridaHealthScience
Center,Jacksonville,Florida,USA

INTRODUCTION
INDICATIONSANDCONTRAINDICATIONSFORLABORINDUCTION
PREINDUCTIONSTATUSOFTHECERVIX
METHODSOFLABORINDUCTION
LABORINDUCTIONINWOMENWITHPREVIOUSCESAREANDELIVERY
EFFECTONPREGNANCYOUTCOME
CONCLUSION
REFERENCES

INTRODUCTION
ThehistoryoflaborinductiondatesbacktoHippocrates'originaldescriptionsofmammarystimulationand
mechanicaldilationofthecervicalcanal.1DuringthesecondcenturyAD,Soranuspracticedacombinationof
procedurestoinducelabor,includingartificialruptureofthemembranes.Otherlaborinductionmethods
wereintroducedduringthisperiodMoshionwasthefirsttodescribemanualdilationofthecervix,andCasis
inventedseveralinstrumentscapableofcervicaldilation.Midwaythroughthe16thcentury,Pardeviseda
techniquethatcombinedmanualcervicaldilationandinternalpodalicversioninpatientswithuterine
hemorrhage.2Bourgeois,adiscipleofPar,continuedthispracticeandalsoinducedandaugmentedlabor
withstrongenemasandmixturesofseveralfolkmedicines.3
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Fromthe2ndthroughthe17thcenturies,mechanicalmethodstoinducelaborcameintomorecommonuse.
In1756,atameetingheldinLondon,physiciansdiscussedtheefficacyandethicsofearlydeliveryby
rupturingthemembranestoinducelabor.4
In1810,JameswasthefirstintheUnitedStatestoutilizeamniotomytoinduceprematurelabor.5
Amniotomyandothermechanicalmethodsremainedthemethodsoflaborinductionmostcommonly
employeduntilthe20thcentury.
In1906,Daleobservedthatextractsfromtheinfundibularlobeofthepituitaryglandcausedmyometrial
contractions.6Threeyearslater,Bellreportedthefirstexperiencewithuseofapituitaryextractforlabor
induction.7 Withtheintroductionofpituitaryextractasahormonalmethodoflaborinductionin1913,the
useofthismethodgainedacceptanceamongobstetricians.However,duetotheuseoflargedosesandthe
impurityoftheextract,numerousadverseeffectswerereported.Gradually,asthenumberofreportedcases
ofuterineruptureincreased,pituitaryextractbecamediscreditedinmanycenters.
Initially,oxytocin(pituitaryextract)wasadministeredviaintramuscularorsubcutaneousroutes.In1943,
Pagesuggestedthatthepituitaryextractoxytocinbegivenintheformofanintravenousinfusion,8andin
1949,Theobaldreportedhisinitialresultswiththisformofadministration.9Fourteenyearslaterin1953,
thestructuralformulaofoxytocinwasdiscovered,andsyntheticoxytocinhasbeeninusesince1955.
In1968,Karimandcolleagueswerethefirsttoreporttheuseofprostaglandinsforlaborinduction.10Since
then,theuseofprostaglandins,indifferentvarietiesandformsofadministration,hasbecomeacommon
methodoflaborinduction.11Morerecently,thesyntheticprostaglandinanaloguemisoprostolhasgained
acceptanceasaneffectiveandsafemethodoflaborinduction.12

INDICATIONSANDCONTRAINDICATIONSFORLABORINDUCTION
Althoughmostpatientsexperiencespontaneouslaboratterm,inductionoflaborissometimesindicated.
Laborinductionisaclinicalinterventionthathasthepotentialtoconfermajorbenefitstothemotherand
newborn.Inductionoflaborisacommonobstetricprocedure.In1993,approximately640,000births(16%
ofalllivebirths)intheUnitedStateswerearesultoflaborinduction.13
Commonindicationsforinducinglaborincludehypertensivedisordersofpregnancy,postdatism,
intraamnioticinfection,suspectedfetaljeopardy,andmaternalmedicalproblemsincludingdiabetesmellitus
andchronicrenaldisease.However,laborinductioniscontraindicatedwhenvaginaldeliverywouldendanger
thelifeofthemotherorfetus.Commonobstetricalcomplicationsthatprecludelaborinductioninclude
placentaprevia,transversefetallie,prolapsedumbilicalcord,andpriorclassicaluterineincision.
Theguidingprinciplesforlaborinductionmustbetheobstetrician'sjudgmentthatthebenefitstoeitherthe
motherorthefetusoutweighthoseofcontinuingthepregnancyandthattheinducedlabormustreplicate
spontaneouslaborascloselyaspossible.

PREINDUCTIONSTATUSOFTHECERVIX

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Successfullaborinductionisclearlyrelatedtothestateofthecervix.Womenwithanunfavorablecervix,
whohavenotexperiencedcervicalripeningphasepriortolabor,presentthegreatestchallengewithregard
tolaborinduction.Inaddition,thedurationoflaborinductionisaffectedbyparityandtoaminordegreeby
baselineuterineactivityandsensitivitytooxytocicdrugs.Manyinvestigatorshaveidentifiedtheimportance
ofassessingcervicalstatuspriortoinductionoflabor.Calkinsandcolleagueswerethefirsttocarryout
systematicstudiesofthefactorsinfluencingthedurationofthefirststageoflabor.14Theyconcludedthat
thelength,thickness,andparticularlytheconsistencyofthecervixwereimportantparameters.In1955,
Bishopdevisedacervicalscoringsystemformultiparouspatientsinwhich03pointsaregivenforeachof
fivefactors.15, 16Hedeterminedthatwhenthetotalscorewasatleast9,thelikelihoodofvaginaldelivery
followinglaborinductionwassimilartothatobservedinpatientswithspontaneousonsetoflabor.Although
severalmodificationshavebeensuggested,theBishopscorehasbecomeaclassicalparameterinobstetrics
andhassincebeenappliedtonulliparouspatients.Inrecentyears,severalstudieshaveevaluatedthe
possibleroleoftransvaginalultrasoundexaminationofcervicallengthinthepredictionoflaborinduction
andoutcome.Arecentlypublishedsystematicreviewwithmetaanalysisof20diagnosticstudiesconcluded
thatsonographiccervicallengthwasnotaneffectivepredictorofsuccessfullaborinduction.17

METHODSOFLABORINDUCTION
Nonmedicalmethods
Numerousnonmedicalmethodsforcervicalripeningandlaborinductionhavebeenemployed(Table1).
Althoughpopularwithmidwives,mostarenotroutinelyusedbyobstetricians,perhapsbecausetheyhave
notbeensubjecttoproperlyperformedrandomizedtrials.
Table1.Nonmedicalmethodsforcervicalripeningandlaborinduction
Sexualintercourse
Breaststimulation
Herbalpreparations
Homeopathicsolutions
Purgatives
Enemas
Acupuncture
Strippingofthemembranes
Thereisreasonableevidencetosuggestthatsexualintercourseandbreaststimulationmaybeeffectivein
ripeningthecervixandinducinglaboratterm.18, 19Duetotheuncontrolledsecretionofprostaglandins
and/oroxytocincausedbythesemethods,itmaybesafertolimittheseapproachestowomenattermwith
healthy,uncomplicatedpregnancies.
Themedicalliteraturedoesnotaddresstheuseofherbalpreparationsorhomeopathicsolutions.Purgatives
suchascastoroilandenemaswerewidelyusedinthepastbuthavelargelybeenabandonedaseffective
methodsforlaborinduction.Acupuncturewitheithermanualorelectricalstimulationisanacceptedmethod
forlaborinductioninAsiaandEuropehowever,itisnotwidelyemployedintheUnitedStates.20

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Strippingofthemembranesisperhapsthebeststudiednonmedicalmethodforcervicalripeningandlabor
induction.Anumberofrandomizedclinicaltrialshaveshownthatmembranestrippingsuccessfullyinduces
labor.21, 22However,potentialrisksincludeinfection,prematureruptureofmembranes,andbleedingfrom
placentalcontact.
Mechanicalmethods
Mechanicalmethods,althoughmainlyeffectiveincausingcervicaldilation,havebeenusedformanyyearsto
inducelabor.23Themechanicalstimulationoftheendocervicalcanalhasbeenshowntotriggerthereleaseof
prostaglandins.Themorepopularmechanicalmethodsincludeamniotomy,balloontippedcatheters,and
naturalandsyntheticlaminaria.
Amniotomy,orartificialruptureoftheamnioticmembranes,causeslocalsynthesisandreleaseof
prostaglandins,leadingtolaborwithin6hoursinnearly90%oftermpatients.TurnbullandAndersonfound
thatamniotomywithoutadditionaldrugtherapysuccessfullyinducedlaborinapproximately75%ofcases
within24hours.24
Mechanicaldilationoftheunripecervixusingballoontippedcathetershasbeenemployedforcervical
ripeningandlaborinductionformanyyears.Althoughvariousballooncathetershavebeendescribed,Foley
catheterswith2550mlballoonsarethemostcommonlyused.Concomitantuseofballoontippedcatheters
andpharmacologicagentshasbeeneffectiveinlaborinductionhowever,thecostofcombinationtherapyis
markedlyincreased.25
Naturalandsyntheticlaminariahavebeenshowntobeeffectiveincervicalripening,moresothanlabor
induction.Althoughtheirsafetyandefficacyhavebeenestablishedinthesecondtrimester,ahighincidence
ofinfectionisassociatedwiththeuseoflaminariaduringthethirdtrimesterofpregnancy.26
Sincemechanicalagentsrepresentforeignbodiesplacedintoorthroughthecervix,manyobstetriciansfeel
thattheirusecouldincreaseinfectionrisk.Arecentlypublishedmetaanalysisof30randomizedtrials
comparinglaborinductionwithmechanicalmethodswithalternativepharmacologicagentsorplacebo
demonstratedthatmaternalandneonatalinfectionswereincreasedinwomenwhounderwentlabor
inductionwithmechanicalmethods.27 Thisfindingraisesthequestionofwhetherprophylacticantibiotics
areindicatedinpatientsundergoinglaborinductionwithmechanicalmethods.
Pharmacologicalmethods
OXYTOCIN
Oxytocin,aneurohormoneoriginatinginthehypothalamusandsecretedbytheposteriorlobeofthe
pituitarygland,representstheagentmostfrequentlyusedforlaborinduction.Acontrolledintravenous
infusion,withorwithoutamniotomy,causesenoughuterineactivitytoproducecervicaldilationandeffect
delivery.Becauseoxytocinoftendoesnotpromotecervicalripening,itisusuallynoteffectiveinpatientswith
unripecervices.Theincidenceoffailedinductionsunderthesecircumstancesapproaches50%butcanbe
markedlyreducedwiththeuseofpreinductioncervicalripeningagents.28
Duetothehighactivityofplacentaloxytocinase,theplasmahalflifeisshort,andsteadystatelevelsare
achievedafter40minutesofcontinuousintravenousinfusion.Gestationalageisamajorfactoraffectingthe
doseresponsetooxytocin.Duetotheappearanceofoxytocinreceptorsinthemyometrium,theuterusstarts
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torespondtooxytocinatapproximately20weeks'gestation.From34weeks'gestationuntilterm,nochange
insensitivityisnoted.However,oncespontaneouslaborbegins,uterinesensitivityincreasesrapidly.
Theoptimuminitialoxytocindose,intervalandfrequencyofdosageincrease,andmethodsofinfusionare
thesubjectofconsiderabledebate.Severalrandomizedtrialshaveshownawiderangeofdosagesand
frequenciestobesuccessful.29, 30, 31Doseincrementschedulesasshortas15and30minuteshavebeen
comparedusingstartingdosesof0.52.5mU/minutewithincreasesinthesameamountnosignificant
differencewasfoundbetweenthetwogroups.
Mostcommonly,oxytocinisinitiatedatadosageof1mU/minute,withincreasesof1or2mU/minuteevery
2030minutesuntilamaximumadministrationrateof1632mU/minuteisreachedoradequateuterine
activityispresent.Otherprotocolsforoxytocininfusionhavebeenreported.Amoreconservativemodeof
infusioncallsforastartingdoseof0.5mU/minutewithsimilardoseincreasesatintervalsof60minutes.
Both20and40minutedosageintervalshavebeenshowntobesafeandefficientwhenusingoxytocinat
startingdosesof6mU/minutewithequalincreases.
Therecognitionthatendogenousoxytocinissecretedinspurtsduringpregnancyandspontaneouslaborhas
promptedexplorationofamorephysiologicmannerofinducinglaborwiththisagent.Cummiskeyand
Dawood32performedarandomizedtrialtodeterminethesafetyandefficacyofpulsedadministrationof
oxytocinincomparisonwiththetraditionalcontinuousinfusion.Theauthorsconcludedthatpulsed
administrationofoxytocinisassafeandeffectiveascontinuousinfusion.Oneobviousadvantageisthe
reductionoffluidvolumerequiredtoadministerthedrugandthelowerdosesofoxytocinrequired.
Becausethemostcommonadverseeffectofoxytocininfusionisfetalheartrate(FHR)deceleration
associatedwithincreaseduterineactivity,itisessentialthatFHRanduterinecontractionsbecontinuously
monitoredtoobserveanytachysystoleorhyperstimulationrequiringintervention.Waterintoxication,a
resultoftheantidiureticeffectofoxytocin,canoccurwhenlargevolumesofelectrolytefreefluidsare
infused.
PROSTAGLANDINS
Inductionoflaborwithprostaglandins(PGs)offerstheadvantageofpromotingcervicalripeningwhile
stimulatingmyometrialcontractility.TheuseofPGsasinductionagentshasbeenreportedextensivelyina
varietyofPGclasses,doses,androutesofadministration.33, 34, 35Thedistinctionbetweencervicalripening
andlaborinductionissuperfluousinpatientsreceivingprostaglandinsbecausemanywomenwillgointo
laboronreceivingprostaglandins.
Dinoprostone(PGE2)istheprostaglandinmostcommonlyemployedinobstetrics.Thisprostaglandinplays
animportantroleinthecervicalripeningprocessandininitiatingandmaintaininglabor.Theoptimalroute
foradministrationofPGE2hasnotyetbeendetermined.Generally,tworoutesofadministrationhavebeen
used:intravaginalandintracervical.Theintracervicalroutehasbeenusedinapproximatelytwothirdsof
reportedclinicaltrials.Dinoprostoneforintracervicalapplicationisapprovedforcommercialuseinthe
UnitedStatesbytheFoodandDrugAdministration(FDA)asPrepidil(dinoprostonePGE2).Thecommercial
dinoprostonegelcontains0.5mgofdinoprostonein2.5mloftriacetinandcolloidalsilicondioxidegelina
prefilledapplicator.Peakabsorptionofthedrugoccurswithin3045minutesofapplication.Repeatdoses

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maybegivenat6hourintervals,withamaximum24hourdoseof1.5mgdinoprostone.Placebocontrolled
trialshaveshownthatapplicationofintracervicalPGE2moreoftenleadstosuccessfulcervicalripeningand
laborinductioninpatientswithsimilarBishopscores.36, 37
Asustainedrelease10mgdinoprostonevaginalinserthasalsoreceivedFDAapprovalandiscommercially
available(Cervidil,ForestLaboratories,StLouis,MO).Thevaginalinsertconsistsofathin,flat,polymeric
hydrogelchip(299.50.8mm)withroundedcornersplacedinaknittedpolyesterretrievalpouch.Each
insertcontains10mgofdinoprostoneinadriedpolymermatrixthatreleasesdinoprostoneatacontrolled
rateof0.3mg/hourfor12hourswhenrehydratedonexposuretothevaginalmucosa.Theinserthasbeen
showntopromotecervicalripeninginpregnantwomenatornearterm,producingaBishopscoreofatleast
3by12hours.Activelaborandvaginaldeliveryaremorelikelytooccurwithinthis12hourperiod,reducing
theneedforoxytocininfusion.Nearlythreequartersofpatientsrequireonlyasingleapplication.38
PriortoFDAapprovaloftheintracervicalandvaginalinsertdinoprostonepreparations,hospitalprepared
gelwasfrequentlyutilized.Themajorityofthesepreparationscombinedadinoprostonesuppository
(ProstinE2,Pharmacia&Upjohn,Kalamazoo,MI)withmethylcellulosegel(KYJelly)andwereapplied
eithervaginally(2.55mg)orintracervically(0.5mg).Comparativestudieshavenotshownanybenefitof
theFDAapprovedproductoverthehospitalpreparedgels.39, 40
ThemostcommoncomplicationsobservedinpatientstreatedwithPGE2forcervicalripeningandlabor
inductionhavebeentachysystoleandhyperstimulationoftheuterus.Theseresultsappeartobedoserelated
andarerarelyseeninpatientsreceivingsmalldoses(0.5mg).OthercomplicationsresultingfromPGE2
inductionincludeuterinerupture,amnioticfluidembolism,andmyocardialinfarction.Fortunately,these
seriouscomplicationsareextremelyrare.
Numerousreports,includingametaanalysis,havefoundthatmisoprostol,asyntheticPGE1 analogue,safely
andeffectivelyripensthecervixandinduceslaborinpatientswithunfavorablecervices.41Intravaginaldoses
of2550ghavebeenshowntoshortentheintervalfrominductiontovaginaldeliveryandtolowerthe
cesareandeliveryrate.Severalstudieshaveshownsimilarresultswithoraldosesof100gevery4hours.
Althoughtachysystoleisfrequentlynotedwithrepeatedvaginaldosesof50g,theincidenceof
hyperstimulationsyndrome(tachysystoleassociatedwithFHRabnormalities)isnotincreased.Inadditionto
beingasafeandeffectivemethod,itisveryeconomical.
Thereareconcernsthatdividingthetabletsmaynotprovideaccurateorconsistentdosesofmisoprostol,and
thereisuncertaintyaboutvaginalreleasecharacteristicsfromatabletdesignedfororaluse.Researchis
currentlyunderwaytoassessthesafetyandefficacyofamisoprostolvaginalinsertatdosesof50and100
g.Arecentlypublishedrandomizedcontrolledtrialcomparedthemisoprostolvaginalinsert(50and100
g)withthecommerciallyavailabledinoprostonevaginalinsert.Themisoprostolvaginalinsertwith100g
andthedinoprostoneinserthadsimilarmediantimeintervalstovaginaldelivery.The50ginserthad
significantlylongertimetovaginaldelivery.42
Otherpharmacologicmethods
MIFEPRISTONE
Theroleofmifepristone(RU486),aprogesteroneantagonist,inlaborinductionisnotaswellestablishedas
itisfortherapeuticabortions.Mifepristonehasbeenusedwithsomesuccessfortheinductionoflaborin
casesofintrauterinefetaldemiseofatleast16weeks'gestation.Arandomizeddoubleblindtrialemploying
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200mgofmifepristonedailyfor2daysresultedinashorterintervaltotheonsetoflabor,andlessoxytocin
wasrequiredforthoseachievingvaginaldelivery.43Inthemifepristonegroup,58%wentintospontaneous
labor,comparedwith22.6%intheplacebogroup.Thecesareandeliveryratedidnotdifferbetweenthetwo
groups,andnosideeffectswereencounteredinthetreatmentgroup.Morerecently,Elliotandcolleagues44
comparedtheeffectsof50mgand200mgoforalmifepristonewithplacebooncervicalripeningandlabor
inductioninprimigravidwomenwithunfavorablecervicesatterm.Atadoseof200mg,mifepristone
resultedinafavorablecervixorspontaneouslabormoreoftenthandidplacebo.Furtherstudiesare
requiredtoconfirmtheroleofmifepristoneasalaborinducingagent.
RELAXIN
Relaxinisapolypeptidehormone,similartoinsulin,producedbytheovaries,decidua,andchorion.Because
itaffectsconnectivetissueremodeling,ithasbeenstudiedasacervicalripeningagent.Severalclinicaltrials
usingpurifiedporcinerelaxin,administeredeithervaginallyorintracervically,demonstratedits
effectivenessincervicalripening.Recently,however,studiesemployingvaginalrecombinanthumanrelaxin
(14mg)haveshownnosignificantbenefitasapreinductioncervicalripeningagent.45, 46, 47
CYTOKINES
Theroleofcytokinesincervicalripeningiscurrentlyunderinvestigation.Thesechemotacticagentspromote
themigrationandactivationofinflammatorycells,whichinturnareasourceofcollagenaseandother
enzymescapableofdigestingextracellularmatrixproteins.Topicalapplicationofcertaincytokines
(interleukin8[IL8]andIL1)havebeenshowntoinducecervicalripeninginpregnantguineapigswithout
initiatingfrankuterineactivity.48
NITRICOXIDE
Animalstudieshaveshownthatthefreeradicalgasnitricoxideisupregulatedintheuterinecervixduring
laborandleadstocervicalripening.49Recentstudiesusingnitricoxidedonors(isosorbidemonotitrateand
glyceryltrinitrate)haveshownenhancementofcervicalripeninginpatientsundergoingfirsttrimester
terminationofpregnancy.Theroleofnitricoxideincervicalripeningandlaborinductionisstillconsidered
investigational.50Recentpublicationshaveassessedtheefficacyandsafetyofvaginalnitricoxide(isosorbide
mononitrate)foroutpatientpreinductioncervicalripening.Theresultsofthesestudiesindicatethatthis
agentshowsomepromiseasaneffectivecervicalripeningagent.51, 52

LABORINDUCTIONINWOMENWITHPREVIOUSCESAREAN
DELIVERY
Ingeneral,cliniciansfavoringatrialoflaborinawomanwhohashadapreviouscesareanalsoconsiderlabor
inductionanappropriateprocedurewhenindicated.Likewise,somecliniciansfeelthatifthereisno
contraindicationtolaboranddelivery,thereisnocontraindicationtocervicalripening,inducedlabor,or
augmentedlaborforpatientswithapreviouscesareanbirth.
Mostmethodsemployedforcervicalripeningandlaborinductioninpatientswithanunscarreduterusare
alsousedinpatientswithpreviouscesareandelivery.Severaltrialshaveshownthatcervicalripeningand
laborinductionwithoxytocinorPGE2issafeandeffectiveinpatientswithpreviouscesarean.53, 54Chez
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performedaliteraturereviewfrom1981to1994andfoundthattheoverallincidenceofdehiscence(0.3%)
anduterinerupture(0.5%)wassimilarinpatientswithpreviouscesareanundergoinglaborinduction
comparedwithpatientsinspontaneouslabor.55Thereareinsufficientdatawithregardtotheuseof
misoprostolforlaborinductioninpatientswithapreviouscesarean.Becauseofthreecasesofuterine
ruptures,tworecentreportswarnedagainsttheuseofthisdruginpatientswithscarreduteri.56, 57
However,thesepatientshadunknownscarsandreceivedlargeamountsofoxytocinforaugmentation.
Inarecentsystematicreview,therateofuterineruptureduringlaborinductioninwomenwithprevious
cesareandeliveryrangedfrom0.35%,inapropspectivecohortstudyofoxytocin,to4.35%inan
observationalstudyofamniotomy,oxytocinanddinoprostone.Theresultsofthisreviewindicatedthatthere
wasnosignificantincreaseinuterinerupturerateamongthoseinducedcomparedwithspontaneouslabors.
Whencomparedwithwomeninspontaneouslabor,thosewhoreceivedoxytocinanddinoprostonehad
slightlyincreasedcesareandeliveryrates.58

EFFECTONPREGNANCYOUTCOME
Laborinductionperformedwhenthecervixisunripeisassociatedwithahigherincidenceofprolonged
labor,instrumentaldelivery,andcesareanbirth.Bahnandassociates59examinedtheeffectoflabor
inductionlengthonmaternalandneonataloutcome.Theyconcludedthatprolongedinductionisassociated
withasmallincreasedriskofinfectiousmorbidity,withanestimated10%incidencenotedafter40hoursin
womenwhodelivervaginally.
Laborinductionhasbeenfoundtohavevariableeffectsonthecesareandeliveryrate.Undoubtedly,labor
inductioninnulliparouswomenwithanunfavorablecervixisassociatedwithanincreasedcesareandelivery
rate.Ametaanalysisandextensivereviewoftheliteraturedidnotdemonstrateasignificantreductionin
cesareandeliveryrateswiththeuseofdinoprostone(PGE2)preparations.11However,inasimilarstudy,
SanchezRamosandcolleaguesconcludedthatlaborinducedusingmisoprostolwasassociatedwitha
reducedincidenceofcesareandeliveries.41
Neonataloutcomesfollowinglaborinductioncomparefavorablywiththoseachievedafterspontaneous
labor.ThelikelihoodofabnormalApgarscores,needforadmissiontotheneonatalintensivecareunit,or
perinataldeathisnotsignificantlyincreasedwithlaborinduction.Ahigherincidenceofneonatal
hyperbilirubinemiahasbeenreportedwithoxytocininducedlabors.Morerecently,acohortstudyof100
newbornswhosemotherhadbeeninducedwitheitheroxytocinormisoprostol,concludedthatneitheragent
appearedtohaveharmfuleffectsonbilirubinlevelsintheneonate.60

CONCLUSION
Laborinductionappearstobeasafealternativetospontaneouslabor.Regardlessofthemethodemployed,
itisessentialthatthepatientandherobstetricianunderstandtherationaleforinducinglabor,therisksof
themethodchosen,andtheoptionsthatwillbeconsideredincaseoffailedinduction.Thegoaloflabor
inductionmustalwaysbetoensurethebestpossibleoutcomeformotherandnewborn.

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