September 2006 · Vol. 18, No. 9OB DILEMMAS: Is this induction necessary?
3 cases, 3 evidence-based choices
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Fast Track
Elective induction should be strongly discouraged in nulliparous women
Do not induce labor in a woman who has had more than 1 low transverse cesarean delivery
Membrane sweeping causes the release of endogenous prostaglandins and can lead to labor without further induction
Success is more likely with a Bishop score ≥5 and gestational age >28 weeks
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Judith
Chung,
MD;
Clinical Instructor of Obstetrics and Gynecology, Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Irvine Deborah
A.
Wing,
MDAssociate Professor of Clinical Obstetrics and Gynecology, Division Director of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Irvine
Typically labor is induced when the benefits of expeditious delivery outweigh those of continuing pregnancy, although elective inductions are on the rise.1,2 Labor induction is not without consequence, however, most notably the increased risk of cesarean delivery. And once the decision is made to induce labor, the best means may not be entirely clear, particularly when there are so many choices available.
We present 3 scenarios and our recommendations for each. In each case, we cite the supporting evidence to date on the critical questions that lead to an appropriate decision.
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