Induction of Labor: An Overview of Guidelines

Importance Induction of labor (IOL) is a common obstetric intervention that stimulates the onset of labor using artificial methods. Objective The aim of this study was to summarize and compare recommendations from 4 national or international medical societies on the IOL. Evidence Acquisition A descriptive review was conducted of major published guidelines on IOL: the American College of Obstetricians and Gynecologists' Induction of Labor and Management of Late-Term and Postterm Pregnancies, the guidelines of the Society of Obstetricians and Gynaecologists of Canada (SOGC) on Induction of Labour, those of the National Institute for Health and Care Excellence (NICE) on Inducing Labour, and the World Health Organization's (WHO's) Recommendations for Induction of Labour and WHO Recommendations: Induction of Labour at or Beyond Term. These guidelines were compared in terms of their recommendations on clinical indications and methods. Results Many similar indications and contraindications to IOL are identified between American College of Obstetricians and Gynecologists and SOGC, whereas NICE and WHO do not mention any contraindications. The timing of IOL in postterm pregnancies also differs among the guidelines. Regarding the methods of induction, all the medical societies recommend the use of membrane sweeping, mechanical methods, prostaglandins, and oxytocin, whereas NICE argues against the use of misoprostol for IOL. The American College of Obstetricians and Gynecologists and SOGC consider amniotomy a method of IOL, whereas NICE and WHO do not recommend it. All the guidelines also make similar recommendations regarding the management of uterine tachysystole in cases of IOL. Conclusions The World Health Organization seems to be the most evidence-based guideline with recommendations based mainly on Cochrane reviews. The variation in the clinical indications and methods of IOL highlights the need to adopt an international consensus, which may help to optimize the quality of obstetric care and further promote evidence-based medicine. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After participating in this activity, the learner should be better able to identify the appropriate indications for induction of labor; explain the effectiveness and associated risks of using prostaglandins, misoprostol, oxytocin, and amniotomy for induction of labor; and assess the definition and alternatives of failure of induction of labor.