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Induction of labor

Key sources
The following summarized guidelines for the evaluation and management of induction of labor are prepared by our editorial team based on guidelines from the Society of Obstetricians and Gynaecologists of Canada (SOGC 2023), the World Health Organization (WHO 2022; 2014), the Austrian Society of Gynecology and Obstetrics (OEGGG/DGGG/SGGG 2021), and the Society for Maternal-Fetal Medicine (SMFM 2018).
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Guidelines

1.Diagnostic investigations

Digital vaginal examination: perform digital vaginal examination at 4-hour intervals for routine assessment and identification of delay in active labor.
B
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2.Medical management

Setting of care: as per WHO 2022 guidelines, do not offer routine outpatient induction of labor for improving birth outcomes.
D

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  • Indications for induction of labor

  • Oxytocin

  • Prostoglandins

3.Inpatient care

Monitoring of induction: as per WHO 2014 guidelines, obtain an active phase partogram with a 4-hour action line for monitoring the progress of labor.
B

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  • Electronic fetal monitoring

4.Nonpharmacologic interventions

Activity and positioning: encourage adopting mobility and upright position during labor in patients at low risk.
B

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  • Food intake

  • Companionship

5.Therapeutic procedures

Balloon catheter
As per WHO 2022 guidelines:
Offer balloon catheter for induction of labor.
B
Offer the combination of balloon catheter plus oxytocin administration for induction of labor.
B

6.Surgical interventions

Amniotomy: as per SOGC 2023 guidelines, consider performing amniotomy when the modified Bishop score is ≥ 7. Recognize that amniotomy is most effective when combined with an induction agent (oxytocin or prostaglandin E1).
B

7.Preventative measures

Prevention of delay: do not offer a package of care for active management of labor for preventing delay in labor.
D
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