Induction of Labor
Indications: Post-dates (42+wks) Late Term (41+ wks) Elective 39+wks Diabetes Hypertension Many more - check out ACOG Medically indicated delivery 39week induction ARRIVE Trial - Multicenter RCT showing benefit to 39wk IOL over expectant management to ~41wks Included Primips No medical indications for IOL prior to 40+5 Results IOL group had LOWER c-section rate than expectant group Neonatal composite outcome had a trend (not statistically significant) toward lower neonatal compilations in IOL group Conclusion IOL at 39wks is as safe as expectant management without increased risks Many pregnant people are now offered a 39wk IOL rather than waiting for spontaneous labor The IOL Process: Evaluate and Prep: Full H&P Ultrasound for position - Vertex VE for cervical exam: dilation/effacement/Station, also position and consistency Calculate Bishops Score → help determine mode of IOL Options for IOL: if biship score