When should labour be induced

The decision to induce labour is a matter of rather complex clinical judgement. It usually constitutes a choice between three options: allowing the pregnancy to continue, inducing labour or performing elective Caesarean section. The decision takes into account a number of factors. • Anticipated benefits to the mother, such as improving a medical condition which is caused or aggravated by pregnancy, including pre-eclampsia, placental abruption and certain respiratory, hepatic and cardiac disorders; relieving discomfort, such as from multiple pregnancy, poly-hydramnios or spontaneous symphysiotomy; allowing essential treatment to be commenced, such as for cervical cancer; relieving emotional distress after intrauterine death; or alleviating anxiety about the baby s well-being.

• Estimated risks to the mother, such as increased pain and need for analgesia, uterine hyperstimulation, Caesarean section, infection, complications of the procedures, post-partum haemorrhage, uterine rupture (very rarely), anxiety if the induction is protracted or unsuccessful, and loss of self-esteem because of perceived failure to give birth normally.

• Anticipated benefits to the baby, such as improved growth and development when intrauterine growth is suboptimal, and reduced risk of intrauterine death from complications such as diabetes, prolonged pregnancy (beyond 41 weeks), amnionitis, prelabour ruptured membranes, rhesus immunization, fetal compromise and cholestasis of pregnancy.

• Estimated risks to the baby, such as prematurity and compromise from uterine hyperstimulation.

Several factors influence the decision.

• The condition of the mother.

• The condition of the baby.

• The gestational age of the baby, and level of certainty about the baby's age. When fetal lung maturity is uncertain, amniocentesis may be performed to assess markers for lung maturity such as the alcohol 'shake' test, lecithin/sphingomyelin ratio and phosphatidyl glycerol level.

• Previous Caesarean section.

• The preference of the mother.

• The likelihood that induction of labour will be efficient and vaginal delivery successful.

The last factor is in part dependent on the state of the uterine cervix, which is related to the imminence of spontaneous labour.

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