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Medical Induction of Labour

• Published: July 1999
• Revised: January 2008
• Topic: Prenatal
• Scope: Management
• Abstract: Guideline to assist with the initiation of effective uterine contractions for the purpose of delivery of the infant. Guideline provides indications and contraindications, discusses oxytocin and prostaglandins as well as tocolytics.
• Target Population: Induction is indicated when the continuance of pregnancy may no longer be advisable in the following clinical circumstances:
  • • Gestational hypertension
  • • Rh incompatibility
  • • Term, pre-labour rupture of membranes
  • • Maternal medical conditions (e.g., insulin dependent diabetes, renal disease)
  • • Gestation over 41 weeks
  • • Evidence of fetal compromise
  • • Utero-placental insufficiency
  • • Intrauterine fetal death
  • • Chorioamnionitis
  • • Logistic factors (e.g., history of rapid labour, distance from hospital)
• Exclusions: Pregnancies with:
  • • Malpresentations (e.g., transverse or oblique lie, footling breech)
  • • Absolute cephalo-pelvic disproportion
  • • Placenta previa
  • • Previous major uterine surgery or classical Caesarean section
  • • Invasive carcinoma of the cervix
  • • Prolapsed cord
  • • Active genital herpes
  • • Gynecological, obstetrical, or medical conditions that preclude vaginal delivery
• Working Group Membership: Family physicians, obstetricians, pediatricians, geneticists, midwives