Failed Induction of Labour

Abstract

Over a 15-month period 1,057 consecutive inductions of labour were performed representing a 10% induction rate; 174 (16.5%) of these patients were delivered by Caesarean section of which 74 (7.0%) were for failed induction of labour, 58 (5.5%) for fetal distress, 19 (1.8%) for cephalopelvic disproportion, 6 for malposition and 17 for other reasons. The mean cervical score at induction of labour was 5.7 and 5.5 for cephalopelvic disproportion (CPD) and malposition respectively but was 4.0 for failed induction. The mean cervical dilatation at the time of Caesarean section was 5.7 cm and 6.6 cm for CPD and malposition respectively whereas it was 3.5 cm for failed induction. Mean maximum dose of oxytocin was 19.2 milliunits per minute (mu/min) and 22.5 mu/min for CPD and malposition respectively whereas it was 24.7 mu/min for cases of failed induction. Nulliparas with a cervical score of 3 or less had a 65.4% Caesarean section rate of which more than two-thirds were for failed induction of labour. Analysis of indications for induction of labour revealed that a fair number of inductions had debatable obstetric indications. Tailoring induction of labour to the cervical score and indication might reduce the Caesarean section rate for failed induction of labour. Rational management to ensure an adequate dose of oxytocin and sufficient time in the first stage of labour is important. Failed induction of labour may be differentiated from failure of labour progress due to CPD or malposition.

Prediction of the efficacy of dinoprostone slow release vaginal insert (Propess) for cervical ripening: A prospective cohort study

“…Cervical status evaluated by Bishop score is a good predictor of the likelihood of achieving vaginal delivery . Low Bishop scores are associated with higher incidence of prolonged labor, operative vaginal delivery and cesarean delivery . In these cases, cervical ripening should be initiated at the initial stage of labor induction.…”

Outcome of Surgical Induction of Labourin a Combined Military Hospital

“…An ideal method of induction must be cost effective, must ensure efficacy and safety for the mother and the foetus with minimal induction delivery interval, and should be convenient for the patient and the medical staff. 21 Induction is indicated when the risk of continuing the pregnancy, for the mother or the fetus, exceeds the risk associated with induction of labour and delivery. The management of labour determines to a great extent the outcome both for the mother and baby.…”

Sweeping of membranes in formal induction of labour

“…There may be a subset of women with particular cervical findings, who will benefit from sweeping of the membranes. Nulliparous women with a poor cervical score have a caesarean section rate as high as 65% following formal induction of labour while the same is not true in nulliparous as well as multiparous women with a good cervical score 2,3 .…”