Induction of Labor by Prostaglandin: A Review for Indications and Risk for Cesarean Section

Abstract

Objective: Labor induction by medication is now preferred by many obstetricians. The impact of induction remains ambiguous, although many studies and systematic reviews have been conducted. Few studies have reported for its better outcomes while other studies with poor outcomes. The objective of the study is to identify the common indications of induction and the risk of cesarean section after induction. Methods:Various standardized databases, such as Pub Med, Scopus, and Google Scholar, were used to collect the scientific studies, where prostaglandin was used as drug of choice for induction of labor. The key words used were induction of labor, indications of induction, induction by misoprostol, induction and risk of cesarean section, etc. The survey spans over 22 years of study articles published from the year 1995-2017.Result: A total of 112 studies have been included to analyze the indications and risk of cesarean section. The most common indication found in most of the studies was post-term pregnancy. The risk of cesarean section varied from 3% to 48.7%. The common reasons for which the cesarean section was planned were, failed induction, nonprogress of labor, fetal distress, and undiagnosed CPD. Conclusion:Most of the studies recommend induction of labor as a safer option with lower risk of c-section.

Study of comparison of maternal and fetal outcomes in spontaneous labour and induced labour

“…3,21 No statistically significant difference was observed with respect to birth weight of babies in the two groups, a finding in line with Sujata et al and Tripathy et al amongst others. 12,13 NICU admissions were significantly higher in induction of labor group as compared to spontaneous labor group, with majority of admissions being due to meconium aspiration syndrome and birth asphyxia (25.86% in group A and 29.16% in group B). This was relatively much higher than what Macer et al in their study found out (0.8%).…”

“…11 Rest of the previously similar studies were also in agreement with this observation. 3,12,13 Majority of patients in spontaneous labor group delivered in less than 6 hours (mean 4.820±3.48 hours) while those after induction mostly delivered between 6 to 11 hours (mean 10.302±5.73 hours), the difference between two groups being significant. Pant et al had observed that the Bishops score was related to the mean duration of labor and reported that patients who had induction of labor had significantly higher duration of labor than the patients who went into spontaneous labor.…”

“…17 The most common indication for caesarean section in both the groups in the present study was fetal distress (88.89% and 75.09%), mostly in agreement with observations of Bueno et al (meconium stained liquor and/or fetal distress), Babu et al (fetal distress) and Tripathi et al (fetal distress, oligohydramnios and meconium stained liquor). 13,18,19 Failed induction was one of the major indication of section in all these studies in the induction of labor group.…”