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Depending on a patient's obstetric and medical history, there are indications for late preterm, early-term, late-term, and post-term labor induction. Obstetric indications encompass placental, uterine, and fetal conditions such as growth restriction and multiple gestations, oligohydramnios or polyhydramnios, alloimmunization, and preterm prelabour rupture of membranes. Maternal indications that warrant labor induction include hypertensive disorders and pregestational and gestational diabetes. This activity reviews the indications, contraindications, and possible complications of labor induction. It highlights the role of the interprofessional team in the management of pregnant women undergoing induction of labor for various reasons. Objectives: Identify the indications for IOL. Assess the contraindications for IOL. Evaluate the complications of IOL. Communicate the importance of improving care coordination among interprofessional team members to improve outcomes for pregnant women undergoing IOL. Access free multiple choice questions on this topic.

Induction of labor (IOL) is a common obstetric intervention that stimulates the onset of labor using artificial methods[1]. Rates of labor induction have nearly doubled since 1990.[2] There is substantial variation in IOL rates worldwide, and this can be attributed to variability in the guidelines and lack of consensus on the clinical practice guidelines on IOL. Nowadays, in high-income countries, the proportion of neonates born following IOL is estimated to be approximately 25%. In contrast, the corresponding rates are generally lower in low- and middle-income countries (LMIC).[1] This topic reviews indications, contraindications, complications, and methodologies for IOL.

More and more women are labor-induced, and indications are often not urgent. This means that the safety aspects of induction methods become more important, although this could be at the expense of effectiveness. Mechanical methods could have advantages over pharmacological methods as they are widely available, low in cost, and may have fewer side effects, such as excessive uterine contractions (uterine hyperstimulation). This could be safer for the baby because if contractions are too long or very close together, the baby may not receive sufficient oxygen. Pharmacological induction can cause uterine tachysystole, with more than 5 contractions in 10 minutes. Tachysystole may lead to fetal decelerations or bradycardia; much literature has been published regarding the risks of uterine tachysystole with prostaglandins.[13] Further complications include intrapartum vaginal bleeding, presence of meconium-stained amniotic fluid, umbilical cord prolapse, pain not relieved with regional anesthesia, perineal lacerations, postpartum hemorrhage, chorioamnionitis, and postpartum endometritis.[2]

Pregnant women offered or undergoing IOL should be managed by a coordinated interprofessional team involving the obstetric provider, specialty-trained obstetric nurse, midwives, anesthetic staff, and a neonatology team. Ultimately, whenever there is a change in the pregnant woman's or fetal status, a collaborative effort between all healthcare team members must be made to ensure the pregnant woman's and her fetus(s) health. The nurses and midwives play a crucial role during the IOL process. Clear communication among the interprofessional team members is vital for achieving the best standard of care for pregnant women undergoing IOL and their families. Witten patient information leaflets should be given to pregnant women offered IOL. They should be easy to understand, and women can also be referred to online resources to help them make informed decisions about their pregnancies.

Depending on the acuity level of the facility, continuous electronic fetal monitoring is often done during labor. Many healthcare systems require regular documentation of the electronic fetal heart rate and tocodynamometer and notations written for resuscitative interventions in the presence of a category 2 or fetal heart rate tracing. Nursing should alert obstetric providers and anesthetic staff about potential concerns and the possibility of proceeding with an operative vaginal delivery or cesarean section, depending on the patient's stage of labor and fetal heart rate tracing.

Most hospitals have policies or protocols regarding labor induction, medication administration, fetal heart rate monitoring, oral intake during IOL, pain control, maternal observations, and obstetric emergencies. As noted above, fetal heart rate should be monitored, along with the contraction pattern and adequacy of contractions if an intrauterine pressure catheter is present. Electronic medical records often have flowsheets and checklists for nurses to record events during admission. Depending on the patient's medical history, such as a hypertensive disorder or diabetes mellitus (gestational or pregestational), the hospital may have protocols for the frequency of blood pressure or blood glucose assessments, respectively. Patients on high-alert medications during induction, such as antihypertensives, magnesium sulfate, or insulin, may need more frequent monitoring, depending on the hospital's specific protocol. Changes noted by the nurse during these assessments warrant notifying the obstetric care provider to see if further intervention is required, such as administering additional antihypertensives or glucose in hypoglycemia. Other monitoring during IOL may include the timing of amniotomy and the color of amniotic fluid, which can be crucial to inform further management.