Induction of Labour


Induction of Labour;

Explain about the prediction of successful Labor induction

Explain the factors that lead to the success of labour induction


Induction of Labour



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Induction of Labour

“Pregnancy is the only time when you can do nothing at all and still be productive” is a famous quote by Evan Esar. According to Bekru et al. (2018), “There are a number of pregnancy complications that confer significant risk to the mother or fetus. According to Meier et al. (2019), “IOL is a process by which labor is artificially initiated when the benefits of delivery are believed to outweigh the risks of await‐ ing the spontaneous onset of labor” (p.2). According to Marconi (2019), “The rate of labor induction is steadily increasing and, in industrialized countries, approximately one out of four pregnant women has their labor induced” (p.1). According to Bekru et al. (2018), “Approximately 20% of parturient undergo induction of labor (IOL) for various reasons’ (p.1). According to Adwy et al. (2018), “Induction of labor (IOL) represents a common procedure in everyday obstetric practice: it is used in 30 –40% of women in labor” (p.2). “The number of induced labors is expected to rise as IOL before the estimated delivery date is increasingly being shown to be beneficial in women with a number of obstetric and medical conditions” (Meier et al., 2019, p.2). “In some middle‐ and low‐income countries such as Sri Lanka, as many as 35.5% of deliveries were induced in 2007‐2008, suggesting that rising IOL rates are a global phenomenon” (Meier et al., 2019, p.2). According to Lou et al. (2019), “Induction of labor (IOL) has increased in recent decades in Western countries for example, the induction rate in the United States has more than doubled from 9.5% of all deliveries in 19902 to 23.8% in 2015. Similarly, the National Hospital Service’s (NHS) maternity statistics4 reported an increase in inductions from 20.3% to 29.4% from 2006 to 2016 alone” (p.1). “Induction of labor (IOL) is certainly one of the most frequently performed obstetric procedures in the world: recent data indicate a percentage of induction of up to 35.5% in Sri Lanka, 24.5% in the United States, and from 6.8 to 33% in Europe. In spite of the extreme diffusion of the procedure, there are still numerous unanswered questions or questions that have not obtained a unanimous consensus in the scientific literature” (Marconi, 2019, p.1). “Another key contributor to the rise in IOL has been the increased awareness of the potential risks of late‐ and post-term pregnancy because the higher gestational age has been associated with increased risk of adverse outcomes, including placenta insufficiency and stillbirth” (Lou et al., 2019, p.2). “Consequently, many health authorities have introduced clinical guidelines that prescribe “elective” or “non‐medically indicated”13 IOL in low‐risk, post-term pregnancies” (Lou et al., 2019, p.2). Marconi (2019) also stated that “Induction of labor should be considered when the benefits of prompt vaginal delivery outweigh the maternal and fetal risks of waiting for the spontaneous onset of labor” (p.1). There are ways that the health officials can use to predict successful labour induction and also factors that can ensure that the process is successful.

Prediction of Successful Labor Induction

There are many predictions of a successful labour inductions. According to Marconi (2019), “The identification of the factors associated with the success of the induction, intended as vaginal delivery, is fundamental for a procedure which is considered to contribute to the increase in the cesarean delivery rate” (p.1). “One of the main factors is certainly the assessment of the cervix” (Marconi, 2019, p.1). “From the time of its presentation, the Bishop score (BS) is the most used method to assess the cervix, with a BS of 6 or less indicating an unfavorable cervix and a score of 8 or more a favorable one (and a BS of 7 being homeless)” (Marconi, 2019, p.1). According to Gillor et al. (2017), “The Bishop score remains the standard method for predicting the safety and duration of induced labor” (p.1). “However, this method of assessment is subjective, and it has been shown to be a poor predictor of labor in women scheduled for induction” (Gillor et al., 2017, p.1). “The sonographic measurement of cervical length before IOL has also been suggested as a predictor of successful induction, however a recent meta-analysis has shown that cervical length has only moderate capacity for the prediction of IOL” (Gillor et al., 2017, p.1). “A review that considered more than 40 relatively mediocre-quality articles that correlated the BS at the beginning of the induction with its outcome concluded that BS is a poor predictor and should not be used to decide whether or not to induce labor” (Marconi, 2019, p.1). “In an attempt to increase its predictive value, a series of clinical and biochemical parameters have been added, and a modified simplified BS has also been proposed which includes only dilation, station, and effacement, alone or in combination with other parameters” (Marconi, 2019, p.1). “The predictive capacity of the transvaginal sonographic assessment of the cervix has also been evaluated either by itself or in combination with other parameters” (Marconi, 2019, p.1). “At present, however, the BS remains the main tool for the assessment of the cervix at the beginning of the induction and the evaluation of cervical ripeness (i.e. its changes) during the induction process” (Marconi, 2019, p.1). Thus, there are many predictions of a successful labour inductions, and the Bishop score remains the standard method for predicting the safety and duration of induced labor.

Factors that Lead to the Success of Labour Induction

There are many factors that lead to the success of labor induction. According to Marconi (2019), “factors that have been associated with the success of the induction are parity, gestational age and size of the fetus, body mass index (BMI), age of the mother and the presence of comorbidities, and biochemical markers such as fibronectin, activin A, and insulin growth factor binding protein either alone or variously combined” (p.1). According to Batinelli et al. (2018), “Induction of labour (IOL) is a widely used practice in obstetrics and involves many women nowadays” (p.2). “There is a general agreement in considering parity as a major predictor of IOL success and regarding the gestational age, IOL success of late preterm (34–36 6 weeks) is similar to that of term pregnancies, while in weeks between and it varies between 56.9 and 66.7%, considering only live births” (Marconi, 2019, p.1). “In principle, it can be said that the success of the induction, meaning vaginal birth, increases with the gestational age and that >50% of women (also nulliparous with an unripe cervix) give birth vaginally” (Marconi, 2019, p.1). “Scoring systems, nomograms, and prediction model systems have been proposed but have not been validated yet” (Marconi, 2019, p.1). According to Bekru et al. (2018), “There is a consensus that the success of induced labour is directly related to the status of the cervix, with higher CS rates in those with an unfavorable cervix” (p.1). Thus, s ome of the factors associated with the induction’s success are parity, gestational age and size of the fetus, body mass index (BMI), and the mother’s age.


In conclusion, labor induction is an essential medical procedure that reduces mortality rate and aims to ensure the safety and wellbeing of both the mother and child. Initiating the labor process enables the healthcare professionals to effectively manage te complications associated with the pregnancy and also the potential risk involved. The h ealth care professionals should have an honest and open communication with the pregnant mothers concerning these risks and its benefits and better alternatives so that they can make the best decision. Induction of labour should be performed in a safe and effective manner that ensures the safety of both the mother and child.




Al‐Adwy, A. M., Sobh, S. M., Belal, D. S., Omran, E. F., Hassan, A., Saad, A. H., … & Nada, A. M. (2018). Diagnostic accuracy of posterior cervical angle and cervical length in the prediction of successful induction of labor. International Journal of Gynecology & Obstetrics, 141(1), 102-107.

Batinelli, L., Serafini, A., Nante, N., Petraglia, F., Severi, F. M., & Messina, G. (2018). Induction of labour: clinical predictive factors for success and failure. Journal of Obstetrics and Gynaecology, 38(3), 352-358.

Bekru, E. T., & Yirdaw, B. E. (2018). Success of labour induction institution based cross-sectional study Wolaita Sodo, South Ethiopia. International Journal of Nursing and Midwifery, 10(12), 161-167.

Gillor, M., Vaisbuch, E., Zaks, S., Barak, O., Hagay, Z., & Levy, R. (2017). Transperineal sonographic assessment of angle of progression as a predictor of successful vaginal delivery following induction of labor. Ultrasound in Obstetrics & Gynecology, 49(2), 240-245.

Lou, S., Hvidman, L., Uldbjerg, N., Neumann, L., Jensen, T. F., Haben, J. G., & Carstensen, K. (2019). Women ‘s experiences of postterm induction of labor: A systematic review of qualitative studies. Birth, 46(3), 400-410.

Marconi, A. M. (2019). Recent advances in the induction of labor. F1000Research, 8.

Meier, K., Parrish, J., & D’Souza, R. (2019). Prediction models for determining the success of labor induction: A systematic review. Acta Obstetricia et Gynecologica Scandinavica, 98(9), 1100-1112.



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