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ACOG induction of labor 2022

Clinical Guidance for Integration of the Findings - ACO

  1. A randomized controlled trial comparing elective induction of labor at 39 weeks gestation with expectant management among low-risk nulliparous women was published in the New England Journal of Medicine on August 8, 2018 1.The study was a large unmasked multicenter trial conducted from March 2014 to August 2017 that approached 22,533 eligible women, of which 6,106 (27%) provided informed.
  2. July 2018 Number 194 Polycystic Ovary Syndrome June 2018 Induction of Labor August 2009 For additional quantities, please contact sales@acog.or
  3. Sometimes labor induction does not work. Early labor is the time when a woman's contractions start and her cervix begins to open. Women who have induction at 39 weeks should be allowed up to 24 hours or longer for the early phase of labor. They also should be given oxytocin at least 12-18 hours after stripping of the membranes
  4. FOGSI- ICOG 2018 Induction of Labor Methodology The President FOGSI and Chairperson ICOG, 2018 realized the need of evidence based guidelines for induction of labor for the country for uniform clinical practice to be used by obstetric care providers
  5. INTERIM UPDATE ACOG PRACTICE BULLETIN Clinical Management Guidelines for Obstetrician-Gynecologists NUMBER 222 (Replaces Practice Bulletin No. 202, December 2018) CommitteeonPracticeBulletins—Obstetrics
  6. In the outpatient group, the Foley was inserted the day before admission for scheduled induction; insertion was performed at scheduled admission in the inpatient group. The primary outcome was duration of time from admission to the labor and delivery unit to delivery. With 80% power and a two-sided α of 0.05, a sample size of 126 was estimated.
  7. Term Prelabor Rupture of Membranes. When membranes rupture at term before the onset of labor, approximately 77-79% of women will go into labor spontaneously within 12 hours, and 95% will start labor spontaneously within 24-28 hours 13 14.In the TERMPROM trial, a RCT of labor induction versus expectant management of rupture of membranes at term, the median time to delivery for women managed.

The American College of Obstetricians and Gynecologists 409 12th Street, SW, PO Box 96920, Washington, DC 20090-6920. Gestational diabetes mellitus. ACOG Practice Bulletin No. 190. American College of Obstetricians and Gynecologists. Obstet Gyne-col 2018;131:e49-64 ABSTRACT: The neonatal risks of late-preterm and early-term births are well established, and the potential neonatal complications associated with elective delivery at less than 39 0/7 weeks of gestation are well described. However, there are a number of maternal, fetal, and placental complications in which either a late-preterm or early-term delivery is warranted The ARRIVE trial was a U.S. multicenter randomized controlled trial conducted at 41 hospitals through the Maternal-Fetal Medicine Units Network. 1 Low-risk nulliparous women were randomized to either elective induction of labor, defined as induction of labor between 39 0/7 and 39 4/7 weeks of gestation, or expectant management. Although there was no significant difference in the primary. The ARRIVE study (A Randomized Trial of Induction Versus Expectant Management), authored by Grobman et al. (NEJM, 2018), was undertaken to determine if elective induction of labor (IOL) of low-risk nulliparous women at 39 weeks reduces adverse perinatal and neonatal morbidity compared to expectant management

INTRODUCTION. When labor is induced, cervical status has an impact on the duration of induction and the likelihood of vaginal delivery. If the cervical status is unfavorable, a ripening process is generally employed prior to induction to shorten the duration of induction and maximize the possibility of vaginal delivery Background: While there are well-accepted standards for the diagnosis of arrested active-phase labor, the definition of a failed induction of labor remains less certain. One approach to diagnosing a failed induction is based on the duration of the latent phase. However, a standard for the minimum duration that the latent phase of a labor induction should continue, absent acute maternal or.

ACOG and SMFM have reviewed the published results of the ARRIVE Trial and determined that it is reasonable for obstetric care providers to offer an induction of labor to low-risk women after discussing the options thoroughly, as shared decision making is a critical element. Women eligible for induction must meet the following criteria OBJECTIVE: To evaluate antenatal risk factors associated with failed induction of labor among obese women to develop a predictive model for induction of labor outcome. METHODS: We conducted a population-based cohort study of all obese (body mass index higher than 30.0) women with singleton live births who underwent attempted induction of labor between 37 and 44 weeks of gestation in the United. On the topic of induction, one study on 20,095 women attempting VBAC found a rate of uterine rupture of 0.52% with spontaneous labor, 0.77% for labor induced without prostaglandins and 2.24% for prostaglandin-induced labor. Prostaglandins should be avoided in the third trimester in women who have had a previous cesarean section SAMPLE Induction of Labor Checklist- from FPQC. AWHONN Position Statement: Non-Medically Indicated Induction and Augmentation of Labor. ACOG Optimizing Protocols in Obstetrics: Oxytocin for Induction. ACOG Patient Safety Checklist #5: Scheduling Induction of Labor. ACOG Practice Bulletin #107: Induction of Labor

Practice Bulletin ACO

Induction of labor is performed for 24.5% of all births in the United States. 1 Indications for induction include maternal comorbidities (eg, diabetes mellitus, hypertensive diseases) and conditions that affect fetal wellbeing (eg, prelabor rupture of membranes, fetal growth restriction). 2 Typically, an induction of labor starts with cervical ripening followed by continuous infusion of. Labor induction versus expectant management in low-risk nulliparous women. N Engl J Med. 2018;379:513-523. The term elective induction of labor has long had a negative connotation because of its association with increased CD rates and adverse perinatal outcomes SUMMARY: ACOG released updated guidance on gestational diabetes (GDM), which has become increasingly prevalent worldwide. Class A1GDM refers to diet-controlled GDM. Class A2GDM refers to the clinical scenario where medications are required. Highlights and changes from the previous practice bulletin include the following an arrest of labor disorder are less likely to succeed in their attempt at VBAC than those whose first cesarean delivery was for a nonrecurring indication (eg, breech presentation) (39-44). Similarly, there is consistent evi-dence that women who undergo labor induction or aug-mentation are less likely to achieve VBAC than wome Labor is a complex, physiologic event that involves an intricate interaction of multiple hormones. Women can make fully informed decisions about induction of labor only when they understand the process of induction, potential benefits and risks associated with the pharmacologic and/or mechanical methods used to induce labor, alternatives to induction, and the potential benefits and risks of.

Due to an unfavorable cervix, many of the women presenting for induction experience longer labor times, increased rates of cesarean section and increased healthcare costs. The purpose of the study was to examine the difference in cesarean section rates, maternal and neonatal morbidity and costs for outpatient vs inpatient Foley induction For expecting mothers, the onset of labor is a highly-anticipated process; however, close to 25% of women will have their labor induced. In fact, the rate of induction of labor doubled between 1990 and 2006 and has continued to trend upwards. [] Regardless of whether labor is induced or spontaneously occurs, the goal is vaginal birth The largest declines in labor induction for the nation occurred at 38 weeks of gestation . Declines in labor induction occurred for almost 3 out of 4 states over the study period. For 36 states and the District of Columbia (DC), induction rates at 38 weeks were lower in 2012 than in 2006. Declines ranged from 5% in Maryland to 48% in Utah

ad a singleton hospital birth at 38 0/7 weeks of gestation of gestation in Ontario, Canada, between 2012 and 2016. Women who underwent induction of labor at 38 0/7 to 38 6/7 weeks of gestation for chronic hypertension (n=281) were compared with those who were managed expectantly during that week and remained undelivered at 39 0/7 weeks of gestation (n=1,606). Separately, women who underwent. In response to the ARRIVE study, ACOG has opined that it is reasonable for obstetricians and health-care facilities to offer elective induction of labor to low-risk nulliparous women at 39 weeks gestation. 8 The ACOG advisory prudently notes that the obstetrician should consider a woman's preference, available resources and ensure an.

Induction of Labor at 39 Weeks ACO

ACOG Green Journal: Risk Calculator to Predict Cesarean Delivery Among Women Undergoing Induction of Labor. Reference: Rossi, et. al. (2020) Risk Calculator to Predict Cesarean Delivery Among Women Undergoing Induction of Labor. Obstetrics & Gynecology, 135(3) p 559-568; DOI: 10.1097/AOG.000000000000369 The 6106 ARRIVE participants — all at 39 weeks to 39 weeks and 4 days of gestation — were randomized to induction of labor or expectant management. Cesarean deliveries were less common in the.

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ACOG addresses the management of pregnant women with pregestational diabetes, including specific guidance for the multiple aspects of care. SMFM has provided a sample of an open access checklist in a Special Statement that can be found in 'Learn More - Primary Sources' 1. Induction of labour is recommended for women who are known with certainty to have reached 41 weeks (>40 weeks + 7 days) of gestation. Low Weak 2. Induction of labour is not recommended in women with an uncomplicated pregnancy at gestational age less than 41 weeks. Low Weak 3. If gestational diabetes is the only abnormality, induction of labou The specific type of testing and how often to test varies from provider to provider (ACOG, 2018). Recently updated practice guidelines on labor induction with gestational diabetes. The American College of Obstetricians and Gynecologists (ACOG) advises against inducing labor before 39 weeks in people with GDM who have well-controlled blood sugar.

ACOG: Outpatient Foley Catheter for Induction of Labor in

After publication of the ARRIVE trial findings, both ACOG and SMFM released statements supporting elective labor induction at or beyond 39 weeks' gestation in low-risk nulliparous women with good gestational dating. 2,3 They cited the following as important issues: adherence to the trial inclusion criteria except for research purposes, shared decision-making with the patient, consideration. The elective induction of labor before 39 weeks is inconsistent with ACOG recommendations and the standard of care. But once a woman reaches 39 weeks, clinical judgment and institutional culture end up playing a substantial role in the decision to induce ACOG and SMFM have reviewed the published results [and] determined that it is reasonable for obstetric care providers to offer an induction of labor to low-risk women after discussing the.

Induction of labor is indicated when the potential risks of continuing a pregnancy outweigh the benefits. At times, this is clear (e.g., when one of the indications listed on the following page threatens the health of the mother or baby) (ACOG Practice Bulletin 107 Induction of labor). Other definitions of abnormal contraction patterns can include: A series of single contractions lasting 2 minutes (120 seconds) or more, contractions of normal duration (60 seconds) occurring within one minute of each other, insufficient return of uterine restin (See Induction of labor: Techniques for preinduction cervical ripening.) (See Cervical ripening and induction of labor in women with a prior cesarean delivery.) PREVALENCE. Between 1990 and 2019, the overall frequency of labor induction tripled in the United States, rising from 9.5 percent in 1990 to 29.4 percent in 2019 Preterm delivery occurs in approximately 12% of all births in the United States and is a major factor that contributes to perinatal morbidity and mortality (1, 2). Preterm prelabor rupture of membranes (also referred to as premature rupture of membranes) (PROM) complicates approximately 3% of all pr

Managing Gestational Diabetes: The Clinical Pharmacist’sEvidence on: Induction for Gestational Diabetes - Evidence

ACOG Practice Bulletin 173: Fetal Macrosomia. Abstract: Suspected fetal macrosomia is encountered commonly in obstetric practice. As birth weight increases, the likelihood of labor abnormalities, shoulder dystocia, birth trauma, and permanent injury to the neonate increases. The purpose of this document is to quantify those risks, address the. Elective delivery prior to term gestation is associated with adverse neonatal outcomes. The impact of American College of Obstetricians and Gynecologists (ACOG) guidelines recommending against induction of labor (IOL) < 39 weeks' postmenstrual age (PMA) on the frequency of early-term births and NICU admissions in Erie County, NY was evaluated in this study

Approaches to Limit Intervention During Labor and Birth ACO

  1. Practice Bulletins authored by the American College of Obstetricians and Gynecologists (ACOG) are evidence-based documents that summarize current information on techniques and clinical management issues for the practice of obstetrics and gynecology.. The official list of current bulletins is published monthly and includes reaffirmed dates for older bulletins
  2. Risk factors for cesarean delivery in preterm, term and post-term patients undergoing induction of labor with an unfavorable cervix. Gynecol Obstet Invest ; 2009 ; 67 ( 2 ): 113-17 . 10
  3. Labor Induction or Augmentation and Autism [2014] Society for Maternal-Fetal Medicine. SMFM Statement on Elective Induction of Labor in Low-Risk Nulliparous Women at Term: the ARRIVE Trial [2018] WHO. World Health Organization. WHO recommendations: Induction of labour at or beyond term [2018] WHO recommendations for induction of labour [2011
  4. e Bishop's Score prior to Foley catheter insertion. 5
  5. In the ACOG/Society for Maternal-Fetal Medicine (SMFM) consensus on the safe prevention of the primary cesarean delivery 46, it is stated that if the maternal and fetal status allow, cesarean deliveries for the induction of labor in the latent phase can be avoided by allowing longer durations of the latent phase (up to 24 hours or longer.
  6. Labor induction versus expectant management in low-risk nulliparous women. N Engl J Med. 2018;379:513-523. American College of Obstetricians and Gynecologists. Practice advisory: clinical guidance for integration of the findings of the ARRIVE trial: Labor induction versus expectant management in low-risk nulliparous women. August 2018
How to Use Evening Primrose Oil to Start Labor | How To Adult

ACOG Practice Bulletin No

  1. g for either maternal or fetal benefit. Much literature has been published and continues to be published on both the maternal and fetal safety of induction of labor, especially as it relates to cesarean section rates
  2. It's true, most babies will come when they are ready for life outside the womb, but sometimes induction of labor is suggested by the care giver or desired by the pregnant person. ACOG recommendations support a normal, full-term pregnancy lasting between 39 weeks and 0 days and 41 weeks and 6 days as long as both the mother and the baby are.
  3. A 2018 cost-effectiveness analysis of induction of labor at 39 weeks of gestation versus expectant management among a theoretical cohort of 1.6 million low-risk nulliparous women found that induction of labor resulted in 54,498 fewer cesarean deliveries and 79,152 fewer cases of hypertensive disorders of pregnancy, again consistent with the.
  4. Objective: In 2010, the American College of Obstetricians & Gynecologists (ACOG) published a new clinical practice guideline on trial of labor after cesarean (TOLAC) that was considered less restrictive. It allowed for offering TOLAC to women with two prior cesarean deliveries, even without a prior vaginal delivery, and for labor induction
[PDF] A Comparative Study of Trans vaginal Sonography and

Cervical Ripening. If your cervix is firm, long, or closed, cervical ripening may be recommended before initiating labor. These options may vary and can range from natural approaches to more traditional methods (see 'Natural Ways to Induce Labor'). Induction sometimes necessitates a cervical ripening phase, which is advisable if your cervix is not ready for active labor as a ripe. Women opposed to induction of labor in the absence of maternal and fetal indications were almost 4 times more likely to be concerned about the possibility that induction of labor in the absence of maternal and fetal indications could cause fetal harm (odds ratio, 3.9; confidence interval, 1.2-13.2) Literature review indicates increased risk of rupture with induction or augmentation of labor, although ACOG guidance notes issues related to study design, including a large multi-centered trial (33,699 women) 1.4% risk of rupture for prostaglandins +/- oxytocin; 1.1% oxytocin alone; 0.9% augmented labor CERVIDIL® (dinoprostone, 10 mg) is a vaginal insert approved to start and/or continue the ripening of the cervix in pregnant women who are at or near the time of delivery and in whom there is a medical reason for inducing (bringing on) labor Labor induction is actually a 2-step. process. The first step is called. pre-labor and involves your cervix. In order for delivery to happen, your cervix needs. to open (dilate), soften, and thin out. The medical. term for this process is cervical ripening. Go, Team, Go

Medically Indicated Late-Preterm and Early-Term - acog

  1. Premature rupture of the membranes (PROM) occurs in about 8-10% of pregnancies and its most important complication is chorioamnionitis, so labour induction has an important role in this situation. This study was performed to compare oxytocin and sublingual Misoprostol for labour induction in PROM ca
  2. Comments on the Arrive Trial Elliott Main, MD, Medical Director and the CMQCC Leadership Team February 8, 2018 The Arrive Trial was released on February 1st at the Society for Maternal Fetal Medicine's Annual Meeting.1 The Arrive trial was a randomized controlled trial comparing labor induction at 39 weeks to expectant management to 42 2/7 weeks among low risk nulliparous women
  3. New Orleans, LA — Induction and augmentation of labor with the hormone oxytocin may not be as safe for full-term newborns as previously believed, according to research presented today at the Annual Clinical Meeting of The American College of Obstetricians and Gynecologists. Researchers say this is the first study of its kind to present data on the adverse effects of Pitocin use on newborns
  4. ister Pitocin for at least 12-18 hours after membrane rupture before calling the induction a failure (and recommending cesarean surgery).10 The latent phase of labor can be pro
  5. To analyze blood loss after delivery in women with induction of labor compared to women with spontaneous onset of labor. In this secondary analysis of a prospective cohort study investigating postpartum hemorrhage, 965 deliveries were analyzed including 380 women with induction of labor (39%) between 2015 and 2016. Primary outcome parameters were rate of postpartum hemorrhage, estimated blood.
  6. Note: Since this article was published, ACOG released new VBAC guidelines in 2017 and 2018.Both maintain that LAC (labor after cesarean) induction remains an option. Many of the comments left at the Forced Cesarean story questioned the safety of LAC induction. Many people believe that is it excessively dangerous and that planned VBACs should never been induced or augmented

21 ACOG Committee on Practice Bulletins—Obstetrics.. Induction of labor. ACOG Practice Bulletin No. 107. American College of Obstetricians and Gynecologists. Obstet Gynecol 2009; 114: 386-397 ; 22 Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999-2008. JAMA 2010; 303 (03) 235-24 Cesarean birth is still the most common surgical procedure for women in the United States, a procedure that occurs in close to one in three births per year (Altenau et al., 2017).Data for 2019 showed a total cesarean birth rate in the United States of 31.7% (Martin et al., 2021), which exceeded the target established by the World Health Organization of 10% to 15% (World Health Organization, 2015)

D. Coates, et al., Induction of labour indications and timing: A systematic analysis of clinical guidelines, Women Birth (2019), article in press. 2. ACOG. Induction of labor: ACOG practice bulletin. Clinical management guideline for obstretricians-gynecologists. America: The American College of Obstetricians and Gynaecologists; 2009. 3. NICE What are two drawbacks of inducing labor? Your health care provider will discuss with you the possibility of a need for a C-section. Low heart rate. The medications used to induce labor — oxytocin or a prostaglandin — might cause abnormal or excessive contractions, which can diminish your baby's oxygen supply and lower your baby's heart. Insufficient evidence to conclude that early induction of labor when fetal macrosomia is suspected decreases the risk of shoulder dystocia. 5. Steps to resolving shoulder dystocia per ACOG: stop pushing, McRobert's maneuver w/ head traction, suprapubic pressure, rotational maneuvers, then posterior arm delivery V18.1 SPECIAL REPORT ©2018 NPIC NPIC.ORG | 1 V18.1 Special Report: Induction Coding Analysis . labor induction appears to be an important contributor. ACOG has released guidelines that standardize when to diagnose a failed The revised ACOG definitions for labor and labor induction/augmentation are shown in Table 1 on the following page

Elective Induction of Labor in the 39th Week of Gestation

Accessed Feb. 23, 2018. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 561: Nonmedically indicated early-term deliveries. Obstet Gynecol 2013;121:911-915. Caughey AB, Sundaram V, Kaimal AJ, et al. Systematic review: Elective induction of labor versus expectant management of pregnancy. Ann Intern Med 2009;15:252-263 As induction of labor involves coordination between the health care provider and the infrastructure in which induction and [birth] will occur, it is critical that personnel and facilities coordinate polices related to the offering of elective induction of labor (ACOG & SMFM, 2018, para. 5) Women opposed to induction of labor in the absence of maternal and fetal indications were almost 4 times more likely to be concerned about the possibility that induction of labor in the absence of maternal and fetal indications could cause fetal harm (odds ratio, 3.9; confidence interval, 1.2-13.2) in August of 2018, ACOG discouraged elective induction before 41 -42 weeks of gestation. In response to the ARRIVE Trial, ACOG issued a practice advisory 2 stating that, it is reasonable for obstetricians and health care facilities to offer elective induction of labor to low-risk nulliparous [first-time Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. However, debate continues to surround the diagnosis and treatment of GDM despite several recent large-scale studies addressing these issues. The purposes of this document are the following: 1) provide a

The ARRIVE Trial and Professional Guidance: Elective 39

2018 May 15;97(10):671-672. A 2015 retrospective cohort study of 7,543 women with singleton term pregnancies undergoing labor induction examined the association between BMI and cesarean. Grobman WA, Rice MM, Reddy UM, et al. Labor Induction versus Expectant Management in Low-Risk Nulliparous Women. N Engl J Med 2018; 379:513. ACOG Committee Opinion No. 766 Summary: Approaches to Limit Intervention During Labor and Birth. Obstet Gynecol 2019; 133:406. American College of Obstetricians and Gynecologists Committee on Obstetric.

Techniques for ripening the unfavorable cervix prior to

November 1, 2018 • First Practice Bulletins 45 Obstetric 35 Gynecology • Methodology summary listed on published document • Posted on ACOG website • Induction of Labor - Patient Safety Checklist (2011 • On March 1, 2014, ACOG released new labor management guidelines, which changed the • Spontaneous labor vs. induction of labor Delivery and induction rate in the 12 months Before and After new ACOG guidelines 1 7/16/2018 4:07:42 PM.

Defining failed induction of labo

• The potential need for induction of labour for women with a post-term pregnancy should be discussed with women in advance, so that they have an opportunity to ask questions and understand the benefits and possible risks. 2. Induction of labour is not recommended for women with an uncomplicated pregnancy at gestational age less than 41 weeks Labor induction is also appropriate at later gestational age, based on patient preference, or if the option for dilation and evacuation is unavailable. (ACOG, 2009). 3.3. Before 28 weeks gestation, misoprostol appears to be the most efficient method of induction. Typical dosage is 200-400 mcg vaginally every 4-12 hours (ACOG, 2009). (note: see. Number 188, JaNuary 2018 (Replaces Practice Bulletin Number 172, October 2016) ACOG PRACTICE BULLETIN clinical management guidelines for obstetrician women viewed induction of labor more positively than expectant management (13). Induction of labor wit The researchers carried out the ARRIVE study (A Randomized Trial of Induction Versus Expectant Management) to find out if elective induction of labor (using medicine to start labor without a medical reason) during the 39 th week of pregnancy would result in a lower rate of death and serious complications for babies, compared to waiting until at. The first patient inclusion was on 12 February 2018, and we hope to recruit a total of 80 patients within 18 months of the first recruitment. ACOG Committee on Practice Bulletins -- Obstetrics. ACOG Practice Bulletin No. 107: Induction of labor. A randomized trial of Foley Bulb for Labor Induction in Premature Rupture of Membranes in.

ACOG Practice Advisory/SMFM Clinical Statement: Clinical

• 20% of pregnant women undergo induction of labor (IOL) • Overall rate of IOL has doubled in 20 years • 800,000 IOL annually • Utah: 50,000 births • 10,000 women IOL • Likely will increase with recent results of the ARRIVE study (NEJM August 2018 Induction of labor compared to expectant management in low-risk women and associated perinatal outcomes. Am J Obstet Gynecol. 2012;207:502.e1-e8. Darney BG, Snowden JM, Cheng YW, et al. Elective induction of labor at term compared with expectant management: maternal and neonatal outcomes Induction rates increased from 22% in 2006 to 27% in 2018, and appropriate management of induction at or labor induction between 39 ACOG practice bulletin no. 107: induction of. ACOG has released a guidance update on Prelabor Rupture of Membranes (PROM). The use of 'prelabor' is in keeping with reVITALize terminology (see 'Related ObG Topics' below) and is defined as the 'spontaneous rupture of membranes that occurs before the onset of labor' The Committee on Practice Bulletins—Obstetrics of the American College of Obstetricians and Gynecologists (ACOG) has issued new clinical management guidelines on fetal macrosomia. ACOG Practice.

Obstetrics & Gynecology: Predictive Model for Failed

Dr. Grobman's 2018 New England Journal of Medicine study was so pivotal that ACOG changed its guidelines in 2018 to say that doctors can offer induction at 39 weeks to first-time mothers if both. Labor should be induced immediately, regardless of gestational age, in patients with intrauterine infection, placental abruption, or evidence of fetal compromise. View/Print Table Table In the present study, labor induction to active labor interval and time from induction to delivery were found to be longer in the dinoprostone compared to the oxytocin group (p = 0.001, p = 0.519, respectively). In one study, in term women with PROM oxytocin use shortened the induction to active labor onset compared to dinoprostone

risks and benefits of elective induction of labor at 39 weeks versus expectant management. 1 Grobman WA, etal. Labor Induction versus Expectant Management in Low-Risk Nulliparous Women. New Eng J Med 2018;379:513-23 in 1956.2 Before 1990, induction of labor occurred in less than 10% of singleton births. After nearly 20 years of consecutive increases, labor induction for singletons reached a high of 23.8% in 2010 and then started to Author Affiliation: Department of OBGYN, Vanderbilt University School of Medicine, Nashville, Tennessee (However, a 2018 study of elective inductions in low-risk women found they resulted in fewer C-sections than spontaneous labor.) The American College of Obstetricians and Gynecologists (ACOG) lists three primary reasons to induce labor