Oxytocin has been used for decades to induce or augment labor. Other efective methods include prostaglandins, such as misoprostol and dinoprostone, and mechanical methods that encompass membrane stripping, artiicial rupture of membranes, extraamnionic saline infusion, transcervical balloons, and hygroscopic cervical dilators. Importantly, and as recommended in Guidelines or Perinatal Care, each obstetrical department should have its own written protocols that describe administration of these methods for labor induction and augmentation (American Academy of Pediatrics, 2017).
Maternal complications associated with labor induction are cesarean delivery, chorioamnionitis, uterine rupture, and postpartum hemorrhage from uterine atony. Of these, labor induction carries a two-to threefold greater risk for cesarean delivery (Hofman, 2003; Maslow, 2000; Smith, 2003). his risk is particularly higher among nulliparas (Luthy, 2004; Wolfe, 2014; Yeast, 1999). More recently, this association has been questioned (Macones, 2009; Melamed, 2016; Miller, 2015; Saccone, 2015). Indeed, Darney and colleagues (2012) reported the cesarean delivery risk was actually lower for women with labor induction at 39 weeks' gestation compared with that in women expectantly managed. In their review, Little and Caughey (2015) found a reduced cesarean delivery rate when women undergoing labor induction were compared with women expectantly managed, as opposed to women spontaneously laboring. Currently, this is the topic of a randomized trial by the 1aternal-Fetal Medicine Units (MFMU) NetworkA Randomized Trial of Induction Versus Expectant v1anagement-ARRIVE (National Institutes of Health, 2015).
Amniotomy is often selected to augment labor (p. 511).
Women whose labor is managed with amniotomy have a higher incidence of chorioamnionitis compared with those in spontaneous labor (American College of Obstetricians and Gynecologists, 2016).
Rupture of a prior uterine incision during labor in women with a history of prior uterine surgery can be catastrophic (Chap. 31, p. 598). The MFMU Network reported a threefold greater risk of uterine scar rupture with oxytocin, and this was even higher with prostaglandin use (Landon, 2004). he American College of Obstetricians and Gynecologists (20 17b) recommends against the use of prostaglandins for preinduction cervical ripening or labor induction in women with a prior uterine incision.
Uterine atony and associated postpartum hemorrhage are more common in women undergoing induction or augmentation (Chap. 41, p. 759). And, atony with intractable hemorrhage, especially during cesarean delivery, is a frequent indication for peripartum hysterectomy. In a study from Parkland Hospital, labor induction was associated with 17 percent of 553 emergency peripartum hysterectomies (Hernandez, 2013). In the United States, the postpartum hysterectomy rate rose 15 percent between 1994 and 2007 (Bateman, 2012). his was largely attributed to increased rates of atony associated with more medical labor inductions and more primary and repeat cesarean deliveries. In another analysis, elective induction was also linked with a threefold higher rate of hysterectomy (Bailit, 2010).
Until recently, elective induction for convenience had become increasingly prevalent. Clark and coworkers (2009) described 14,955 deliveries at �37 weeks' gestation. hey noted that 32 percent were elective deliveries, and 19 percent were elective labor inductions.