What is Labour Induction?

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Labour induction/cervical ripening is a set of actions aimed at bringing forward the birth of the baby in a vaginal delivery, either for medical or gestation reasons, paying special attention to the baby’s well-being. One of the most common reasons for inducing labour is prolonged pregnancy, above 42 weeks.

Other reasons considered when recommending labour induction are: intrauterine growth retardation, a suspected baby weight over 4 kg (foetal macrosomia), poorly controlled diabetes and hypertensive pregnancy disorders, among others.

Risks of a prolonged pregnancy

As the weeks go by, the risk of complications increases, notably after week 41 or even earlier; especially, if the mother is over 40 years of age or is overweight. From 41 weeks of pregnancy, risks have been described both for the mother (e.g. vaginal tears, caesarean section, vaginal deliveries requiring forceps or a vacuum) and for the baby (excessive foetal weight, lack of amniotic fluid, meconium aspiration and, very rarely, even death).

The vast majority of women (about 8 out of 10) go into labour or experience their water breaking before 41 weeks. The rest reach 41 weeks without the onset of labour being apparent. The factors behind this are unknown; although it is more common in women with a first pregnancy, elderly women or those who are overweight/obese.  It is also much more frequent if the mother has had a prolonged pregnancy before.

One of the few strategies that have been shown to reduce the incidence of prolonged pregnancy has been the disengagement of the amniotic membranes, as this has been related to spontaneous onset of labour in the following days. This can be offered after 40 weeks of pregnancy, provided there is sufficient dilation and there are no contraindications. Before it can be implemented, the potential risks of this procedure are reported, such as bleeding and discomfort during it (being a group B streptococcus (GBS) carrier does not contraindicate the performance of this manoeuvre).


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