The rising tide: Trends in induction of labor at term
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The rate of induction of labor (IOL) has been increasing over the past 10years. Traditionally, IOL was utilized when it was deemed that the risk of continuing the pregnancy outweighed the benefit. This could be due to prolonged pregnancy past 41-42 weeks; gestation (post-dates), suspected maternal or fetal complications, or prolonged spontaneous rupture of membranes (PSROM) without spontaneous onset of labor. However, as more recent evidence has demonstrated reduced maternal and neonatal adverse events among patients undergoing elective IOL (eIOL) compared with expectantly managed patients, there has been a change in attitude towards eIOL in the normal-risk woman. The commentary regarding eIOL has been fraught with controversy. Despite concerns expressed by some healthcare providers, professional medical organizations have welcomed the concept of elective, risk-reducing induction as a reasonable option for patient choice.
Although it is acknowledged that IOL rates (as well as cesarean birth rates) are increasing, it is less obvious what are the causes of the rising IOL rates. Additionally, it is unclear to what degree various indications for IOL influence both the overall induction rate and the cesarean delivery (CD) rate. There is lack of clarity as to whether the higher-risk population undergoing medically indicated IOL (mIOL) contribute more to the increasing CD rates, as theorized or whether eIOL plays a significant role in these trends.
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