General approach to labor induction

There is no universally accepted definition of favorable or unfavorable cervix. Many clinicians consider a Bishop score <6 indicative of an unfavorable cervix and the need for a ripening agent, while others use a lower threshold (eg, ≤3 or 4). The choice of cervical ripening method is based on clinician and patient preference, as long as there are no contraindications to a specific method. An intracervical balloon catheter or a prostaglandin (E1 or E2) can be used alone, in combination, or sequentially until the cervix is favorable.

AROM: artificial rupture of membranes.

* Either a low- or high-dose oxytocin regimen is acceptable as the regimen that achieves optimal maternal and perinatal outcomes has not been identified. Refer to UpToDate content on oxytocin dosing regimens.

¶ A workshop convened by the United States National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Criteria proposed that the following minimum criteria be met before diagnosing a failed induction: failure to generate regular (eg, every 3 minutes) contractions and cervical change after at least 24 hours of oxytocin administration with at least 12 to 18 hours of oxytocin administration after rupture of membranes. The time devoted to cervical ripening before initiating oxytocin is not considered.

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General approach to labor induction