This document discusses the definition, indications, timing, criteria, and contraindications of induced labor. It notes that induced labor is initiated before spontaneous labor to achieve delivery when the benefits outweigh the risks of continuing the pregnancy, such as in cases of post-dates pregnancy, preeclampsia, diabetes, or fetal compromise. The timing depends on the indication, and criteria include confirmed dates and no acute fetal distress. Contraindications include conditions that could increase risks during a vaginal delivery. District hospitals have limits on the number of prostaglandins that can be used to induce labor without specialist consultation.

1. Dr Ling Soon Diek
O&G specialist
Sarawak General Hospital

2. DEFINITION
 Artificial initiation of labour
(before the onset of
spontaneous labour)
 With the aim of achieving
delivery

3. INDICATIONS
 IOL is indicated when:
 The benefits of delivery to the
mother or fetus outweigh those of
continuing with the pregnancy
 When delivery will be of benefit to
the health of the fetus or mother
or both
 The risks of IOL should be
weighed against the benefits of
continuing with the pregnancy Risk
Benefits

4. INDICATIONS
 Maternal problems
 Diabetes mellitus/GDM
 Hypertensive disorders
 Renal disease
 Abruptio placenta
 Anticipated compromise of fetal welfare with continuation of
pregnancy
 IUGR
 Oligohydramnios
 Chorioamnionitis
 Previous IUD
 History of APH
 Twins
 IUD
 Prolonged pregnancy
 Others
 PPROM
 PROM

5. TIMING OF IOL
Indications Timing
Post dates 40 weeks + (7-10) days
PIH or HPT
Not on treatment By 40 weeks
On treatment +/-38 weeks (depends on severity)
Diabetes/GDM
Not on insulin Around 39 weeks
On insulin 38 weeks (depends on severity)
Indeterminate APH By 40 weeks
EDD given by late scan >20w 38-40 weeks (Discuss with specialist)
Unbooked, unsure of dates Discuss with specialist
PPROM (persistent) >34 weeks (only in specialist hospital)
PROM Immediate - 24 hours of leaking
Social induction To discuss with specialist

6. CRITERIA FOR IOL
 Dates are correct:
 Sure of LMP (regular cycle, was not on contraception)
 Early scan (<20 weeks)
 No acute fetal distress @ no factors that can
increase risk of fetal distress in labour e.g severe
IUGR
 Mother’s verbal consent

7. CONTRAINDICATIONS FOR IOL
 Any contraindication for normal vaginal delivery
 Suspected CPD
 2 previous scars
 Cord presentation
 Malpresentation
 Placenta praevia
 Maternal HIV infection
 Active perineal herpes simplex

8. IN DISTRICT HOSPITAL
 No IOL for previous scar and grandmultipara
 All IOL must be discussed with specialist
 Maximum 2 prostin (3mg each) is allowed in a day
 Start induction in the morning
 Review 6 hours after 1st prostin, if no contraction, can
insert 2nd prostin
 CTG before prostin
 CTG one hour after prostin
 If required > 2 prostin, to discuss with specialist