Advertisement
JOGC

Induction of Labour: Review

      The issue of induction of labour and risk of Caesarean section has been a topic of recent discussion, catalyzed by the publication of a new review paper in the Canadian Medical Association Journal.
      • Mishanina E.
      • Rogozinska E.
      • Thatthi T.
      • Uddin-Khan R.
      • Khan K.S.
      • et al.
      Use of labour induction and risk of cesarean delivery: a systematic review and meta-analysis.
      In response to an influx of queries regarding the CMAJ paper and its potential effect on SOG guidelines, the Clinical Practice Obstetrics Committee has reviewed the SOGC Induction of Labour guidelines published in 2013
      • Leduc D.
      • Biringer A.
      • Lee L.
      • Dy J.
      Clinical Practice Obstetrics Committee, Society of Obsetricians and Gynaecologists of Canada. Induction of labour. SOGC Clinical Practice Guideline No. 296, September 2013.
      and concluded that no update or revision to the SOGC is required at this time. The committee emphasized that the CMAJ meta-analysis included no new information or studies that were not used in the 2013 SOGC guideline.
      It is also important to note that results from the CMAJ review paper report on an induction group encompassing all indications for induction of labour, with term labour defined as 37 to 42 weeks’ gestation and measured outcomes limited to Caesarean section. The SOGC guideline recommends requiring an obstetrical or medical indication (e.g. premature rupture of membranes, hypertension, intrauterine growth restriction) for induction of labour before 41 weeks. This is consistent with guidelines published by the Royal College of Obstetricians and Gynaecologists and the American Congress of Obstetricians and Gynecologists.
      The data does confirm that induction of labour for specific indications is not associated with higher risk of Caesarean section and in some indications, such as post-term induction, it lowers the risk of Caesarean section. It is important to note that these study findings should not be generalized to any and all inductions of labour, especially when no indications exist; SOGC stands by its recommendation that induction of labour should be carried out only after careful discussion with women who have specific indications.
      The SOGC is aware of two clinical trials underway that are examining induction of labour versus expectant management.
      • Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
      Nottingham Clinical Trials Unit
      The outcomes of these studies will be monitored by the Clinical Practice Obstetrics Committee for potential change of practice implications.
      It is to be noted that, to ensure the best quality of care, the SOGC is currently developing a standard of practice under which evidence will be reviewed on a regular basis to decide whether all or part of a guideline should be updated based on new robust (Canadian Task Force on Preventive Health Care
      • Woolf S.H.
      • Battista R.N.
      • Angerson G.M.
      • Logan A.G.
      • Eel W.
      Canadian Task Force on Preventive Health Care
      New grades for recommendations from the Canadian Task Force on Preventive Health Care.
      level I) evidence.

      REFERENCES

        • Mishanina E.
        • Rogozinska E.
        • Thatthi T.
        • Uddin-Khan R.
        • Khan K.S.
        • et al.
        Use of labour induction and risk of cesarean delivery: a systematic review and meta-analysis.
        CMAJ. 2014; 186: 665-673
        • Leduc D.
        • Biringer A.
        • Lee L.
        • Dy J.
        Clinical Practice Obstetrics Committee, Society of Obsetricians and Gynaecologists of Canada. Induction of labour. SOGC Clinical Practice Guideline No. 296, September 2013.
        J Obstet Gynaecol Can. 2013; 36: 248-252
        • Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
        A Randomized Trial of Induction Versus Expectant Management (ARRIVE). US National Institute of Health, Bethesda, MD2014 (Available at:) (Accessed on December 10, 2014)
        • Nottingham Clinical Trials Unit
        Induction of labour versus expectant management for women over 35 years of age. NCTU, Nothingham, GB2013 (Available at:) (Accessed on December 10, 2014)
        • Woolf S.H.
        • Battista R.N.
        • Angerson G.M.
        • Logan A.G.
        • Eel W.
        • Canadian Task Force on Preventive Health Care
        New grades for recommendations from the Canadian Task Force on Preventive Health Care.
        CMAJ. 2003; 169: 207-208