Benefits, Harms, and Costs
- 1.Induction of labour should be a shared decision between the pregnant individual and the care provider, with respect for an individual’s choice. The consent discussion should be documented and include the benefits and risks of both induction and expectant management, along with the induction process, including methods, timing, and how these may affect the patient and fetus (strong, moderate).
- 2.All pregnant individuals should be offered a first-trimester dating ultrasound at 8–12 weeks gestation to confirm gestational age (strong, high).
- 3.Regular sweeping of the membranes may be offered from 38 weeks gestation to reduce the incidence of late term pregnancy. Group B Streptococcus is not a contraindication to a membrane sweep (conditional, low).
- 4.Castor oil, nipple stimulation, and breast compression can reduce the need for induction of labour and may be offered to low-risk individuals at term (conditional, low).
- 5.Late term induction of labour should be offered at or after 41 weeks gestation (strong, high).
- 6.Suspected macrosomia or large for gestational age alone is not an indication for induction of labour before 39 weeks (conditional, low).
- 7.Cesarean delivery may be considered for ultrasound estimated fetal weight >4500 g in the presence of diabetes and estimated fetal weight >5000 g in the absence of diabetes (conditional, moderate).
- 8.Routine elective induction of labour at 39 weeks gestation is not recommended. If requested, the provider should take into account patient preferences, local health care resources, and local cesarean delivery rates associated with induction (strong, moderate).
- 9.Induction of labour may be offered at 39 weeks gestation for advanced maternal age (≥40 years) (strong, high).
- 10.There is insufficient evidence that induction of labour is associated with maternal or fetal benefits for pregnancies conceived via assisted reproductive technologies (conditional, low).
- 11.For patients who are positive for group B Streptococcus with a singleton pregnancy and term rupture of membranes, IOL should be offered as soon as resources allow, and antibiotic prophylaxis should be started while awaiting IOL (conditional, moderate).
- 12.For patients who are negative for group B Streptococcus with a singleton pregnancy and term rupture of membranes, IOL may be offered as soon as resources allow. Expectant management for up to 24 hours is also acceptable. Digital pelvic exams should be avoided until active labour begins, and then done only when indicated (strong, moderate).
- 13.Either oral misoprostol or oxytocin can be used for induction of labour in the setting of term pre-labour rupture of membranes, regardless of Bishop score (strong, high).
- 14.The modified Bishop score should be used and documented to determine if cervical ripening is required (strong, high).
- 15.Fetal presentation should be confirmed by abdominal exam and/or ultrasound prior to inducing labour (strong, high).
- 16.Quality assurance audits for induction of labour practices are important within health care organizations. Important quality measures include the indication for induction, the induction approach, and outcomes (strong, high).
Abbreviations:ART (assisted reproductive technologies), CD (cesarean delivery), GBS (group B Streptococcus), IOL (induction of labour), PROM (pre-labour rupture of membranes)
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This document reflects emerging clinical and scientific advances as of the publication date and is subject to change. The information is not meant to dictate an exclusive course of treatment or procedure. Institutions are free to amend the recommendations. The SOGC suggests, however, that they adequately document any such amendments.
Informed consent: Patients have the right and responsibility to make informed decisions about their care, in partnership with their health care provider. In order to facilitate informed choice, patients should be provided with information and support that is evidence-based, culturally appropriate, and personalized. The values, beliefs and individual needs of each patient in the context of their personal circumstances should be considered and the final decision about care and treatment options chosen by the patient should be respected.
Language and inclusivity: The SOGC recognizes the importance to be fully inclusive and when context is appropriate, gender-neutral language will be used. In other circumstances, we continue to use gendered language because of our mission to advance women’s health. The SOGC recognizes and respects the rights of all people for whom the information in this document may apply, including but not limited to transgender, non-binary, and intersex people. The SOGC encourages health care providers to engage in respectful conversation with their patients about their gender identity and preferred gender pronouns and to apply these guidelines in a way that is sensitive to each person’s needs.