Abstract
Objective
This guideline presents evidence and recommendations for cervical ripening and induction
of labour. It aims to provide information to birth attendants and pregnant individuals
on optimal perinatal care while avoiding unnecessary obstetrical intervention.
Target Population
All pregnant patients.
Benefits, Harms, and Costs
Consistent interprofessional use of the guideline, appropriate equipment, and trained
professional staff enhance safe intrapartum care. Pregnant individuals and their support
person(s) should be informed of the benefits and risks of induction of labour.
Evidence
Literature published to March 2022 was reviewed. PubMed, CINAHL, and the Cochrane
Library were used to search for systematic reviews, randomized controlled trials,
and observational studies on cervical ripening and induction of labour. Grey (unpublished)
literature was identified by searching the websites of health technology assessment
and health technology related agencies, clinical practice guideline collections, clinical
trial registries, and national and international medical specialty societies.
Validation Methods
The authors rated the quality of evidence and strength of recommendations using the
Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations).
Intended Audience
All providers of obstetrical care.
RECOMMENDATIONS
- 1.Cervical ripening is recommended when the modified Bishop score is less than 7 (strong, high).
- 2.Health care providers should not routinely offer amniotomy or oxytocin (individually or in combination) until the modified Bishop score is 7 or greater (strong, high).
- 3.Should cervical ripening and/or IOL be unsuccessful, health care providers should consider an alternative or combined method of cervical ripening and/or IOL before proceeding with cesarean delivery (strong, high).
- 4.Health care providers should consider balloon catheters first-line agents for cervical ripening whenever feasible, as they are safe and effective, including in an outpatient setting and in a trial of labour after cesarean. (strong, high).
- 5.Health care providers may use either prostaglandin E1 or prostaglandin E2 vaginal gel or insert to achieve safe and effective cervical ripening (strong, high). Providers should consider the degree of ripening required (based on the Bishop score) and the desire for outpatient management when choosing a prostaglandin for cervical ripening (conditional, moderate).
- 6.Health care providers may use prostaglandin and balloon catheters concurrently for cervical ripening (conditional, moderate).
- 7.Health care providers can use prostaglandin E2 for outpatient cervical ripening when there is a normal electronic fetal monitoring tracing (strong, moderate).
- 8.Health care providers can use prostaglandin E1 for inpatient management of cervical ripening (strong, high). If a break from cervical ripening is required, patients can be sent home from the hospital 2 hours after an oral dose and 4 hours after a vaginal dose if electronic fetal monitoring is normal (strong, moderate).
- 9.Health care providers should be cautious when using any prostaglandin in a potentially compromised fetus (strong, moderate).
- 10.Health care providers may use prostaglandin E1 in the first or second trimester, but not in the third trimester with previous cesarean delivery or significant uterine surgery (strong, moderate).
Keywords
Abbreviations:
CD (cesarean delivery), EFM (electronic fetal monitoring), IOL (induction of labour), PGE1 (prostaglandin E1), PGE2 (prostaglandin E2), PROM (prelabour rupture of membranes), SL (sublingual)To read this article in full you will need to make a payment
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References
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Article info
Publication history
No. 432b, January 2023 (Replaces No. 296, September 2013)
Footnotes
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.
Identification
Copyright
© 2022 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
