Induction and augmentation of labor

Induction of labor is one of the most common obstetrical interventions performed in the United States. It is indicated when the risks of continuing pregnancy outweigh the risks of labor induction, provided there are no contraindications to vaginal delivery. The incidence of labor induction in the United States was 23.2% in 2011, which was double the incidence reported in 1990 (Hamilton BE, Martin JA, and Ventura SJ. Births: preliminary data for 2012. National Vital Statistics Reports 2013;62(3):1-20). This chapter covers the indications, contraindications, methods, and risks of labor induction and augmentation of labor. Specifically, nonmedically indicated induction of labor should not be performed prior to 39 weeks of gestation (American College of Obstetricians and Gynecologists Committee Opinion No. 560: Medically indicated late-preterm and early-term deliveries. Obstetrics & Gynecology 2013;121(4):908-910; American College of Obstetricians and Gynecologists Committee Opinion No. 561: Nonmedically indicated early-term deliveries. Obstetrics & Gynecology 2013;121(4):911-915). Although a variety of agents and dosing regimens are used for cervical ripening and labor induction and augmentation, each labor and delivery unit should have established protocols to ensure quality and patient safety.