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Induction of labor

What's new

The European Association of Perinatal Medicine (EAPM) has published a new guideline for the management of arrested or protracted labor in nulliparous women. Amniotomy alone may be considered in nulliparous women at term with a fetus in cephalic presentation and diagnosed with arrested or protracted labor. A low-dose oxytocin regimen is suggested for labor augmentation. Amniotomy can be performed before initiating oxytocin infusion during the first stage of spontaneous labor. Oxytocin augmentation can be continued for at least 4 hours with adequate contractions before considering a Cesarean section, provided fetal and maternal conditions are reassuring. .

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of induction of labor are prepared by our editorial team based on guidelines from the European Association of Perinatal Medicine (EAPM 2025), the American Academy of Family Physicians (AAFP 2024), the American College of Obstetricians and Gynecologists (ACOG 2024), the Society of Obstetricians and Gynaecologists of Canada (SOGC 2023), the World ...
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Classification and risk stratification

Bishop score: as per SOGC 2023 guidelines, use the modified Bishop score to determine if cervical ripening is required.
A
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Diagnostic investigations

Confirmation of fetal presentation: as per SOGC 2023 guidelines, conform fetal presentation by abdominal examination and/or ultrasound before labor induction.
A
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  • Digital vaginal examination

Medical management

Setting of care: as per WHO 2022 guidelines, do not offer routine outpatient induction of labor for improving birth outcomes.
D
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  • Indications for induction of labor

  • Oxytocin

  • Prostaglandins

Inpatient care

Monitoring of induction: as per WHO 2014 guidelines, obtain an active phase partogram with a 4-hour action line for monitoring the progress of labor.
B
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  • Electronic fetal monitoring

Nonpharmacologic interventions

Activity and positioning: as per WHO 2014 guidelines, encourage adopting mobility and upright position during labor in patients at low risk.
B
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  • Food intake

  • Companionship

  • Membrane sweeping

  • Alternative therapies

Therapeutic procedures

Balloon catheter
As per WHO 2022 guidelines:
Offer balloon catheter for induction of labor.
B
Offer the combination of balloon catheter plus oxytocin administration for induction of labor.
B
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  • Cervical dilators

  • Neuraxial anesthesia

Surgical interventions

Amniotomy
As per EAPM 2025 guidelines:
Consider performing amniotomy alone when there is arrested or protracted labor in nulliparous patients at term (≥ 37/0 weeks) with a fetus in cephalic presentation, following positive consent.
C
Consider performing amniotomy before administering oxytocin infusion after diagnosing arrested or protracted labor in nulliparous patients during the first stage of spontaneous labor.
C
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  • Cesarean delivery

Patient education

General counseling: as per SOGC 2023 guidelines, decide on the induction of labor through a shared decision-making process between the pregnant individual and the care provider, with respect for an individual's choice. Document the consent discussion including 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.
B
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Preventative measures

Prevention of delay: as per WHO 2014 guidelines, do not offer a package of care for active management of labor to prevent delay in labor.
D
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