Induction & Augmentation of Labor

SWARAJ HOSPITAL & RESEARCH INSTITUTE

BOLANGIR, ODISHA  •  OBSTETRICS & GYNAECOLOGY CLINICAL PATHWAY SERIES

Clinician Reference Infographic

Induction & Augmentation of Labor — A Practical Guide

Induction means artificially starting labor before it begins on its own. Augmentation means strengthening contractions in a labor that has already started spontaneously but is progressing too slowly — usually because uterine activity is inadequate. The methods overlap heavily, but the decision to start always comes down to the same question: does continuing the pregnancy carry more risk than delivering it?

🎯 AT A GLANCE — INDICATIONS & READINESS

Common Indications for Induction

Post-term pregnancy (≥41 weeks), term PROM, hypertensive disorders of pregnancy

Diabetes in pregnancy at term, fetal growth restriction, oligohydramnios

Intrauterine fetal death, chorioamnionitis, or a maternal medical condition requiring delivery

Contraindications (Same as for Vaginal Delivery)

Placenta or vasa praevia, transverse lie, cord presentation, prior classical caesarean or major uterine surgery

GREEN: favorable cervix (Bishop ≥8), no contraindications — induction expected to behave much like spontaneous labor

AMBER: unfavorable cervix (Bishop <6) — needs cervical ripening first; expect a longer process

RED: contraindication present, or high-risk factors (e.g., previous caesarean, grand multiparity) — senior-led decision required

📋 THE BISHOP SCORE — IS THE CERVIX READY?

Scores five features of the cervix and fetal station — dilatation, effacement, station, consistency, and position — out of a maximum of 13

Score ≥ 8 — Favorable: induction success rates approach those of spontaneous labor

Score < 6 — Unfavorable: cervical ripening is needed before oxytocin/amniotomy is likely to work

🌱 CERVICAL RIPENING (UNFAVORABLE CERVIX)

Pharmacological

Vaginal or oral misoprostol (PGE1)

Dinoprostone (PGE2) gel or vaginal pessary

Mechanical

Foley catheter balloon — a useful option where prostaglandins are unavailable or relatively contraindicated (e.g., prior caesarean)

Membrane sweep — a simple bedside method from around 39–40 weeks; can reduce the need for formal induction

🛠️ INDUCTION & AUGMENTATION METHODS

Amniotomy (ARM) — artificial rupture of membranes, usually once the cervix is favorable

Oxytocin infusion — titrated carefully with continuous monitoring of contractions and fetal heart rate

ARM + oxytocin together is the standard combination once the cervix is favorable, and the usual approach for augmenting a slow labor

Augmentation follows the same principles as induction once labor has started — the target is adequate contractions, not maximal ones.

🚨 STOP OR REASSESS — WARNING SIGNS

Uterine tachysystole — more than 5 contractions in 10 minutes

Non-reassuring fetal heart rate pattern on CTG

Signs of scar rupture in a prior caesarean — severe pain, scar tenderness, sudden fetal distress, maternal tachycardia

Cord prolapse after amniotomy, especially with a high presenting part

Failure to progress despite adequate contractions — reassess for cephalopelvic disproportion

💧 OXYTOCIN — PRACTICAL POINTS

1

Start low and titrate slowly, increasing at fixed intervals per protocol

2

Aim for 3–5 contractions in 10 minutes, each lasting 40–60 seconds

3

Continuous CTG monitoring is mandatory throughout the infusion

4

Reduce or stop immediately if hyperstimulation or fetal distress occurs

Previous caesarean scar: oxytocin use needs a senior-led decision and heightened vigilance for signs of scar rupture — the risk is real, even if low.

Previous Caesarean (VBAC)

Induction raises uterine rupture risk versus spontaneous labor

Senior-led decision, continuous monitoring throughout

PROM at Term

Induction reduces infection risk versus prolonged expectant care

A defined period of awaiting spontaneous labor is also reasonable per protocol

Post-Term Pregnancy

Induction from ≥41 weeks reduces perinatal risk

Routinely offered rather than reserved for complications

Failed Induction

No adequate labor despite ripening and oxytocin

Reassess the mode of delivery — often ends in caesarean

Watch For

Uterine Tachysystole

>5

CONTRACTIONS
PER 10 MINUTES

Excessive uterine activity from oxytocin or prostaglandins can reduce placental blood flow and cause fetal distress — continuous monitoring during induction and augmentation exists specifically to catch this early.

Reduce or stop the oxytocin infusion immediately if tachysystole occurs

Consider tocolysis (e.g., terbutaline) if hyperstimulation persists with fetal distress

Reposition the mother to left lateral, give oxygen and IV fluids as needed

Resume oxytocin at a lower rate only once contractions and fetal heart rate have normalized, per protocol

Reminder: the goal of augmentation is adequate contractions, not maximal ones — more oxytocin is not automatically better.

Swaraj Hospital & Research Institute · Department of Obstetrics & Gynaecology, Bolangir, Odisha

Clinician-facing summary for structured teaching and triage; drug doses, titration protocols, and thresholds vary by institution — follow local labour ward guidelines.