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Failed Induction of Labor: Strategies to Improve the Success Rates

Talaulikar, Vikram S. MD, MRCOG*; Arulkumaran, Sabaratnam MD, PhD, FRCS, FRCOG

Obstetrical & Gynecological Survey: November 2011 - Volume 66 - Issue 11 - p 717-728
doi: 10.1097/OGX.0b013e31823e0c69

The rates of induction of labor (IOL) are rising all over the world. In developed countries, one of every 4 babies is born after IOL at term. The recent World Health Organization guidelines on IOL recommend that failure of induction does not necessitate cesarean delivery [WHO recommendations for induction of labor. World Health Organization, 2011]. These guidelines come when there are concerns that failed primary inductions in nulliparous women, which have led to escalation of the cesarean delivery rates. Obstetricians must recognize the risks associated with IOL (including failure and need for cesarean delivery) and avoid inductions for borderline indications, which are not evidence based. The issue of “failed induction of labor” is topical, and there is a need to define this entity and offer alternatives to cesarean delivery in the management of this group of women. Research is required to develop a test to accurately identify those fetuses most at risk of morbidity or stillbirth who would truly benefit from an early IOL and assess the cost-effectiveness of policies of routine IOL. In this review, we summarized the current recommendations for best practice in the area of IOL, defined “failed induction,” and described options to improve the success rate after “failed primary induction of labor.”

Target Audience: Obstetricians & Gynecologists and Family Physicians

Learning Objectives: After the completing the CME activity, physicians should be better able to classify the factors determining success or failure of induction of labor, counsel women about risks and benefits of various methods of induction of labor, and compare the options of management available after failed primary induction of labor.

*Clinical Research Fellow, †Professor and Head of Department, Department of Obstetrics and Gynaecology, St. George's Hospital Medical School, Cranmer Terrace, London

Chief Editor's Note: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA Category 1 Credits™ can be earned in 2011. Instructions for how CME credits can be earned appear on the last page of the Table of Contents.

The authors, faculty and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interest in, any commercial organizations pertaining to this educational activity.

Correspondence requests to: Vikram Sinai Talaulikar, MD, MRCOG, Department of Obstetrics and Gynaecology, St. George's Hospital Medical School, Cranmer Terrace, London SW17 0RE. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.