Fri Jun 09 2023

Indications:  Post-dates (42+wks)  Late Term (41+ wks) Elective 39+wks  Diabetes Hypertension  Many more - check out ACOG Medically indicated delivery  39week induction ARRIVE Trial - Multicenter RCT showing benefit to 39wk IOL over expectant management to ~41wks  Included  Primips  No medical indications for IOL prior to 40+5   Results  IOL group had LOWER c-section rate than expectant group  Neonatal composite outcome had a trend (not statistically significant) toward lower neonatal compilations in IOL group  Conclusion IOL at 39wks is as safe as expectant management without increased risks Many pregnant people are now offered a 39wk IOL rather than waiting for spontaneous labor  The IOL Process:    Evaluate and Prep: Full H&P Ultrasound for position - Vertex VE for cervical exam: dilation/effacement/Station, also position and consistency  Calculate Bishops Score → help determine mode of IOL Options for IOL: if biship score <8 for prime or <6 for multip, ripen first!...