Ranked Criteria for Labor Induction

These criteria were developed by a Seattle hospital, consistent with 2003 Compendium of Selected Publications from ACOG standards.

They are ranked as Urgent Medical Criteria, then High Priority Medical Indications, then Medium Priority, then Purely Elective. Within those categories, the criteria are not in rank order.

I put these criteria on the website to help give readers an idea of what a research-based inquiry showed about the relative severity of various conditions, and in which areas the benefit of induction would likely outweigh the risk. These criteria could be used as a basis for a discussion with a caregiver to help determine the urgency of induction; however, these can not be considered medical recommendations. Only a caregiver familiar with the big picture of your health and the status of your pregnancy can make medical recommendations for you.

Urgent Medical Criteria

· Non-reassuring fetal status at ≥ 35 weeks

o Non-reactive non-stress test greater than 40 minutes

o Spontaneous decelerations

o Reactive positive CST

o Abnormal U/A Doppler with absent or reversed diastolic flow

o BPP ≤ 4

o Severe oligohydramnios (AFI ≤ 5)

· Chorioamnionitis

· Severe pre-eclampsia

· PROM at ≥ 35 weeks

· IUGR below the 3^rd percentile

· IDDM with significant maternal or fetal complications

In these cases, patient will be admitted to the hospital for induction, cesarean, or other treatment as appropriate.

If there are rooms available, non-emergent inductions are scheduled. Scheduler begins with the highest priority patients, and work through priorities.

High Priority Medical Indications.

· ≥ 42 weeks

· IDDM ≥ 40 weeks (class B or worse)

· 2^nd trimester voluntary termination for abnormalities

In the presence of these indications, the patient’s cervix will be evaluated. If nulliparous, consider cervical ripening.  If multiparous and ripe cervix, schedule for induction. If multiparous and unfavorable cervic (Bishop < 6), consider cervical ripening.

If there is still a room available:

Medium Priority Medical Indications.

· Maternal medical disorders

· Heparin

· Fetal demise

· Fetal malformation requiring immediate or urgent specialty coordination (i.e. cardiac, neuro)

· Mild pre-eclampsia

o If mild PIH at ≥ 37 weeks, no amnio for FLM required

· ≥ 41 weeks

· IUGR < tenth percentile, ≥ 3^rd percentile

· IDDM 38-40 weeks (class B or worse)

· AFI: 5 – 8

· Multiple gestation ≥ 38 weeks

· History of previous fetal demise

Assess, evaluate, determine plan. If discharged home, revise follow-up plan, reassess at next visit.

If there is still a room available:

Purely elective. Patients should be at least 39 weeks gestation.

· History of rapid labor

· Lives remote from hospital

· Social reasons

Elective inductions will be done only on standby status.

Note that the policy does not include induction for suspected macrosomia (large babies).

Back to Inductions.