Induction of Labor: A Narrative Review for Clinical Use

Induction of labor (IOL) is a pivotal obstetric intervention employed when continuing pregnancy poses greater risks than delivery. Cervical readiness, defined as vaginal delivery within 24-48 hours without significant complications, is assessed via the Bishop Score or transvaginal ultrasonography (TVS). TVS is a key predictor of IOL success. Mechanical methods, such as a Foley catheter, and pharmacological agents (e.g., misoprostol and dinoprostone), facilitate cervical ripening. Indications for IOL include postterm pregnancy, hypertensive disorders, and intrauterine fetal demise, with timing tailored to maternal and fetal factors such as 39 weeks for low-risk cases and 37 weeks for mild preeclampsia. Special conditions, such as previous cesarean sections, require individualized approaches due to risks like uterine rupture, while hypertensive disorders necessitate prompt intervention to optimize outcomes. Complications such as failed induction, uterine hyperstimulation, and fetal distress underscore the need for vigilant monitoring. Despite challenges, IOL remains integral to obstetric care, enhancing maternal and neonatal safety through evidence-based practices. Future research should refine success metrics and optimize combined mechanical-pharmacological strategies to improve efficacy and reduce adverse events, ensuring a balanced risk-benefit profile across diverse clinical contexts. This narrative review synthesizes current evidence on IOL, encompassing definitions, indications, methods, clinical scenarios, complications, and outcomes, emphasizing collaborative decision-making between healthcare providers and pregnant individuals.