• Induction of labour involves the artificial process of cervical ripening and uterine contractions with the goal of a vaginal delivery. This video provides an overview of techniques used in mechanical cervical ripening, hormonal cervical ripening, amniotomy and oxytocin administration.
  • Mechanical cervical ripening utilizes a Foley balloon catheter, exerting pressure on the cervical canal and lifting fetal membranes, which triggers the release of endogenous prostaglandins.
  • Hormonal ripening involves administration of PGE1 orally or vaginally, or applying PGE2 to the posterior cervical fornix.
  • Aminotomy is performed once the cervix is favourable, and involves puncturing the membrane with an amniotic hook, eleasing the prostaglandins within the amniotic fluid.
  • The final step in the induction of labour pathway is oxytocin administration to stimulate and optimize uterine contractions.
0 1 2
Cervical Dilation (cm) 0 1-2 3-4
Effacement (%) 0-30 40-50 60-70
Station (ischial spines) >=-3 -2 -1/0
Cervical consistency Firm Medium Soft
Cervical position Posterior Mid Anterior
Indications Contraindications Cautions
Foley Unfavorable cervix

Previous Cesarean Section

Ruptured Membranes

Undiagnosed Vaginal Bleeding

Simultaneous use of prostaglandins

Low lying placenta

Abnormal FHR

Prostagladin E2 (dinoprostone) Unfavorable cervix Known Hypersensitivity

Previous CS or uterine surgery

Undiagnosed Vaginal Bleeding

Muliparity >6 term pregnancies

Overdistension of the uterus (multiple

pregnancies, polyhydramnios)

Suspicion of cephalopelvic


Asthma, COPD (may cause


Epilepsy with poorly controlled seizures


Ruptured membranes (Cervidil) you can

use prostin gel with ROM

Avoid concurrent oxytocin use

Prostaglandin E1 (misoprostol) Unfavorable cervix Known Hypersensitivity

Previous CS or uterine surgery

Undiagnosed Vaginal Bleeding

Artificial Rupture of membranes After cervical ripening

Favorable cervix

Poor application of the presenting

part/unstable lie

Fetal head not engaged

Oxytocin IOL with ruptured membranes Less than 30 minutes following removal

of prostin pessary

Less than 6 hours following insertion of

prostin gel

Previous CS