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Database - Alliance francophone pour l'accouchement respecté (AFAR)

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Created on : 25 Jul 2004
Modified on : 02 Dec 2007

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Bibliographical entry (without author) :

Induction of labour. Bibliographic sources. Singapore Ministry of Health. Induction of labour. Singapore: Singapore Ministry of Health; 2000 Aug. 22 p. [28 references]

Author(s) :

Ministry of Health, Singapore

Year of publication :


URL(s) :…

Résumé (français)  :

Abstract (English)  :


Each recommendation is rated based on the level of the evidence and the grades of recommendation. Definitions of the grades of the recommendations (A, B, C, Good Practice Points) and level of the evidence (Level I- Level IV) are presented at the end of the Major Recommendations field.

C - Induction of labour is indicated when the benefits of delivery to the mother or foetus outweigh those of continuing with the pregnancy. The risks of induction should be weighed against the benefits of continuing with the pregnancy. (Grade C, Level IV)

C - The decision to perform a social induction of labour should be taken on a case-by-case basis, after fully discussing the potential risks and disadvantages with the patient (Royal College of Obstetricians & Gynaecologists [RCOG], 1998). (Grade C, Level IV)

C - Induction of labour should be performed in an environment where trained personnel and facilities are available to deal immediately with any complication of induction of labour. (Grade C, Level IV)

C - Continuous electronic foetal heart rate monitoring in active labour is recommended (RCOG, 1998; American College of Obstetricians & Gynaecologists, 1995; Spencer & Ward, 1993). (Grade C, Level IV)

A - The favourability of the cervix, or otherwise, should be assessed prior to induction. If the cervix is unfavourable and the induction necessary, ripening of the cervix is useful. (Grade A, Level Ia)

C - Prostaglandins should be administered at a facility where continuous uterine activity and foetal heart rate monitoring can be performed. (Grade C, Level IV)

A - The oxytocin levels required to produce effective contractions vary widely among individuals (Amico, Seitchik, & Robinson, 1984; Arulkumaran et al, 1985) and thus the oxytocin titrated must be individualised. (Grade A, Level Ib)

C - Continuous electronic foetal monitoring is recommended whenever an oxytocin infusion is used. (Grade C, Level IV)

B - Induction of labour is not contraindicated in women with one previous low segment transverse caesarean section as long as the labour is monitored closely. (Grade B, Level III)

Grades of Recommendation

Grade A (evidence levels Ia, Ib): Requires at least one randomized controlled trial as part of the body of literature of overall good quality and consistency addressing the specific recommendation.

Grade B (evidence levels IIa, IIb, III): Requires availability of well conducted clinical studies but no randomised clinical trials on the topic of recommendation.

Grade C (evidence level IV): Requires evidence obtained from expert committee reports or opinions and/or clinical experiences of respected authorities. Indicates absence of directly applicable clinical studies of good quality.

Good Practice Points: Recommended best practice based on the clinical experience of the guideline development group.

Levels of Evidence

Level Ia: Evidence obtained from meta-analysis of randomised controlled trials.

Level Ib: Evidence obtained from at least one randomised controlled trial.

Level IIa: Evidence obtained from at least one well-designed controlled study without randomisation.

Level IIb: Evidence obtained from at least one other type of well-designed quasi-experimental study.

Level III: Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.

Level IV:Evidence obtained from expert committee reports or opinions and/or clinical experiences of respected authorities.

Sumário (português)  :

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Argument (français) :

Ressources bibliographiques sur le déclenchement

Argument (English):

Argumento (português):

Keywords :

➡ physiology ; induction of labor ; post-term pregnancy

Author of this record :

Bernard Bel — 25 Jul 2004

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