Induction of Labor: Update and Review

Rates of labor induction in the United States have more than doubled in the past 2 decades. Trends of indications and risk factors related to induction of labor are also increasing. Professional organizations such as the American College of Obstetricians and Gynecologists and The Joint Commission have taken steps to discourage elective induction of labor prior to 39 weeks’ gestation and have created new definitions of early‐term, full‐term, late‐term, and postterm gestation to guide clinicians in the timing of birth for specified indications. Induction of labor is associated with potential risks to both the woman and her fetus. The cost associated with induction of labor and the impact on the health care system is of growing concern. Education of women and the process of shared decision making when obtaining informed consent are key factors in reducing early elective births. Use of tools such as scheduling forms, hard stop methods, induction of labor indication tools, and informed consents may aid the provider in reducing overdiagnosis, overtreatment, and disease creep. This article provides a review of the trends of induction of labor, medical indications and criteria, associated risks, cost and health system impact, and initiatives to lower the incidence of induction of labor.     

The Endomyometrial Thickness Measurement for Abnormal Implantation Evaluation by Pelvic Sonography

Emergency physicians, obstetrician‐gynecologists, and other medical specialists use pelvic sonography when caring for patients presenting with early pregnancy‐related symptoms. A thin endomyometrial mantle and eccentric placement of a gestational sac should raise the suspicion for an abnormally implanted pregnancy. In such cases, an interstitial ectopic pregnancy or a cornual pregnancy, two clinically distinct entities, must be considered. This article reviews the literature and guidelines on the sonographic measurement of the endomyometrial mantle as a criterion for determining a pregnancy at risk for an abnormal implantation location. We sought to clarify the history and evolution of this measurement to determine what should be considered an abnormal measurement and to understand its diagnostic utility and management implications for the clinician using sonography.