If you or your baby are not doing well during or after attempting induction, a cesarean birth may be needed. FOGSI. This content is only available to members and subscribers. .2 Grading . Vaginal Birth After Cesarean Delivery (VBAC), Copyright 2023 American College of Obstetricians and Gynecologists, Privacy Statement . 107: Induction of labor Obstet Gynecol. Search for doctors near you. Labor Stimulation with Oxytocin: Examples of Low- and High-Dose Oxytocin, American College of Obstetricians and Gynecologists ; . All ACOG committee members and authors have submitted a conflict of interest disclosure statement related to this published product. e29 Yes. An official website of the United States government. 816: Consumer Testing for Disease Risk (Obstet Gynecol 2021;137:e16). This procedure, called an amniotomy, may be done after a woman has been given oxytocin. The timing of delivery in such cases must balance the maternal and newborn risks of late-preterm and early-term delivery with the risks associated with further continuation of pregnancy. The purpose of this document is to review current methods for cervical ripening and induction of labor and to summarize the effectiveness of these approaches based on appropriately conducted outcomes-based research. Mendelson reported that during general anaesthesia, there was an increased risk of the stomach contents entering . The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Then the balloon expands, which helps open the cervix. 200 Wapner RJ Medically indicated late-preterm and early-term deliveries. Levels of evidence. Nonetheless, it is important to remember that most cases of preeclampsia occur in healthy . If a woman's labor does not progress, it may be . ; : INTRODUCTION The culmination of normal pregnancy involves three stages: pre labour, cervical ripening and labour. Contracept X. . 2019 : (Monday through Friday, 8:30 a.m. to 5 p.m. Am J Obstet Gynecol 2017; DOI: 10.1016/j.ajog.2017.07.039. SMFM endorses the ACOG Practice Advisory: Clinical guidance for integration . (Monday through Friday, 8:30 a.m. to 5 p.m. . , Disclaimer. Am J Obstet Gynecol Unauthorized use of these marks is strictly prohibited. Cervical ripening is the first component to labor induction. July 23, 2009. Am J Obstet Gynecol ACOG Practice Bulletin No. 2009 Jun;31(6):557-566. doi: 10.1016/S1701-2163(16)34221-9. Mercer BM An evidence-based guideline produced by the RCOG with funding from the NHS Executive and the National Institute for Clinical Excellence (NICE). Nonmembers: Subscribe now to access exclusive ACOG Clinical content, including: ACOG Clinical is designed for easy and convenient access to the latest clinical guidance for patient care. ACOG Committee Opinion No. The https:// ensures that you are connecting to the Induction of labour: information for the public; Induction of labour: information for the public. 409 12th Street SW, Washington, DC 20024-2188, Privacy Statement Laminaria are inserted into the opening of the cervix to widen it. Responsibilities of the Most Responsible Health Practitioner for Induction by Cervical Ripening 5.1 Provide an order to initiate cervical ripening. Oxytocin: A hormone made in the body that can cause contractions of the uterus and release of milk from the breast. ABSTRACT: The neonatal risks of late-preterm and early-term births are well established, and the potential neonatal complications associated with elective delivery at less than 39 0/7 weeks of gestation are well described. Oxytocin is a hormone that causes contractions of the uterus. FOIA Obstet Gynecol Surv. Copyright 2021 by the American College of Obstetricians and Gynecologists. If you and your pregnancy are doing well and the amniotic sac has not ruptured, you may be given the option to go home. Society for Maternal-Fetal Medicine (SMFM). Neither ACOG nor its officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented.All ACOG committee members and authors have submitted a conflict of interest disclosure statement related to this published product. Prostaglandins are medications that can be used to ripen the cervix. 409 12th Street SW, Washington, DC 20024-2188, Privacy Statement Using a thin tube that has an inflatable balloon on the end. Fibroids: Growths that form in the muscle of the uterus. ACOG Practice Bulletin No. Effect of the Foley catheter and synchronous oxytocin administration on cervical ripening. They are forms of chemicals made naturally by the body. Please try reloading page. Preeclampsia: A disorder that can occur during pregnancy or after childbirth in which there is high blood pressure and other signs of organ injury. American College of Obstetricians and Gynecologists. 01 . 702: Female Athlete Triad (Obstet Gynecol 2017;129:e1607). Individual subscriptions include print and online access. Frye DK The tube is inserted into the cervix and then expanded. indication for induction of labour unless concurrent medical co-morbidities exist or there are other indications that induction of labour is required. However, there are a number of maternal, fetal, and placental complications in which either a late-preterm or early-term delivery is warranted. 5. Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high. The guidelines for induction of labour in 2021 require that if a woman is in a position of low risk to childbearing, she should be allowed to have an induction of labour. Your hospital may offer induction at 39 weeks if it has the staff and resources to do so. Also called premature rupture of membranes. Bulk pricing was not found for item. The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine make the following recommendations: Deferring delivery to the 39th week is not recommended if there is a medical or obstetric indication for earlier delivery. Elective induction should not be done before 39 weeks of pregnancy. The WHO Labour Care Guide is a tool that aims to support good-quality, evidence-based, respectful care during labour and childbirth, irrespective of the setting or level of health care. Results: Read ACOGs complete disclaimer. Provider assessment is recommended once infusion rate is at 20 mu/min and is mandatory in order to exceed an infusion rate of 30 mu/min. You have prelabor rupture of membranes (PROM). Bulk pricing was not found for item. Would you like email updates of new search results? 2017 Kilpatrick S and care for pregnant women who are thinking about or having induction of labour. You can schedule another appointment to try induction again. There is a lack of consensus regarding terminology, etiology, and diagnostic criteria for fetal growth restriction, with uncertainty surrounding the optimal management and timing of delivery for the . . Labor induction may be recommended if the health of the mother or fetus is at risk. BY SPECIALTY. Ripening the cervix is a process that helps the cervix soften and thin out in preparation for labor. 8600 Rockville Pike to maintaining your privacy and will not share your personal information without It is not a substitute for the advice of a physician. ABSTRACT: Fetal growth restriction, also known as intrauterine growth restriction, is a common complication of pregnancy that has been associated with a variety of adverse perinatal outcomes. Management of suboptimally dated pregnancies. Or if the contractions have already started, breaking the sac can make them stronger or more frequent. official website and that any information you provide is encrypted "These guidelines will help physicians utilize the most appropriate method depending on the unique characteristics of the pregnant woman and her fetus. Last reviewed: August 2022. Other treatments may be needed to steady the fetal heart rate. During pregnancy, this organ holds and nourishes the fetus. For trusted, in-depth advice from ob-gyns, turn to Your Pregnancy and Childbirth: Month to Month. Saade G Clark SL 8600 Rockville Pike Terms and Conditions of Use, Get the latest on COVID-19, pregnancy, and breastfeeding, Special Procedures for Labor and Delivery. It can be used to start labor or to speed up labor that began on its own. Get new journal Tables of Contents sent right to your email inbox, https://www.acog.org/clinical/clinical-guidance/acog-endorsed, https://www.asccp.org/Assets/b2263c88-ec67-4ab0-9f07-6f112e76f8d7/637269576182030000/2019-asccp-risk-based-management-consensus-3-5-pdf, https://onlinelibrary.wiley.com/doi/full/10.1002/jum.14677, https://www.perinatalquality.org/Vendors/NSGC/NIPT/, https://www.nsgc.org/page/abnormal-non-invasive-prenatal-testing-results, https://www.acog.org/clinical/journals-and-publications/clinical-updates, Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222, ACOG Practice Bulletin No. https://www.acog.org/membership/member-benefits/acog-app Tsakiridis I, Giouleka S, Mamopoulos A, Kourtis A, Athanasiadis A, Filopoulou D, Dagklis T. Obstet Gynecol Surv. ACOG is a nonprofit organization of women's health care physicians advocating highest standards of practice, continuing member education and public awareness of women's health care issues. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. This information is designed as an educational aid for the public. [2008, amended 2021] 1.2.22 Consider induction of labour for babies in the breech position if: birth needs to be expedited, and. There are problems with the fetus, such as poor growth. The selected Green Journal articles are free through the end of the calendar year. Copyright 2023 by the American College of Obstetricians and Gynecologists. government site. Am Fam Physician. Visit our ABOG MOC II collection. These signs include an abnormal amount of protein in the urine, a low number of platelets, abnormal kidney or liver function, pain over the upper abdomen, fluid in the lungs, or a severe headache or changes in vision. You can schedule another appointment to try induction again. ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. The point in pregnancy at which it is suggested will depend on the reason for suggesting it. Any updates to this document can be found on Still, the Your message has been successfully sent to your colleague. The site is secure. Use of induction of labour and emergency caesarean section and perinatal outcomes in English maternity services: a national hospital-level study. 724: Consumer Testing for Disease Risk (Obstet Gynecol 2017;130:2703) has been withdrawn and replaced by ACOG Committee Opinion No. The rates of induction of labor have significantly increased during the last decades. Bookshelf Bczek G, Rzoca E, Rzoca P, Rychlewicz S, Budner M, Bie A. Int J Environ Res Public Health. 2022 Apr 13;22(1):316. doi: 10.1186/s12884-022-04663-6. If there is a clear indication for a late-preterm or early-term delivery for either maternal or newborn benefit, then delivery should occur regardless of the results of lung maturity testing. According to ACOG, there are a number of health conditions that may warrant inducing labor but physicians should take into account maternal and infant conditions, cervical status, gestational age, and other factors. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. This may cause the uterus to contract too often. For more information on ACOG-endorsed documents, please visit https://www.acog.org/clinical/clinical-guidance/acog-endorsed. For additional quantities, please contact [emailprotected] National Institute of Child Health and Human Development and the Society for Maternal-Fetal Medicine convened a workshop that summarized the available evidence and made recommendations 4. BJOG. Women who have induction at 39 weeks should be allowed up to 24 hours or longer for the early phase of labor. A health care provider might recommend inducing labor for various reasons, primarily when there's concern for the mother's or baby's health. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. To rupture the amniotic sac, an ob-gyn makes a hole in the sac with a special device. Bulk pricing was not found for item. Most women go into labor within a few hours after the amniotic sac breaks, but sometimes oxytocin may be needed. ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. 100 obstet gynecol res 2022; Insertion of cervical dilator on same date as delivery (cpt code 59200). Prediction model for successful induction of labor by cervical strain elastography diagnosed at late-term pregnancy in nulliparous women: a prospective cohort study. Disclaimer. Publication types Practice Guideline Review MeSH terms Diagnosis and Management of Gestational Diabetes Mellitus: An Overview of National and International Guidelines. ", Disclaimer: This site is primarily intended for healthcare professionals. (Endorsed November 2018), NIPT/Cell Free DNA Screening Predictive Value Calculator. American College of Obstetricians and Gynecologists 409 12th Street SW, Washington, DC 20024-2188. Some examples of these conditions include uterine dehiscence or chronic placental abruption. eCollection 2022. 146: Management of Late-term and Postterm Pregnancies (Obstet Gynecol 2014;124:3906), ACOG Practice Bulletin No. 2022 Dec 23;13(1):38. doi: 10.3390/diagnostics13010038. 33 Second, late-preterm or early-term deliveries may be warranted for maternal benefit or newborn benefit, or both. Unable to load your collection due to an error, Unable to load your delegates due to an error. . 2012 Oct;13(14):2005-14. doi: 10.1517/14656566.2012.722622. Laminaria are thin rods inserted into the cervix to dilate it. This list is not meant to be all-inclusive, but rather is a compilation of indications commonly encountered in clinical practice. 2009 Buy. The timing of delivery in such cases must balance the maternal and newborn risks of late-preterm and early-term delivery with the risks associated with further continuation of pregnancy. or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156 National Society of Genetic Counselors (NSGC) and Perinatal Quality Foundation (PQF). Resources to inform and support clinicians. Labor is induced to stimulate contractions of the uterus in an effort to have a vaginal birth. 2009 Tita AT Gestational Hypertension: High blood pressure that is diagnosed after 20 weeks of pregnancy. When membranes rupture at term before the onset of labor, approximately 77-79% of women will go into labor spontaneously within 12 hours, and 95% will start labor spontaneously within 24-28 hours 13 14.In the TERMPROM trial, a RCT of labor induction versus expectant management of rupture of membranes at term, the median time to delivery for women managed . This site needs JavaScript to work properly. The ways to start labor may include the following: If your labor does not progress, and if you and your fetus are doing well after attempting induction, you may be sent home. , If your labor starts, you should go back to the hospital. A pump hooked up to the IV tube controls the amount given. Table 1. In 2006, more than 22% (roughly 1 out of every 5) of all pregnant women had their labor induced. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. These signs include an abnormal amount of protein in the urine, a low number of platelets, abnormal kidney or liver function, pain over the upper abdomen, fluid in the lungs, or a severe headache or changes in vision. . or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156 April 2020. D'alton M For products jointly developed with other organizations, conflict of interest disclosures by representatives of the other organizations are addressed by those organizations. Generally, induction of labor has merit as a therapeutic option when the benefits of expeditious delivery outweigh the risks of continuing the pregnancy. or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156 | DOI: 10.1097/AOG.0b013e3181b48ef5 Published online on June 24, 2021.Copyright 2021 by the American College of Obstetricians and Gynecologists. 133 These situations include (but are not limited to) transverse fetal position, umbilical cord prolapse, active genital herpes infection, placenta previa, and women who have had a previous myomectomy (fibroid removal) from the inside of the uterus, according to ACOG. Suggested specific timing refers to more defined timing of delivery within the broader categories of late-preterm or early-term delivery. Am J Obstet Gynecol 2017; DOI: 10.1016/j.ajog.2017.10.019. It does not explain all of the proper treatments or methods of care. When you choose labor induction and you and your fetus are healthy, it is called elective induction. There are several methods to start labor if it has not started naturally. Some prostaglandins are not used if you have had a previous cesarean birth or other uterine surgery to avoid increasing the possible risk of uterine rupture (tearing). BMC Pregnancy Childbirth. The site is secure. Change in timing of induction protocol in nulliparous women to optimise timing of birth: results from a single centre study. sharing sensitive information, make sure youre on a federal Read copyright and permissions information. Bethesda, MD 20894, Web Policies 510: Ethical Ways for Physicians to Market a Practice (Obstet Gynecol 2011;118:11957), ACOG Committee Opinion No. Other risks of labor induction may include, chorioamnionitis, an infection of the amniotic fluid, placenta, or membranes. ABSTRACT: More than 22% of all gravid women undergo induction of labor in the United States, and the overall rate of induction of labor in the United States has more than doubled since 1990 to 225 per 1,000 live births in 2006 1.The goal of induction of labor is to achieve vaginal delivery by stimulating uterine contractions before the spontaneous onset of labor. Ripening of the cervix can be done with medications or with special devices. Conclusions: Table 2. | Terms and Conditions of Use. The following ACOG documents have been withdrawn: ACOG Committee Opinion No. , To rupture the amniotic sac, an ob-gyn or other health care professional makes a small hole in the sac with a special tool. The following ACOG documents have been reaffirmed: ACOG Committee Opinion No. . This paper discusses the induction of labour in women of advanced maternal age (40+ years) and the possible benefits of inducing at an earlier stage of gestation (39-40 weeks). The tube is inserted through the vagina and into the opening of the cervix. Terms and Conditions of Use, Get the latest on COVID-19, pregnancy, and breastfeeding, Special Procedures for Labor and Delivery. Available at: https://onlinelibrary.wiley.com/doi/full/10.1002/jum.14677. It is not a substitute for the advice of a physician. , You and your obstetriciangynecologist (ob-gyn) or other health care professional may talk about induction at 39 weeks if: When a woman and her fetus are healthy, induction should not be done before 39 weeks. Data is temporarily unavailable. 501: MaternalFetal Intervention and Fetal Care Centers (Obstet Gynecol 2011;118:40510), ACOG Committee Opinion No. 2001;64 (1):169-170. FAQ507 107: Induction of labor. It involves the clinician inserting one or two fingers into the lower part of the uterus (the cervix) and using a continuous circular sweeping motion to free the . In fact, the rate of induction of labor doubled between 1990 and 2006 and has continued to trend upwards. Contractions usually start about 30 minutes after oxytocin is given. Practice Bulletin will provide guidelines for the diagnosis and management of gestational hypertension and preeclampsia. Conversely, if delivery could be delayed safely in the context of an immature lung profile result, then no clear indication for a late-preterm or early-term delivery exists. This site complies with the HONcode standard for trustworthy health information: Search only trustworthy HONcode health websites: Medical Dialogues is health news portal designed to update medical and healthcare professionals but does not limit/block other interested parties from accessing our general health content. By reading this page you agree to ACOG's Terms and Conditions. Varner MW Unable to load your collection due to an error, Unable to load your delegates due to an error. You might consider induction at 39 weeks to reduce the risk of certain health problems. and transmitted securely. In this guideline we use the terms 'woman' and 'women', based on the evidence used in its . Acog guidelines for vbac induction acog 2019 vbac guidelines. Please try after some time. Effect of Oxytocin Combined with Different Volume of Water Sac in High-Risk Term Pregnancies. Obstet Gynecol 2021;138:e359. The reason for this longstanding principle is that the neonatal risks of late-preterm (34 0/736 6/7 weeks of gestation) and early-term (37 0/738 6/7 weeks of gestation) births are well established, and the potential neonatal complications associated with elective delivery at less than 39 0/7 weeks of gestation are well described 1 2. Antenatal corticosteroid therapy for fetal maturation. Any content/information on this website does not replace the advice of medical and/or health professionals and should not be construed as medical/diagnostic advice/endorsement or prescription. Background. Currently, induction of labor is one of the most . Still, the. Regarding the methods of induction, all the medical societies recommend the use of membrane sweeping, mechanical methods, prostaglandins, and oxytocin, whereas NICE argues against the use of misoprostol for IOL. This action is done when the cervix is partially dilated. If gestational diabetes is the only abnormality, induction of labour ACOG's Practice Bulletin "Induction of Labor" is published in Obstetrics & Gynecology. The purpose of this document is to review the topic of fetal growth restriction with a focus on terminology, etiology, diagnostic and surveillance tools, and guidance for management and timing of delivery. Kotaska A, Menticoglou S, Gagnon R; MATERNAL FETAL MEDICINE COMMITTEE. Federal government websites often end in .gov or .mil. It also may be recommended when labor has not started on its own. ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. acog.org Before 1. "There are certain health conditions, in either the woman or the fetus, where the benefit of inducing labor is clear-cut," says Susan Ramin, MD, from the University of Texas Medical School in Houston who helped lead the development of ACOG's Practice Bulletin. HHS Vulnerability Disclosure, Help With each cesarean birth, the risk of serious placenta problems in future pregnancies goes up. However, a medically indicated late-preterm delivery should not be delayed for the administration of antenatal corticosteroids. . Induction of labor has also been demonstrated to be less effective and to have higher complication rates than dilation and evacuation between 13 weeks and 24 weeks of gestation with an adjusted risk ratio of 8.5 (95% CI, 3.7-19.8) 105. Obstet Gynecol Additionally, recommendations for timing of delivery before 39 weeks of gestation are dependent on an accurate determination of gestational age. 151: Cytomegalovirus, Parvovirus B19, Varicella Zoster, and Toxoplasmosis in Pregnancy (Obstet Gynecol 2015;125:151025), ACOG Practice Bulletin No. A catheter (small tube) with an inflatable balloon on the end. Copyright 2023 by the American College of Obstetricians and Gynecologists. For example: When nearing one to two weeks beyond the due date, and labor hasn't started on its own (postterm pregnancy) When labor doesn't begin after the water breaks (premature rupture of membranes) National Library of Medicine ObstetricianGynecologist (Ob-Gyn): A doctor with special training and education in womens health. Laurie Barclay, MD. Table 1 Online ahead of print. Accessibility Please try again soon. Clipboard, Search History, and several other advanced features are temporarily unavailable. All rights reserved. Committee Opinion No. Importance: Induction of labor (IOL) is a common obstetric intervention that stimulates the onset of labor using artificial methods. Please enable it to take advantage of the complete set of features! American College of Obstetricians and Gynecologists Bailit JL In the 2021 guideline, the "between" has changed to "from," and the conversation is about offering induction and discussing risks that occur "from 41 weeks" (NICE 2021).. For additional quantities, please contact [emailprotected] American Society for Colposcopy and Cervical Pathology. Some error has occurred while processing your request. There is a lack of consensus regarding terminology, etiology, and diagnostic criteria for fetal growth restriction, with uncertainty surrounding the optimal management and timing of delivery for the growth-restricted fetus. Am Fam Physician. Recommendations for the Timing of Delivery When Conditions Complicate Pregnancy*, American College of Obstetricians and Gynecologists ET), This Committee Opinion integrates the findings in this report, as well as more recent evidence, to provide recommendations regarding timing of delivery for frequent obstetric, maternal, fetal, and placental or uterine conditions that would necessitate delivery before 39 weeks of gestation. It does not explain all of the proper treatments or methods of care. Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network (Endorsed December 2015), Abnormal Prenatal Cell-free DNA Screening Results: What do they mean? American College of Obstetricians and Gynecologists The following ACOG documents have been revised: ACOG Committee Opinion No. As with all procedures, the risks must be weighed against the benefits to the woman and the fetus. Acog guidelines for induction of labour 2021 pdf. acog.org The ACOG policies can be found on 817: Options for Prevention and Management of Menstrual Bleeding in Adolescent Patients Undergoing Cancer Treatment (Obstet Gynecol 2021;137:e715), ACOG Committee Opinion No. Once the cervix is dilated, labor can be induced with oxytocin, membrane stripping, rupture of the amniotic membrane, or nipple stimulation. external cephalic version is unsuccessful, declined or contraindicated, and. : Abstract and Figures. Oxytocin is a hormone that causes contractions of the uterus. Looking for ABOG articles? Oxytocin: A hormone made in the body that can cause contractions of the uterus and release of milk from the breast. There are several important principles to consider in the timing of delivery. , ; INTERIM UPDATE: The content in this Committee Opinion has been updated as highlighted (or removed as necessary) to reflect a limited, focused change in delivery timing recommendations around preterm prelabor rupture of membranes. Guidance consultation documents. ABSTRACT: More than 22% of all gravid women undergo induction of labor in the United States, and the overall rate of induction of labor in the United States has more than doubled since 1990 to 225 per 1,000 live births in 2006 1. Conversely, if delivery could be delayed safely in the context of an immature lung profile result, then no clear indication for a late-preterm or early-term delivery exists. Medically Indicated Late-Preterm and Early-Term Deliveries, https://www.acog.org/membership/member-benefits/acog-app, Alliance for Innovation on Women's Health, Postpartum Contraceptive Access Initiative. Yang Q, Zhou CC, Chen Y, Pei JD, Hua XL, Yao LP. Babies born at or after 39 weeks have the best chance at healthy outcomes compared with babies born before 39 weeks. Objective: 2022 Oct 13;4:100085. doi: 10.1016/j.conx.2022.100085. Ozbasli E, Canturk M, Aygun EG, Ozaltin S, Gungor M. Biomed Res Int. This is the place to start your planning. Read common questions on the coronavirus and ACOGs evidence-based answers. Landon MB All rights reserved. Placenta: An organ that provides nutrients to and takes waste away from the fetus. 142: Cerclage for the Management of Cervical Insufficiency (Obstet Gynecol 2014;123:3729), ACOG Practice Bulletin No. Current trends in cervical ripening and labor induction. Misoprostol, a medication for peptic ulcers, is a commonly used off-label drug that both ripens the cervix and induces labor. ACOG Publications: PDF Only ACOG Practice Bulletin No. Evidence acquisition: This clinical practice guideline has been prepared by the Clinical Practice Obstetrics Committee, reviewed by the Maternal Fetal Medicine and Family Practice Advisory Committees, and approved by the Executive and Council of the Society of Obstetricians and Gynaecologists of Canada.