Analgesic considerations for induction of labor

Induction of labor may be indicated to minimize maternal and fetal risks. The rate of induction is likely to increase as recent evidence supports elective induction at 39 weeks gestation. We review methods of induction and then analgesic options as they relate to indications and methods to induce labor. We specifically focus on parturients at high risk for anesthetic complications including those requiring anticoagulation, and those with cardiac disease, obesity, chorioamnionitis, prior spinal instrumentation, elevated intracranial pressure, known or anticipated difficult airway, thrombocytopenia, and preeclampsia. Guidelines regarding timing of anticoagulation dosing with neuraxial anesthetic techniques have been defined through consensus statements. Early epidural placement may be beneficial in patients with cardiac disease, obesity, anticipated difficult airway, and HELLP syndrome. Ques-tions remain regarding how early is too early for epidural place -ment, what options are safest for patients with bacteremia, and what pain relief should be offered to those unable to tolerate cervical exams in early labor. (c) 2021 Elsevier Ltd. All rights reserved.

Automated summary

Induction of labor may be necessary to minimize risks for both mothers and fetuses, with recent evidence supporting elective induction at 39 weeks gestation. Anesthetic interventions and pain relief options for high-risk parturients are important considerations.