Labor induction in the context of "Premature babies"

A self-induced abortion (also called a self-managed abortion, or sometimes a self-induced miscarriage) is an abortion performed by the pregnant woman herself, or with the help of other, non-medical assistance. Although the term includes abortions induced outside of a clinical setting with legal, sometimes over-the-counter medication, it also refers to efforts to terminate a pregnancy through alternative, potentially more dangerous methods. Such practices may present a threat to the health of women in the case that they are incorrectly used.

Self-induced (or self-managed) abortion is often attempted during the beginning of pregnancy (the first eight weeks from the last menstrual period). In recent years, significant reductions in maternal death and injury resulting from self-induced abortions have been attributed to the increasing availability of misoprostol (known commercially as "Cytotec"). This medication is a synthetic prostaglandin E1 that is inexpensive, widely available, and has multiple uses, including the treatment of post-partum hemorrhage, stomach ulcers, cervical preparation and induction of labor. The World Health Organization (WHO) has endorsed two regimens for abortion up to 12 weeks of pregnancy using misoprostol: a standardized regimen of mifepristone and misoprostol and a regimen of misoprostol alone. The regimen with misoprostol alone has been shown to be up to 83% effective in terminating a pregnancy but is more effective combined with mifepristone.

Cervical effacement or cervical ripening refers to the thinning and shortening of the cervix. This process occurs during labor to prepare the cervix for dilation to allow the fetus to pass through the vagina. While this is a normal, physiological process that occurs at the later end of pregnancy, it can also be induced through medications and procedures.

During gestation, the cervix maintains pregnancy by increasing synthesis of various proteins. These proteins have defined interactions that allow the formation of matrix proteins to help fortify the uterine cervix. Toward the end of pregnancy, a series of hormone-mediated biochemical process takes place to degrade the collagen and fiber network to cause the cervix to ripen during labor. Failure to ripen the cervix during labor may delay its onset and cause complications. Current efforts to induce labor include pharmacologic, non-pharmacologic, mechanical and surgical methods.

Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is between 28 and 32 weeks, early preterm birth occurs between 32 and 34 weeks, late preterm birth is between 34 and 36 weeks' gestation. These babies are also known as premature babies or colloquially preemies (American English) or premmies (Australian English). Symptoms of preterm labor include uterine contractions which occur more often than every ten minutes and/or the leaking of fluid from the vagina before 37 weeks. Premature infants are at greater risk for cerebral palsy, delays in development, hearing problems and problems with their vision. The earlier a baby is born, the greater these risks will be.

The cause of spontaneous preterm birth is often not known. Risk factors include diabetes, high blood pressure, multiple gestation (being pregnant with more than one baby), being either obese or underweight, vaginal infections, air pollution exposure, tobacco smoking, and psychological stress. For a healthy pregnancy, medical induction of labor or cesarean section are not recommended before 39 weeks unless required for other medical reasons. There may be certain medical reasons for early delivery such as preeclampsia.

Misoprostol is a synthetic prostaglandin medication used to prevent and treat stomach and duodenal ulcers, induce labor, cause an abortion, and treat postpartum bleeding due to poor contraction of the uterus. It is taken by mouth when used to prevent gastric ulcers in people taking nonsteroidal anti-inflammatory drugs (NSAID). For abortions it is typically used in conjunction with mifepristone or methotrexate, but can be used alone. By itself, effectiveness for abortion is between 82% and 100%. Its efficacy with mifepristone is higher, but varies based on gestational age. The misoprostol-only abortion regimen is typically recommended only when mifepristone is not available. For labor induction or abortion, it is taken by mouth, dissolved in the mouth, or placed in the vagina. For postpartum bleeding it may also be used rectally.

Common side effects include diarrhea and abdominal pain. It is in pregnancy category X, meaning that it is known to result in negative outcomes for the fetus if taken during pregnancy. In rare cases, uterine rupture may occur. It is a prostaglandin analogue—specifically, a synthetic prostaglandin E₁ (PGE₁).

Postterm pregnancy is a pregnancy continuing past the 42nd week of gestation, two weeks beyond the typical 40-week duration of pregnancy. Postmature births carry risks for both the mother and the baby, including fetal malnutrition, meconium aspiration syndrome, and stillbirths. After the 42nd week of gestation, the placenta, which supplies the baby with nutrients and oxygen from the mother, starts aging and will eventually fail . Postterm pregnancy is a reason to induce labor.

Obstetric ultrasonography, or prenatal ultrasound, is the use of medical ultrasonography in pregnancy, in which sound waves are used to create real-time visual images of the developing embryo or fetus in the uterus (womb). The procedure is a standard part of prenatal care in many countries, as it can provide a variety of information about the health of the mother, the timing and progress of the pregnancy, and the health and development of the embryo or fetus.

The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) recommends that pregnant women have routine obstetric ultrasounds between 18 weeks' and 22 weeks' gestational age (the anatomy scan) in order to confirm pregnancy dating, to measure the fetus so that growth abnormalities can be recognized quickly later in pregnancy, and to assess for congenital malformations and multiple pregnancies (twins, etc). Additionally, the ISUOG recommends that pregnant patients who desire genetic testing have obstetric ultrasounds between 11 weeks' and 13 weeks 6 days' gestational age in countries with resources to perform them (the nuchal scan). Performing an ultrasound at this early stage of pregnancy can more accurately confirm the timing of the pregnancy, and can also assess for multiple fetuses and major congenital abnormalities at an earlier stage. Research shows that routine obstetric ultrasound before 24 weeks' gestational age can significantly reduce the risk of failing to recognize multiple gestations and can improve pregnancy dating to reduce the risk of labor induction for post-dates pregnancy. There is no difference, however, in perinatal death or poor outcomes for infants.