World Health Organization (WHO) – WHO recommendations for induction of labour. 2011.
Over recent decades, more and more pregnant women around the world have undergone induction of labour (artificially initiated labour) to deliver their babies. In developed countries, up to 25% of all deliveries at term now involve induction of labour. In developing countries, the rates are generally lower, but in some settings they can be as high as those observed in developed countries.
Induction of labour is not risk-free and many women find it to be uncomfortable. With a view to promoting the best known clinical practices in labour and childbirth and to improving maternal outcomes worldwide, WHO has developed the present recommendations using the procedures outlined in the WHO Handbook for guideline development. The steps involved in the guideline development process included: (i) identification of priority questions and outcomes; (ii) evidence retrieval; (iii) assessment and synthesis of the evidence; (iv) formulation of recommendations; and (v) planning for dissemination, implementation, impact evaluation and updating. Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, evidence profiles related to preselected topics were prepared based on 18 up-to-date Cochrane systematic reviews. An international group of experts participating in a WHO technical consultation – held in Geneva, Switzerland, on 13–14 April 2010 – formulated the recommendations based on the evidence profiles using a process that was participatory and consensus-driven. The participants also identified important knowledge gaps that needed to be addressed through primary research. Overall, the participants placed high emphasis on implementation research related to induction of labour and developed a list of 10 priority research questions, which are presented in this document (see Section 5, Research implications). Issues related to dissemination, adaptation and implementation (including the anticipated impact on the organization of care and monitoring and evaluation of the implementation) of the present guidelines are also addressed herein.
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