• Delia NICOLAICIUC “Cuza-Voda” Obstetrics and Gynecology Clinical Hospital, Iasi
  • Gabriela SIMIONESCU “Cuza-Voda” Obstetrics and Gynecology Clinical Hospital, Iasi
  • Natalia DARII “Cuza-Voda” Obstetrics and Gynecology Clinical Hospital, Iasi
  • Mariana BOLOTA “Cuza-Voda” Obstetrics and Gynecology Clinical Hospital, Iasi
  • Sorana Caterina ANTON “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • B. DOROFTEI “Grigore T. Popa” University of Medicine and Pharmacy Iasi


SYSTEMATIC REVIEW REGARDING PSYCHOLOGICAL AND PHYSIOLOGICAL PROCESS ASPECTS ABOUT THE METHODS OF INDUCING LABOR (Abstract): Aim review article aims to synthesize the mechanisms involved in triggering labor, focusing on the cervical phenomena resulting in maturation, cervical dilation and fetal expulsion. Furthermore, this article highlights the ways in which labor may be induced. Material and methods: The data collected by accessing Medline; Medscape; PubMed and ISI Web of Knowledge using the following keywords: labor induction, oxytocin, cervix ripening, prostaglandins, uterine contraction, amniotomy, membrane stripping, misoprostol, Foley catheter. Review articles, original articles, as well as, case reports were taken into consideration when the search was performed. We identified more than 1,000 abstracts and reviewed over 150 full text articles using the keywords listed above. We preferentially included high quality systematic reviews or large randomized trials. Results: After reviewing the literature we included 28 full text articles in our analysis. A series of factors should be taken into consideration by the obstetrician before considering inducing labor. There are studies that compare the use of oxytocin versus prostaglandins for labor induction and the results are in favor of prostaglandins with a lower rate of number of pregnancies completed by segmental transversal cesarean. However, administration of oxytocin may increase the risk of termination of pregnancy through segmental transversal cesareans. In contrast to, oxytocin and prostaglandins, the mechanical methods of inducing labor may increase the risk of both maternal and neonatal infectious. Conclusions: The decision to trigger labor requires the obstetrician to carefully analyze the timing of induction of birth and the risks and benefits, considering, for each patient, the most effective method of triggering. Thus, we emphasize on the necessity of developing protocols to guide obstetricians, since there is no consensus on the doses that should be administered. The cost-effectiveness of the treatment should be considered.

Author Biographies

Sorana Caterina ANTON, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Mother and Child Medicine

B. DOROFTEI, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Mother and Child Medicine


1. ***ACOG Committee on Practice Bulletins - Obstetrics. ACOG Practice Bulletin No. 107: Induction of labor. Obstet Gynecol 2009; 114(2 Pt 1): 386-397.
2. Balaban DC, Hosu I. PR Trend: Societate si comunicare. Bucuresti: Editura Tritonic, 2009.
3. Luca FA, Filipeanu D, Anton C, Cananau M, Luca AC, Anton E. The Impact of Patterns Provided by the Media on Society Revista de Cercetare si Interventie Sociala, 2016; 52: 204-216.
4. Jukic AM, Baird DD, Weinberg CR, McConnaughey DR, Wilcox AJ. Length of human pregnancy and contributors to its natural variation. Human Reproduction, 2013.
5. Caldeyro- Barcia R, Poseiro JJ. Oxytocin and contractility of the pregnant human uterus. Ann N Y Acad Sci. 1959; 75: 813-830.
6. Yulia A, Johnson MR. Myometrial oxytocin receptor expression and intracellular pathways. Minerva Ginecol 2014; 66(3): 267-280.
7. Prevost M, Zelkowitz P, Tulandi T, Hayton B, Feeley N, Carter CS, Joseph L, Pournajafi-Nazarloo H, Yong Ping E, Abenhaim H, Gold I. Oxytocin in pregnancy and the postpartum: relations to labor and its management. Front Public Health 2014; 2: 1.
8. Pařízek A, Koucký M, Dušková M. Progesterone, inflammation and preterm labor. J Steroid Biochem Mol Biol 2014; 139: 159-65.
9. Shmygol A, Gullam J, Blanks A, Thornton S. Multiple mechanisms involved in oxytocin-induced modulation of myometrial contractility. Acta Pharmacol Sin 2006; 27(7): 827-832.
10. Ravanos K, Dagklis T, Petousis S, Margioula-Siarkou C, Prapas Y, Prapas N. Factors implicated in the initiation of human parturition in term and preterm labor: a review. Gynecol Endocrinol 2015; 631(9): 679-683.
11. Lammers WJ. The electrical activities of the uterus during pregnancy. Reprod Sci 2013; 20(2): 182-189.
12. Xu J, Menon SN, Singh R, Garnier NB, Sinha S, Pumir A. The role of cellular coupling in the spon-taneous generation of electrical activity in uterine tissue. PLoS One 2015; 10(3): e0118443.
13. Williams KC, Renthal NE, Gerard RD, Mendelson CR. The microRNA (miR)-199a/214 cluster me-diates opposing effects of progesterone and estrogen on uterine contractility during pregnancy and la-bor. Mol Endocrinol 2012; 26(11): 1857-1867.
14. Ancuta C, Ancuta E, Chirieac R, Anton C, Surlari Z, Iordache C. TNF Inhibitors and Periodontal Inflammation in Psoriatic Arthritis. Rev. Chim. (Bucharest) 2017; 68(8): 1914-1918
15. Lundberg IE, Cooper RG, Chinoy H, Polymyositis and dermatomyositis. In: Bijlsma JWJ (editors), Textbook of rheumatic diseases, Newgen Knowledge Works Pvt. Ltd., 2012, 568-594.
16. Burmester GR, Pratt AG, Scherer UH, van Laar JM, Rheumatoid arthritis: pathogenesis and clinical features. In:Bijlsma JWJ (editors), Textbook of rheumatic diseases, Newgen Knowledge Works Pvt. Ltd., 2012, 206-232.
17. Ancuţa C, Pomîrleanu DC, Anton CR, Moraru E, Anton E, Chirieac RM, Ancuţa E. Rheumatoid myositis, myth or reality? A clinical, imaging and histological study. Rom J Morphol Embryol 2014; 55(3): 781-785.
18. Arrowsmith S, Kendrick A, Wray S. Drugs acting on the pregnant uterus. Obstet Gynaecol Reprod Med 2010; 20(8): 241-247.
19. Vogel JP, Osoti AO, Kelly AJ, Livio S, Norman JE, Alfirevic Z. Pharmacological and mechanical interventions for labor induction in outpatient settings. Cochrane Database Syst Rev 2017; 9: CD007701.
20. Batinelli L, Serafini A, Nante N, Petraglia F, Severi FM, Messina G. Induction of labor: clinical predictive factors for success and failure. J Obstet Gynaecol 2018; 38(3): 352-335.
21. Moore Lisa, Rayburn, William. Elective induction of labor. Clinical Obstetrics and Gynecology 2006; 49(3): 698-704.
22. Liao D, Hee L, Sandager P, Uldbjerg N, Gregersen H. Identification of biomechanical properties in vivo in human uterine cervix. J Mech Behav Biomed Mater 2014; 39: 27-37.
23. Fernandez M, House M, Jambawalikar S, Zork N, Vink J, Wapner R, Myers K. Investigating the mechanical function of the cervix during pregnancy using finite element models derived from high-resolution 3D MRI. Comput Methods Biomech Biomed Engin 2016; 19(4): 404-417.
24. Heller DS, Goldsmith LT, Aboujaoude R, Kaplan C, Baergen R, Cole D. Collagen expression in the pregnant human cervix is decreased with labor. J Low Genit Tract Dis 2012; 16(1): 4-9.
25. Laughon SK, Zhang J, Troendle J, Sun L, Reddy UM. Using a simplified Bishop score to predict vaginal delivery. Obstet Gynecol. 2011; 117(4): 805-811.
26. Beckmann M, Paterson E, Smith A. Redesigning induction of labor processes. Aust NZJ Obstet Gy-naecol 2018; 58(3): 315-320.
27. Alfirevic Z, Keeney E, Dowswell T, Welton NJ, Medley N, Dias S, Jones LV, Caldwell DM. Methods to induce labor: a systematic review, network meta‐analysis and cost‐effectiveness analysis. BJOG 2016; 123(9): 1462-1470.
28. Trofin FP, Chirazi M, Honceriu, Drosescu P, Grădinariu G, Vorniceanu A, Anton E, Cojocaru D, Ciobica A, Ciornea E, Cojocaru IS. Pre-administration of vitamin C reduces exercise-induced oxidative stress in untrained subjects. Arch Biol Sci Belgrade 2014: 66(3): 1179-1185.
29. Weeks A, Alfirevic Z. Oral misoprostol administration for labor induction. Clin Obstet Gynecol 2006; 49(3): 658-671.
30. Alfirevic Z, Kelly AJ, Dowswell T. Intravenous oxytocin alone for cervical ripening and induction of labor. Cochrane Database Syst Rev 2009: CD003246.
31. Ferguson JE, Head BH, Frank FH et al. Misoprostol versus low-dose oxytocin for cervical ripening: a prospective, randomized, double-masked trial. Am J Obstet Gynecol 2002; 187(2): 273-280.
32. Jozwiak M, Bloemenkamp KW, Kelly AJ, Mol BW, Irion O, Boulvain M. Mechanical methods for induction of labor. Cochrane Database Syst Rev 2012; 3: CD001233.
33. Boulvain M, Stan C, and Irion O. Membrane sweeping for induction of labor. Cochrane Database Sys Rev 2005; 25(1): CD000451.
34. Carter Sarah, Channon A, Berrington A, Carter S. Variations in the Risk of Labor Induction Across Hospitals and NHS Trusts in the United Kingdom. European Journal of Public Health. 2017: 27(3): ckx189.060.
35. Iorga M, Dondas C, Petrariu FD, Scripcariu SI, Socolov DG, Socolov RV. Key factors influencing the level of job satisfaction among obstetrics and gynecology physicians in Romania. Rev Med Chir Soc Med Nat Iasi 2018; 122(1): 39-50.
36. Leventhal H, Brissette I, and Leventhal EA. The common-sense model of self-regulation of health and illness. In The Self-Regulation of Health and Illness Behavior volume I, London: Psychology Press, 2003, 42-65.
37. Postolica R, Iorga M, Petrariu FD, Azoicai D. Cognitive-Behavioral Coping, Illness Perception, and Family Adaptability in Oncological Patients with a Family History of Cancer. BioMed Research In-ternational Volume 2017, Article ID 8104397.