Please select the eligibility criteria that correspond to the clinical trial below.
Title: Elective Induction of Nulliparous Labor: A Randomized Clinical Trial
Brief Summary: Primary outcome: to evaluate the effect of elective induction of labor (IOL), at 39 weeks gestation, on cesarean delivery rates in nulliparous women compared to expectant management (EM).

Secondary outcomes: to evaluate differences in the mean number of clinic visits/antepartum tests avoided with IOL, to compare the differences in utilization of inpatient resources (mean duration of inpatient stay, mean duration of labor), and to evaluate the effect of IOL on the risk of urinary/anal incontinence and sexual dysfunction as analyzed using previously validated measurements. We will evaluate differences in the rate of cervical change once active labor is diagnosed, and the time from completion of active labor, defined as complete dilation and complete effacement, to the delivery of fetus (definition of second stage of active labor). Furthermore, other secondary outcomes to be evaluated include comparisons between IOL and EM in regards to the occurence of chorioamnionitis, stillbirth, operative vaginal delivery, and meconium stained amniotic fluid. An evaluation of the predictive value of cervical length and Bishop score for vaginal delivery will also be examined.


Options:
A: Inclusion Criteria:

* Pregnant women
* ≥ 18 years old
* With a singleton cephalic pregnancy between ≥41+0 weeks and ≤ 42+0 weeks of gestation
* Gestational age estimated from the first trimester ultrasound (realized between 11 and 13+6 weeks of gestation)
* With a decision of induction of labour
* Written informed consent obtained from subject
* Subject covered by or having the rights to the French Social Security system

Exclusion Criteria:

* Bishop score ≥ 6 (favourable cervix)
* Non cephalic presentation (breech, transverse)
* Severe preeclampsia defined as the presence of preeclampsia with at least one of the following items :

  * Severe maternal hypertension (systolic blood pressure ≥ 160 mm Hg and/or diastolic blood pressure ≥ 110 mm Hg)
  * Renal failure with oliguria (\< 500 ml/24h) or creatinine \> 135μmol/L, or proteinuria \> 5 g/day
  * Pulmonary oedema, epigastric pain or HELLP syndrom (hemolysis, elevated liver enzyme, low platelets)
  * Eclampsia or neurologic persisting symptoms (visual disturbances, headache, increased reflexes)
  * Thrombopenia \< 100 G/L
* Prior caesarean section or uterine scar
* Placenta praevia
* Suspected genital herpes infection
* Known VIH seropositivity (confirmed by blood serology)
* Premature rupture of membranes (PROM - continual leaking of amniotic fluid or positive test in favour of PROM)
* Foetus with suspected severe congenital abnormalities
* Pathological fetal heart rate
* Contra-indications to Propess®
* Contra-indications for using Cook® Cervical Ripening Balloon
* Women under guardianship or trusteeship
B: Inclusion Criteria:

* Singleton pregnancy
* 24-42 weeks of gestation
* Cephalic presentation
* Intact membranes
* Bishop score of less than or equal to 6

Exclusion Criteria:

* Contraindications to labor
* Dead or severely anomalous fetus
* Spontaneous labor.
C: Inclusion Criteria:

1. Spontaneous rupture of membranes (ROM) ≥1 hour prior to starting induction; ROM defined as clinical history with the presence of 2 of the following 4: pooling, ferning, nitrazine, oligohydramnios. In the absence of clinical history, oligohydramnios AND pooling must be present for ROM to be diagnosed. Oligohydramnios is defined as a total amniotic fluid index of \<5cm or a maximum vertical pocket \<2cm.
2. Unfavorable cervix, defined as sterile digital exam ≤ 2cm dilated / 80% effaced
3. Gestational age ≥ 34 weeks by best obstetric estimate
4. Clinical management decision is vaginal delivery
5. Singleton gestation
6. Cephalic presentation
7. Willing to participate and able to understand and sign the informed consent document before randomization
8. Women of reproductive age

Exclusion Criteria:

1. Multiple gestations
2. Lethal fetal anomalies, e.g., anencephaly, trisomy 13, trisomy 18
3. Latex allergy
4. Greater than 1 prior cesarean delivery
5. Active labor - defined as contractions more frequent than every 5 minutes (or ≥ 12 contractions in 1 hour) associated with ≥ 1 cm cervical change. In the absence of ≥ 1 cm cervical change after 2 hours, patients with contractions can be included in the study.
6. Suspicion of chorioamnionitis
7. Any contraindications to vaginal delivery, including malpresentation, active herpes, complete placenta previa, greater than two prior cesarean deliveries, etc.
8. HIV positive status or AIDS
9. Intrauterine fetal demise
10. Suspected placental abruption, significant hemorrhage
11. Nonreassuring fetal heart rate (FHR) pattern
12. Participation in a competing trial
D: Inclusion Criteria:

* Nulliparous patients evaluated at 38 weeks gestation without contraindication for induction of labor, and
* Patients who meet dating criteria as outlined above, and
* Patients who have a Bishop score of ≤ 5.

Exclusion Criteria:

* Contraindication to induction of labor,
* Scheduled induction of labor for medical indications, and/or
* Failure to meet dating criteria above, Bishop score of \> 5.

Answer: D