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

* Nulliparous women aged 18 or above
* BMI ≥ 30 at the time of labor induction
* Singleton gestation
* Cephalic presentation (includes successful external cephalic version)
* Intact fetal membranes
* Unfavorable cervix (Bishop score of ≤ 6)
* Gestational age ≥ 32 weeks

Exclusion Criteria

* Patient not candidate for IOL with misoprostol as deemed by the treating physician
* Multiple gestation
* Major fetal anomalies
* Fetal demise
B: 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.
C: Inclusion Criteria:

* Patients 15 years of age or older.
* Diagnosed to be pregnant with an indication for induction of labor.
* Having a Bishop score of 4 points or less.
* Diagnosed as having a singleton pregnancy in a vertex presentation, with intact membranes, and no significant regular uterine contraction at gestational age of \>28 weeks.
* Willingness to comply with the protocol for the duration of the study.
* Have signed an informed consent.

Exclusion Criteria:

* Any contraindication for a vaginal delivery (i.e. placenta previa, non vertex presentation).
* Ruptured membranes.
* Previous cesarean section or any uterine scar.
* Documented labor.
* Suspected fetal distress necessitating immediate intervention.
* Proven malignancy of the cervix.
* Active inflammatory or purulent condition of the lower genital tract.
D: Inclusion Criteria:

Pregnant women with a single fetus and uncomplicated pregnancy, with a gestational age \> 37+ 0 weeks, needing induction of labour

1. ≥18 years of age
2. No medical risk factors.

Exclusion Criteria:

1. Out-patient induction of labour is deemed unsuitable for the following women on the grounds of safety -

   * Grand multiparous women (Parity 5 or more)
   * Multiple pregnancy
   * Women with complex medical or obstetric problems (i.e. placenta previa, recurrent antepartum hemorrhage, diabetes, pre-eclampsia, Intrauterine growth restriction (UGR), Obstetric Cholestasis)
   * Previous caesarean section/uterine scar
2. Women who are contracting and/ or requiring analgesia
3. Women who do not fully understand the information leaflet and unable to provide full informed consent
4. Women for whom out-patient induction is unsuitable according to local hospital protocol

Answer: B