Determinants of outcome of Induction of Labor in Four Teaching Hospitals in Addis Ababa, Ethiopia
Keywords:Induction of labor, Failed induction, cesarean section
INTRODUCTION: Induction of labor is an increasingly common intervention in obstetrics and known to decrease maternal and perinatal mortalities; therefore, it is necessary to determine the safety and effectiveness of our institutions’ cervical ripening methods and labor induction process.
METHODS: A cross sectional prospective quantitative study was done. Data was collected from a sample of 339 induction cases that were selected consecutively during the study period. Data were collected from medical records of cases using a structured questionnaire Data were analyzed using SPSS. Study was approved by the Institutional Review Board of Addis Ababa University.
RESULT: The rate of failed induction was 25.4%. The rate of Cesarean Section was 37.8%. Failed induction contributed to 66.7% of indications for Cesarean section among the induced labors. Direct oxytocin was used in 39.2%, vaginal misoprostol in 27.7%, PGE2 in 23.6% and Foley Catheter in only 9.4%. There is significant association between failed induction and unfavorable Bishop Score, indication for induction, gestational age and nulliparity, all having a P<.01. There was no association between failed induction and method used with maternal and fetal outcomes. A favorable Bishop Score was achieved in only 20% of cases.
CONCLUSION: Failed induction and associated cesarean section rate is high in our setup compared with global rates. Therefore, reviewing our institutions’ induction guideline in an attempt to increase the success of vaginal delivery is important.
2. Rayamanjihi RT, Karki C, Surestha, Pedhyesm. Indications for labor induction and predictors for failed induction at KMCTH. Kathmandu University Medical Journal (2009), Vol. 7, No. 1, Issue 25, 21-2
3. Mesfin E , Getu A. Outcomes of Induction of labor in three teaching hospitals in Addis Ababa , Ethiopia(Unpublished)
4. WHO. Elective Induction VS spontaneous labor in Latin America, World Health organization.2011 sep 1;89(9):657-6
5. Thorsell M, Lyrenas S, Andolf E, Kaijser M. Induction of labor and the risks of emergency C/S in nulliparous and multiparous women, Acta Obstet Gynecol Scand.2011 Oct;90(10)
6. Khan NB, Ahmed I, Malik A, Sheikh L. Factors associated with failed induction of labor in secondary care hospital, J Pac Med Assoc.2012 Jan;62(1):6-10
7. Gessessew A; Lakew Z: Determinant factors in the outcome of induction of labor. 1996 May; page 4. (Unpublished)
8. Berhan Y1, Dwivedi AD. Currently used oxytocin regimen outcome measures at term & postterm. II: Outcome indicators in relation to Bishop Score & other covariates. Ethiop Med J. 2007 Jul;45(3):243-50
9. Diny G.E.Kolman, Corine J.M., Brinkhorst SJ, Van der Post JA, Pajkrt E, Opmeer BC,et al .The bishop as a predictor of labor induction success: a systematic review. AM J Perinatol 2013 Jan 2
10. Huseyin Cengiz, Serdar Yalvac, Ali Yavuzcan, Omer Kandemir . Prediction of successful induction of labor with Dinoprostone in a homogenous group of patients. SAJOG, January 2012, vol.18,No 1
11. Sawson M., Hamdalla MB., Riyadh A., Hassin F.. Trans vaginal U/S cervical length measurement as a successful labor induction. J Fac Med Baghdad 2006; Volume 48, No 2
12. Williams MC1, Krammer J, O'Brien WF The value of the cervical score in predicting successful outcome of labor induction. Obstet Gynecol. 1997 Nov;90(5):784-9.
13. G Justus Hofmeyr, A metin Gulme Zoglu,Cynthia Pillegi , Vaginal misoprostol for cervical ripening and induction of labor, Cochrane Database , Feb 2013
14. Trabelsi H., Mathlouthi N, Zayen S, Dhouib M, Chaabene K, Trabelsi K, et al.,A randomized and prospective study ; Misoprostol vs dinoprostone. Tunis Med .2012 may;90(5):362-9
15. Joswiac M. et al. Foley Catheter Vs vaginal PGE2 gel for induction of labo at term; an open label Randomized Control Trial. Lancet, Oct 25, 2011
16. Vogel JP, Sauza JP, Gulmezoglu AM. Patterns and outcomes of induction of labour in Africa and Asia: a secondary analysis of the WHO global survey on maternal Neonatal health. PLoS one. 2013 Jun 3;8(6): e65612
17. Lin MG, Middleton P., Crowther CA, Flenady VJ, Varatharaju B. Planned early birth vs expectant management for pre-labor rupture of membranes at term. Cochrane database Sys Rev 2006 Jan 25; CD005302
18. Tan BP, Hannah ME,. Prostaglandins versus oxytocin for pre-labor rupture of membrane. Cochrane Database Sys Rev 2000;(2):CD000159
19. Gulmezoglu AM, Crowther CA, Middleton P, Heatley E. Induction of labour for improving birth outcomes for women at or beyond term. The Cochrane review ,2011
20. WHO Recommendation for induction of labor. World Health Organization: 2011
21. Asfaw M., Severe preeclampsia: Effect of termination of pregnancy on perinatal outcome, 2014. AAU institutional repository URI: http://localhost:80/xmlui/handle/123456789/518 Date: 2014-10
22. Teklu S, Gaym A. Prevalence and clinical correlates of the hypertensive disorders of pregnancy at Tikur Anbesa Hospital Addis Abeba, Ethiopia., Ethiop Med J.2006Jan;44(1):17-16
23. Alfirevic Z, Kelly AJ., Dowswell T. Intravenous Oxytocin alone for cervical ripening and induction of labour, Cochrane Database Syst Rev.2009 Oct 7; CD003246
24. Heinmann J, Gillen G, Sanches R, Kaunitz AM , Do mechanical methods of cervical ripening increase infectious morbidity? A systematic review, Am J Obstet Gynecol.2008 Aug;199(2):177-87; discussion 187-8
25. AA Adeniyi, et al. Randomization of two dosing regimens of vaginal misoprostol for cervical ripening and labor induction in low resource setting. Niger J clin pract.2014/ Volume: 17/Issue: 3/ Page:287-291
26. Hofmeyr GJ, Gulmezoglu AM, Cynthia Pillegi. Vaginal misoprostol for cervical ripening and induction of labor. Cochrane Database Syst Rev.2010 Oct 6;(10):CD000941