Induction of labor on request in a resource-poor setting

The Effect of Ultrasound-Measured Preinduction Cervical Length on Delivery Outcome in a Low-Resource Setting

Background

Induction of labour is not without risk, and it calls for a method that will be sensitive enough to predict successful labour induction.

Aim

This study aims to evaluate the role of transvaginal ultrasonographic cervical length measurement at term in the prediction of successful induction of labour (IOL).

Materials and Methods

This prospective study was carried out in the Department of Obstetrics and Gynaecology of Federal Teaching Hospital Abakaliki between 1st of July and 30^th of November 2015. Preinduction Bishop score and cervical length were assessed before induction of labour. Intracervical, cervical, extraamniotic Foley catheter was used to improve the Bishop score. The data were analyzed using the IBM SPSS Statistics 20.

Results

The mean maternal age of the study group was 30.68 ± 6.38 years with a range of 19–43 years. The mean gestational age and parity were 39.57 ± 1.49 and 1.85 ± 0.63, respectively. All the women studied had successful induction of labour with mean induction delivery time of 8.1 ± 3.0 hours and mean duration of labour of 7.4 ± 2.9 hours. Preinduction cervical length is a good predictor of a short duration of labour (P = 0.001). Parturient with a preinduction cervical length of less than 3 cm was likely to have labour lasting less than 6 hours (RR = 4.20 (95% CI 1.85–9.529).

Conclusion

Transvaginal sonographic measurement of cervical length provides a useful prediction of the likelihood of duration of labour following the induction of labour. It is recommended that IOL should be considered and success anticipated in a parturient with a cervical length less than 3 cm.

Induction of labour: determinants and implications of failure to keep an initial appointment in a developing country

The objective of this study was to determine why parturients in a low resource setting fail to keep an appointment for induction of labour and evaluate the subsequent pregnancy outcome. The method used was a prospective matched case control study. Results showed that women with only primary school education were significantly more common in the study group (8% vs 1%; p < 0.05). The main reason for failing to keep the appointment was because they preferred spontaneous onset of labour (56.6%) and the 'spousal factor' (23.9%). Patients who were counselled by the consultant obstetrician were less likely to decline compared with those counselled by the resident doctors. Although the pregnancy outcome was comparable, failed induction of labour leading to caesarean section was significantly commoner among the study group (p < 0.05). It was concluded that social and cultural factors affecting the utilisation of health services should be considered by obstetric care providers in developing countries, to promote safe motherhood.

Social induction of labour: experience in an urban teaching hospital in Nigeria

PURPOSE

To document the experience with social induction of labour (IOL) and compare its outcome with electively induced labour for prolonged pregnancy.

METHODS

A prospective matched case-control study.

RESULT

Social IOL was significantly common in women of high social class (78.3 vs. 45.6%, P = 0.03) and the commonest indication was because the parturient was 'tired of pregnancy' (60.9%). There was no significant difference between both groups in the mean induction to delivery interval, caesarean section and instrumental delivery rates, 5-minute Apgar score <7 and early neonatal death.

CONCLUSION

Social IOL in well-selected cases has comparable outcomes to elective IOL for prolonged pregnancy. There is still the need for evaluating the determinants of maternal request for social IOL and the development of guidelines to regulate its practice.

Does distance matter? Increased induction rates for rural women who have to travel for intrapartum care

OBJECTIVES

Although there has been a devolution of local rural maternity services across Canada in the past 10 years in favour of regional centralization, little is known about the health outcomes of women who must travel for care. The objective of this study was to compare intervention rates and outcomes between women who live adjacent to maternity service with specialist (surgical) services and women who have to travel for this care.

METHODS

The BC Perinatal Database Registry provided data for maternal and newborn outcomes by delivery hospital for 14 referral hospitals (selected across a range of 250-2500 annual deliveries) between 2000 and 2004. Three hospitals were selected for sub-analysis on the basis of almost complete capture of the satellite community population (greater than 90%) to avoid referral bias.

RESULTS

Women from outside the hospital local health area (LHA) had an increased rate of induction of labour compared with women who lived within the hospital LHA. Sub-analysis by parity demonstrated that multiparous women had increased rates of induction for logistical reasons.

CONCLUSION

Rural parturient women who have to travel for care are 1.3 times more likely to undergo induction of labour than women who do not have to travel. Further research is required to determine why this is the case. If it is a strategy to mitigate stress incurred due to separation from home and community, either a clinical protocol to support geographic inductions or an alternative strategy to mitigate stress is needed.

Women's opinions and experiences with induction of labor and cesarean delivery on request in south eastern Nigeria

OBJECTIVE

To assess the opinions and experiences of women regarding induction of labor and cesarean delivery on request in south eastern Nigeria.

METHOD

Women were interviewed using questionnaires on their awareness of their right to request labor induction and/or a cesarean delivery, and of their experience and opinion of the procedures.

RESULTS

Of the 15.1% of the respondents who knew they could request a cesarean delivery, 2.4% had requested one; and of the 56.3% who knew they could request labor induction, 6.9% had requested one. Only 5.3% and 11.3% of the respondents who would chose the former or the latter procedure, respectively, said that they would insist on receiving it. Fear of their physicians' negative attitude regarding the procedures, and/or abandonment of care, ranked highest among their reasons for not insisting.

CONCLUSION

In south eastern Nigeria few women are aware of their right to a cesarean delivery on request and the rate of refusal to perform such deliveries is high among physicians; more women are aware of their right to receive induction of labor on request and the acceptance rate is higher among physicians; and most women are unwilling to insist that their physician respect their choice.