Obstetric outcome and significance of labour induction in a health resource poor setting

Perspectives of midwives on the use of Kaligutim (local oxytocin) for induction of labour among pregnant women in the government hospitals in Tamale

BACKGROUND

The use of herbal medicine and/or its products is common throughout the world. In Tamale Metropolis, pregnant women frequently use local oxytocin to induce labour, as shown by the fact that 90% of midwives reported managing patients who used kaligutim (local oxytocin) to speed up labour. Early career midwives are also aware of this and have personally observed it being used by their clients. The purpose of the study was to assess midwives' opinions on pregnant women's use of the well-known kaligutim (local oxytocin) for labour induction in the Tamale Metropolis.

METHODS

A facility-based, quantitative, cross-sectional research design was used for the study. A total of 214 working midwives from Tamale's three main public hospitals participated. Data for the study were gathered through a standardized questionnaire. For the analysis and presentation of the data, descriptive and analytical statistics, such as basic frequencies, percentages, Fisher's exact test, chi square test and multivariate analysis, were employed.

RESULTS

According to the findings of this study, the safety, dosages, and contraindications of kaligutim during pregnancy and labour are unknown. The cessation of contractions was reported by 44 (22.4%) of the respondents whose clients used local oxytocin. The study also revealed that women in Tamale metropolis use "walgu", a spiritual form of oxytocin, to induce and augment labour. Respondents who responded, "yes" to baby admission to the new-born care unit were 25% more likely to use kaligutim (local oxytocin) than were those who responded, "no" to baby admission to the new-born care unit (AOR = 0.25 95% CI (0.01, 0.53), P = 0.021).

CONCLUSIONS

It can be concluded that using kaligutim to start labour has negative effects on both the mother and the foetus. Additional research is required to evaluate the efficacy, effectiveness, biochemical makeup, and safety of these herbal medicines, particularly during pregnancy and delivery, as well as the spiritual significance of kaligutim (Walgu) and its forms.

Maternal and neonatal outcome in pregnant women undergone induction of labor at Muhimbili National Hospital, Dar Es Salaam, Tanzania

INTRODUCTION

Labor induction is a common obstetric intervention aimed at initiating labor when spontaneous onset is delayed or deemed necessary for maternal or fetal well-being. Despite its widespread use, the practice's impact on maternal and neonatal outcomes remains a subject of ongoing research and debate. This study aims to evaluate the maternal and neonatal outcomes associated with labor induction in a tertiary hospital setting in Tanzania.

METHODOLOGY

A descriptive analytical cross-sectional study was conducted over a seven-month period from January 2021 to July 2021 at Muhimbili National Hospital in Dar es Salaam, Tanzania. A total of 120 pregnant women who underwent labor induction during this period were included in the analysis. Data on maternal demographics, obstetric characteristics, indications for induction, methods of induction, labor outcomes, and neonatal outcomes were collected from medical records and analyzed descriptively.

RESULTS

Among 4773 deliveries during the study period, 120 women underwent labor induction, accounting for 120 (2.5%) of all deliveries. The most common indications for induction were postdate pregnancy 60 (50%), hypertensive disorders of pregnancy 38 (31.7%), and premature rupture of membranes 22 (17.5%). The majority of induced women 74 (61.7%) delivered vaginally, with 46 (38.3%) undergoing cesarean section. Maternal complications were minimal, with the most common being failed induction of labor 17 (14.2%). Neonatal outcomes were generally positive, with 120 (100%) of neonates having Apgar scores of 7 or higher at five minutes, although 10 (8.3%) required admission to the neonatal ward for further care.

CONCLUSION

Labor induction at Muhimbili National Hospital demonstrated favorable maternal and neonatal outcomes, with low rates of maternal complications and positive neonatal Apgar scores. Postdate pregnancy emerged as the most common indication for induction. While the study highlights the benefits of labor induction, its retrospective nature and single-center setting limit the generalizability of findings. Prospective studies with larger sample sizes are warranted to validate these findings and inform evidence-based obstetric practices.

Obstetric Outcome of Induction of Labour in a Tertiary Hospital in Nigeria: A Five-Year Retrospective Cross-Sectional Study

Background

Induction of labour has remained one of the most valuable interventions in obstetric practice. Over the years, the proportion of women undergoing induction of labour (IOL) has been on a steady increase. The significance to obstetrics practice as well as its maternal and perinatal outcomes are sacrosanct, hence the need for its periodic review.

Objective

To determine the obstetric outcomes of induction of labour.

Methods

A five-year retrospective study of all cases of induction of labour at the maternity unit of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria between January 1st 2017 and 31st December 2021. The labour ward's records were assessed to determine the total number of women who had induction of labour during the study period. Women whose case files could be not retrieved were excluded. The folder numbers of the patients were extracted and their case files retrieved from the medical records department of the hospital. The primary outcomes measures were the indications and the methods of induction of labour, while the secondary outcome measures were the mode of delivery, cause of failed induction, and the perinatal outcome. Data were obtained using proformas and analysed using statistical packages for social sciences (SPSS) version 26.0 IBM corporation.

Result

A total of 3,638 deliveries were taken during the period under review and 168 patients had induction of labour giving an overall prevalence of 4.6% (46/1000 deliveries). Induction of labour was successful in 71.2% of cases. Misoprostol was used in 90.4% of cases as an induction agent. The commonest indication for induction of labour was postdate pregnancy (53.8%). Failed induction was due to fetal distress, poor progress of labour from cephalopelvic disproportion/malposition and failed cervical ripening. In about 72% of deliveries, there was good perinatal outcome, 10.3% of babies had moderate to severe asphyxia while 1.3% had neonatal death.

Conclusion

Induction of labour is a safe and beneficial procedure in obstetrics. However, it can be associated with adverse obstetric outcomes.

Outcomes and Associated Factors of Induction of Labor in East Gojjam Zone, Northwest Ethiopia: A Multicenter Cross-Sectional Study

Background

Induction of labor is the initiation of uterine contractions by artificial methods once the fetus has reached viability and prior to spontaneous onset of labor with the aim of achieving vaginal delivery. Although induction of labor is a critical life-saving intervention that potentially reduces adverse pregnancy outcomes, sometimes it has undesirable consequences for the health of the mother and/or the fetus. Hence, this study aimed to evaluate the outcomes and associated factors of labor induction.

Methods

An institution-based cross-sectional study was conducted from February 25 to May 25, 2020, among women undergoing induction at East Gojjam zone public hospitals in northwest Ethiopia. A structured interviewer-administered questionnaire was used to collect data from a sample of 411 mothers who were selected using a systematic random sampling technique. Stata/se™ Version 14 statistical software was used to analyze the data. Multivariable binary logistic regression was used to determine the potential factors affecting successful labor induction. Adjusted odds ratios with their 95% CI intervals were used to declare the strength of the association, and a variable with p value <0.05 was considered to have statistical significance.

Results

The prevalence of successful induction of labor was 70.3% (65.6, 74.7). The favorable Bishop score ((CI 3.90, 1.63-9.29); p value = 0.002), the intermediate Bishop score ((CI 3.53, 2.15-5.82); p value = 0.001), labor induction using oxytocin with cervical ripening ((CI 2.60, 1.21-5.63); p value = 0.015), and urban residence ((CI 0.48, 0.30-0.78); p value = 0.003) were associated with successful induction of labor.

Conclusion

These findings strongly suggest that cervical conditions are important determinants for the success of labor induction. Therefore, healthcare providers should confirm the favorability of the cervical status (using Bishop score) as a strict prerequisite before actual labor induction, and special consideration should be given to those pregnant women who reside in urban areas.

The prevalence and associated factors of success of labor induction in Hargeisa maternity hospitals, Hargeisa Somaliland 2022: a hospital-based cross-sectional study

BACKGROUND

The induction of labor is an artificial initiation of labor and has become one of the most common interventions in modern obstetrics to improve maternal and neonatal health. Understanding the prevalence and pregnancy outcomes following labor inductions is crucial in regions with high rates of maternal mortality and morbidity because of insufficient access to comprehensive emergency obstetric care. Therefore, this study aimed to assess the prevalence and associated factors of the success of induction of labor in Hargeisa maternity hospital Somaliland.

METHODS

A hospital-based cross-sectional study was employed among 453 women in Hargeisa maternity hospitals, Somaliland from January 1st to March 30th, 2022. Data were entered using Epi data version 4.6 and analyzed by using SPSS version 25. Bivariable and multivariable logistic regression were used to identify the associated factors with the success of labor induction and an odds ratio with a 95% confidence interval was used to measure the strength of the association. A P-value of ≤ 0.05 was considered statistically significant in multivariate analysis.

RESULTS

Of a total of 453 study participants who had undergone induction of labor, 349 (77%) of them had successful induction of labor with a 95% CI: 73%, 81%. Favorable Bishop score (AOR = 3.45, 95% CI: 1.98, 5.99), time from the start of induction to delivery < 12 h (AOR = 4.01, 95% CI: 2.16, 7.450), non-reassuring fetal heart rate pattern (AOR = 0.42, 95% CI: 0.22, 0.78) and amniotic fluid change to meconium (AOR = 0.43, 95% CI: 0.23, 0.79) were significantly associated with the success of labor induction.

CONCLUSION

This study implies that three out of four women who underwent induction had successful induction of labor. Favorable bishop score, time from the start of induction to delivery < 12 h, non-reassuring fetal heart rate pattern, and amniotic fluid change to meconium were significantly associated with the success of labor induction. The hospital should establish a clear bishop scoring system and there should be a strict follow-up on the condition of the fetal heartbeat and take corrective actions as needed. The factors related to healthcare facilities and providers need to be addressed by additional prospective studies.

Adverse neonatal outcomes and associated factors among mothers who gave birth through induced and spontaneous labor in public hospitals of Awi zone, Northwest Ethiopia: a comparative cross-sectional study

BACKGROUND

Adverse neonatal outcomes are one of the most common causes of neonatal mortality and morbidity. Empirical evidence across the world shows that induction of labor potentiates adverse neonatal outcomes. In Ethiopia, there has been limited data that compares the frequency of adverse neonatal outcomes between induced and spontaneous labor.

OBJECTIVES

To compare the prevalence of adverse neonatal outcomes between induced and spontaneous labor and to determine associated factors among women who gave birth in public hospitals of Awi Zone, Northwest Ethiopia.

METHODS

A comparative cross-sectional study was conducted at Awi Zone public hospitals from May 1 to June 30, 2022. A simple random sampling technique was employed to select 788 (260 induced and 528 spontaneous) women. The collected data were analyzed using statistical package for social science (SPSS) software version 26. The Chi-square test and an independent t-test were used for categorical and continuous variables, respectively. A binary logistic regression was used to assess the association between the outcome and explanatory variables. In the bivariate analysis, a p-value ≤ 0.2 at a 95% confidence interval was used to consider the variables in the multivariate analysis. Finally, statistical significance was stated at a p-value of less than 0.05.

RESULT

The adverse neonatal outcomes among women who gave birth through induced labor were 41.1%, whereas spontaneous labor was 10.3%. The odds of adverse neonatal outcomes in induced labor were nearly two times higher than in spontaneous labor (AOR = 1.89, 95% CI: 1.11-3.22). No education (AOR = 2.00, 95% CI: 1.56, 6.44), chronic disease (AOR = 3.99, 95% CI: 1.87, 8.52), male involvement (AOR = 2.23, 95% CI: 1.23, 4.06), preterm birth (AOR = 9.83, 95% CI: 8.74, 76.37), operative delivery (AOR = 8.60, 95% CI: 4.63, 15.90), cesarean section (AOR = 4.17, 95% CI: 1.94, 8.95), and labor complications (AOR = 5.16, 95% CI: 2.90, 9.18) were significantly associated factors with adverse neonatal outcomes.

CONCLUSION AND RECOMMENDATION

Adverse neonatal outcomes in the study area were higher. Composite adverse neonatal outcomes were significantly higher in induced labor compared to spontaneous labor. Therefore, it is important to anticipate the possible adverse neonatal outcomes and plan management strategies while conducting every labor induction.

Failed Induction of Labor and Associated Factors Among Women Who Undergone Induction of Labor in Jimma Medical Center, Ethiopia: A Hospital-Based Cross-Sectional Study

BACKGROUND

Although induction of labor is intended to achieve a safe vaginal delivery, its process is not always successful. Failed induction of labor leads to an increased risk of complication for both mother and fetus. Thus, this study aimed to assess the proportion of failed induction of labor and associated factors among women who undergone induction of labor from September 1, 2019 to August 31, 2020 in Jimma Medical Center (JMC), southwest Ethiopia.

METHODS

A hospital-based retrospective cross-sectional study was conducted on 243 charts of women who had induction of labor in JMC selected by a simple random sampling method from January 10 to 30, 2021. The collected data were entered into Epi-data version 4.2 and analyzed by SPSS version 23. Bivariate and multivariable logistic regression analyses were done to test the association. Adjusted odds ratio at 95% confidence interval (CI) andP-value <.05 was used to ascertain statistical significance.

RESULTS

The proportion of failed induction of labor in JMC was 16.9%. Maternal age ≥ 30 years (AOR 7.57; 95%CI = 2.88, 19.9) at (P-value = .000), elective induction (AOR .39; 95% CI = .16, .98) at (P-value = .045), and unfavorable bishop score (AOR 6.94; 95%CI = 2.35, 20.4) at (P-value = .000) were factors statistically significantly associated with failed induction of labor.

CONCLUSIONS

The proportion of failed induction of labor was relatively low in the study area. Advanced maternal age, elective induction, and unfavorable bishop score were associated with failed induction of labor. Thus, the hospital should strictly follow the protocol for induction of labor, and candidates of emergency induction of labor should be counseled thoroughly so as to be well prepared psychologically for the labor thereby reducing the risk of failed induction.

Predictors of Induction of Labor and Success Rate Among Mothers Giving Birth at Jimma University Medical Centre South West Ethiopia: Unmatched Case Control Study

BACKGROUND

Induction of labor is defined as the process of artificially stimulating the uterus to start labor. Despite the unquestionable reputation of labor induction for ending pregnancies, there is a risk to the mother and/or the fetus. Studies from developed and developing countries report increased labor induction rates with additional cases of cesarean section (CS) and fetal distress.

OBJECTIVE

The main aim of this study is to assess predictors of induction of labor and the success rate among mothers giving birth at Jimma University Medical Centre Southwest Ethiopia.

METHODS

A facility based unmatched case control quantitative study design was done among 694 (cases = 347 plus controls is 347) mothers. A systematic random sampling technique was used to select both cases and controls from the registration delivery log book. A standard document review checklist was used to collect data. Multivariate binary logistic regression analysis was done to identify predictors of the outcome of the variable.

RESULTS

The study findings revealed that the success rate of induction of labor in this study was 73.8%. Mothers with stillbirth history were three times more likely to be induced compared with mothers without stillbirth history. Mothers with abortion history were seven times more likely to be induced than mothers without an abortion history. Mothers with a gestational age of ≥42 weeks were 17 times more likely to be induced than mothers with a gestational age of 38–41 weeks. Mothers who had no antenatal care follow-up were seven times more likely to be induced than mothers who had antenatal care follow-up.

CONCLUSION

Maternal age, gestational age, history of abortion, and history of stillbirth were significant predictors of induction of labor which was claimed to increase the rate of uterine rupture, CS and admission to a neonatal intensive care unit (NICU).

A Comparative Study of Maternal-Fetal Outcome in Pregnant Women With Induction of Labor and Spontaneous Onset of Labor in a Rural Tertiary Care Center

OBJECTIVE

The present prospective observational study was conducted to study the incidence, indications, and outcome of induction of labor in a tertiary care center.

MATERIAL AND METHOD

The study group of this prospective cross-sectional study was constituted by all term pregnant women underwent trial of labor. The whole study group was further subdivided in two groups, group 1: Was having all pregnant women with spontaneous onset of labor pains and group 2 was containing all pregnant women underwent induction of labor. For induction only prostaglandins (PGE1 25 microgram tablet and PGE2 gel) were used. The measure of outcome included assessment of the incidence of induction in term pregnant women, major indications of induction of labor, duration of labor, mode of delivery, intrapartum and postpartum maternofetal complications and duration of hospital stay. The study group included 3264 pregnant women and was differentiated into group 1 with 2588 pregnant women and group 2 with 676 pregnant women.

RESULTS

The incidence of induction was 20.71%. Major indications of induction were a fetus who was postdates, premature rupture of membranes, and preeclampsia. The average duration of the induction to delivery interval was 19.13 ± 15.14 hours (hrs.) and admission to delivery interval in the spontaneous labor group was 8.79 ± 07.18 hrs. The incidence of cesarean delivery was 19.52% in the induction group (gp2). Failed induction was the most common indication of lower segment cesarean section (CS). The incidence of CS was 15.99% in spontaneous group (gp1) and fetal distress was most common indication in this group. With this study we found importance of rest after induction process completion, during this watchful rest period 51 pregnant women delivered vaginally. The neonatal intensive care unit (NICU) admission and neonatal death rate was more in group 1.

CONCLUSION

This study revealed that the incidence and indications of induction of labor among term pregnant women were similar to developed countries in spite of active physical life. The complication rate, operative intervention and hospital stay was more with induction group.

Failed induction of labor and associated factors in Adama Hospital Medical College, Oromia Regional State, Ethiopia

Background:

Failed induction of labor continues to be a public health challenge throughout the world. This failed induction of labor is associated with a higher rate of maternal and fetal morbidity because it increases the unwanted effect of emergency cesarean section. It is also associated with an increased risk of numerous adverse maternal and perinatal outcomes such as uterine rupture, nonreassuring fetal heart rate tracing, postpartum hemorrhage, stillbirth, and severe birth asphyxia. Thus, this study was aimed to assess the failed induction of labor and associated factors in the Adama Hospital Medical College, Oromia Regional State, Ethiopia.

Methods:

A facility-based cross-sectional study was conducted from 1 to 30 December 2020 in Adama Hospital Medical College, Ethiopia. A total of 379 women who underwent labor induction in the Adama Hospital Medical College from December 2019 to November 2020 were enrolled in the study. The participants’ charts were selected using a simple random sampling technique. Data were collected using a pretested and validated structured questionnaire. Descriptive statistics were carried out using frequency tables, proportions, and summary measures. Predictors were assessed using a multivariable logistic regression analysis model and reported using adjusted odds ratio with 95% confidence interval. Statistical significance was considered at a p value <0.05.

Results:

Of 379 induced labor included in the study, the proportion of failed induction was found to be 29.6% (95% confidence interval (25.2, 34.3)). Prelabor rupture of the membrane was found to be the most common indication for induction of labor (46.4%) followed by a hypertensive disorder of pregnancy (21.6%). In the final model of multivariable analysis, predictors such as: nulliparity (adjusted odds ratio = 2.32, 95% confidence interval (1.08, 5.02)), unfavorable cervical status (adjusted odds ratio = 3.46, 95% confidence interval (1.51, 7.94)), prelabor rupture of membrane (adjusted odds ratio = 2.60, 95% confidence interval (1.14, 5.91)), hypertensive disorder of pregnancy (adjusted odds ratio = 3.01;95% confidence interval (1.61, 558)), preinduction membrane status (adjusted odds ratio = 3.63; 95% confidence interval (1.48, 8.86)), and birth weight of greater than 4000 g (adjusted odds ratio = 4.33; 95% confidence interval (1.44, 13.02)) were statistically associated with failed induction of labor.

Conclusion:

The prevalence of failed induction of labor was relatively high in this study area because more than a quarter of mothers who underwent induction of labor had failed induction. This calls for all stakeholders to adhere to locally available induction protocols and guidelines. In addition, pre-induction conditions must be a top priority to improve the outcome of induction of labor.

Failed induction of labor and associated factors among women undergoing induction at University of Gondar Specialized Hospital, Northwest Ethiopia

BACKGROUND

Induction of labor is a process of artificially initiating labor to attain vaginal birth. Despite its vital role in the reduction of maternal mortality, the failure rate of induction and its contributing factors were not well studied in Ethiopia; particularly there was a limited study in the study area. This study aimed to assess the prevalence and factors associated with failed induction of labor among women undergoing induction at University of Gondar Specialized Hospital, Northwest Ethiopia.

METHODS

An institution-based retrospective cross-sectional study was conducted among 743 women undergoing induction at University of Gondar Specialized Hospital. A systematic random sampling method was used to draw a sample and the data were retrieved from the maternity registration books and medical records. Data were cleaned and entered into EpiData version 3.1 and SPSS version 20 used for analysis. Frequencies, proportions, and summary statistics were used to describe the study population and a multivariable logistic regression model was fitted to identify factors contributing to failed induction of labor. Odds ratio with 95% confidence interval computed and level of significance declared at P-value< 5%.

RESULTS

The prevalence of failed induction of labor was 24.4% (95% CI: 21.4, 27.9). Age ≤ 30 years (AOR = 3.7, 95% CI: 2.2,6.2), rural residence (AOR = 3.7, 95% CI: 2.4,5.8), being nulliparous (AOR = 2.1, 95% CI: 1.2,3.7), 5 or less Bishop Score (AOR = 3.4, 95% CI: 2.2,5.4), premature rupture of membrane (AOR = 2.7, 95% CI: 1.5,4.6), having pregnancy-induced hypertension (AOR = 4.0, 95% CI: 2.3,7.1), and artificial rupture of membrane with oxytocin (AOR = 0.2, 95% CI: 0.1, 0.4) were associated with failed induction of labor.

CONCLUSIONS

One-fourth of women undergoing induction at University of Gondar Specialized Hospital had failed induction of labor. Age, residence, parity, bishop score, premature-rupture of the membrane, pregnancy-induced hypertension, and method of induction were independent predictors for failed induction of labor. The combination method of ARM with oxytocin, early detection and treatment of pregnancy-induced hypertension and premature rupture of the membrane are highly recommended for reducing failed induction of labor.

The magnitude of failed induction and associated factors among women admitted to Adama hospital medical college: A cross-sectional study

Introduction

Induction of labor is a medical iatrogenic stimulation of uterine contraction before the spontaneous onset of labor to achieve vaginal delivery. It is an increasingly being done obstetric procedure throughout the world and associated with poorer outcomes when compared with spontaneous labor. The published evidence is limited in Ethiopia including the study area. Therefore, this study was aimed at assessing the magnitude of failed induction and associated factors among pregnant women who were admitted to the labor ward of Adama hospital medical college.

Methods

Institution-based cross-sectional study was conducted among 293 women who were eligible for induction using systematic random sampling. The data were collected from 1st January to 30th April 2020 by face-to-face interview using a structured questionnaire and extraction from a maternal chart. Then data was entered into Epi-data version 4.6 and analyzed using Statistical Product and Service Solution version 23. Descriptive statistics were performed to describe the study population. Logistic regression (bivariate and multivariable) analysis was conducted to identify associated factors. The association was expressed in odds ratio with 95% confidence interval and P-value <0.05 was used as cut-off points to declare significance in the final model.

Results

This study showed that the prevalence of failed induction was 20.5% (95% CI: (15.7–25.3%)). The odds of failed induction in unfavorable bishop score were 4.05 higher than the odds in favorable bishop [AOR = 4.05 95%CI (1.19–13.77)]. The odds of failed induction in an intact membrane were 2.05 higher than the ruptured membrane. [AOR = 2.05, 95%CI (1.06–3.98)]. The odds of failed induction in primigravida were 2.33 higher than the odds in the multiparous women [AOR = 2.33, 95%CI (1.26–4.29)].

Conclusions

This study revealed that the magnitude of failed induction was higher when compared to other similar findings. Bishop scores, membrane status, and parity were significantly associated factors with failed induction. Preparation of the cervix before commencing induction is recommended to improve induction success.

Proportion and Outcome of Induction of Labor Among Mothers Who Delivered in Teaching Hospital, Southwest Ethiopia

Background: Despite the induction of labor (IOL) having had some undesired consequences, it also has several benefits for maternal and perinatal outcomes. This study aimed to assess the proportion and outcome of IOL among mothers who delivered in Teaching Hospital, southwest Ethiopia.

Methods: A retrospective cross-sectional study was conducted from June 10 to June 20, 2019, among 294 mothers who gave birth between November 30, 2018, and May 30, 2019, by reviewing their cards using a structured checklist to assess the prevalence, outcome, and consequences of induction of labor. A binary logistic regression analysis was computed to look for the association between outcome variables and independent variables.

Results: The prevalence of labor induction was 20.4%. The most commonly reported cause of induction was preeclampsia (41.6%). The factors associated with IOL were mothers aged 25–34 years [AOR = 2.55, 95% CI (1.18–5.50)] and ≥35 years [AOR = 10.6, 95% CI (4.20–26.9)], having no history of antenatal care [AOR = 2.12, 95% CI (1.10–4.07)], and being Primipara AOR = 2.33, 95% CI (1.18–3.24)]. Of the 60 induced mothers, 23.3% had failed induction. The proportion of mothers with dead fetal outcomes and maternal complications was 5 and 41.7%, respectively. The unfavorable Bishop Score before induction [AOR = 1.85, 95% CI (1.32–4.87)] and induction using misoprostol [AOR = 1.48, 95% CI (1.24–5.23)] were the factors associated with failed induction of labor.

Conclusion: The prevalence of induced labor was considerably higher than rates in other Ethiopian studies; however, the prevalence of induction failure was comparable to other studies done in Ethiopia. The study found that Bishop's unfavorable score before induction and induction using misoprostol was the factor associated with unsuccessful induction. Therefore, the health professionals should confirm the favorability of the cervical status before the IOL to increase the success rate of induction of labor.

Outcome of induction and associated factors among induced labours in public Hospitals of Harari Regional State, Eastern Ethiopia: A two years' retrospective analysis

BACKGROUND

Induction of labor (IOL) is an essential intervention to reduce adverse maternal and neonatal outcomes. It is also improved pregnancy outcomes, especially in resource-limited countries, where maternal and perinatal mortality is unacceptably high. However, there is a scarcity of evidence regarding the outcome of induction of labor and its predictors in low-income countries like Sub-Saharan Africa. Therefore, this study was aimed at assessing the outcome of induction of labor and associated factors among mothers who underwent labor induction in public Hospitals of Harari Regional State, Estern Ethiopia.

METHODS

A facility-based cross-sectional study was conducted from 1 to 30 March, 2019 in Harari Regional State, Eastern Ethiopia. A total of 717 mothers who underwent induction of labor in public Hospitals of Harari Regional State, Eastern Ethiopia from January 2017 to December 2018 were enrolled in the study. Data were collected using a pretested structured questionnaire. The collected data were entered into Epi-data version 3.1 and exported to SPSS version 24 (IBM SPSS Statistics, 2016) for further analysis. A multivariable logistic regression analysis was performed to estimate the effects of each predictor variable on the outcome of induction of labor after controlling for potential confounders. Statistical significance was declared at p-value <0.05.

RESULTS

Overall, the prevalence of success of induction of labor was 65% [95% CI (61.5, 68.5)]. Pre-eclampsia/eclampsia was found to be the most common indication for induction of labor (46.70%) followed by pre-labor rupture of fetal membrane (33.5%). In the final model of multivariable analysis, predictors such as: maternal age < 24 years old [AOR = 1.93, 95%CI(1.14, 3.26)], nulliparity[AOR = 0.34, 95%CI(0.19, 0.59)], unfavorable Bishop score [AOR = 0.06, 95%CI(0.03, 0.12)], intermediate Bishop score [AOR = 0.08, 95%CI(0.04, 0.14)], misoprostol only method [AOR = 2.29, 95%CI(1.01, 5.19)], nonreassuring fetal heart beat pattern [AOR = 0.14, 95%CI (0.07, 0.25)] and Birth weight 3500 grams and above[AOR = 0.32, 95% CI (0.17, 0.59)] were statistically associated with the successful outcome of induction of labor.

CONCLUSION

The prevalence of successful of induction of labor was relatively low in this study area because only two-thirds of the mothers who underwent induction of labor had a successful of induction. Therefore, this result calls for all stakeholders to give more emphasis on locally available induction protocols and guidelines. In addition, pre-induction conditions must be taken into consideration to avoid unwanted effect of failed induction of labour.

The Magnitude of Failed Induction of Labor and Associated Factors Among Women Delivered at Public Hospitals of Arsi Zone, Southeast Ethiopia, 2020: A Cross-Sectional Study

Background

Failed induction of labor is one challenge in all obstetrics care given all over the world, which increases the incidence and percentage of cesarean sections. It is still a major challenge in both developed and developing countries. This study was significant because it identified the magnitude and associated factors of failed induction of labor.

Objective

To assess the magnitude of failed induction of labor and associated factors among women delivered at public hospitals in the Arsi zone, South East Ethiopia.

Methods

We conducted institutional-based cross-sectional study design in public hospitals in the Arsi zone. We used random-sampling methods, and collected the data using a structured questionnaire and checklist and analysed using a statistical package for social science (SPSS) version 25 software, described and presented data using texts, tables, and charts. We took those variables with a p-value of 0.05 as statistically significant determinants of failed induction of labor.

Results

The magnitude of failed induction of labor was 21.3%. AOR =8.788, 95% CI = (2.884–12.397), maternal residence in urban [AOR=0.356, 95% CI: (0.143–0.886)], multi para 0.390 times less likely than prime para with odds ratio [AOR=0.390, CI: (0.147, 0.632)], Bishop score before induction started 4 [AOR=5.155, CI: 3.062–7.387]. Indications for IOL: PROM more likely than IUGR [AOR=4.158, 95% CI: (2.415, 9.554)], time from start of induction to deliver less than twelve hours [AOR=6.511, 95% CI: (2.477, 10.116)], were statistically significant determinants of failed induction of labor.

Conclusion

Magnitude of failed induction of labor was law in Arsi zone public hospitals when compared to the study done in St. Luke C. Hospital. The factors identified as significantly associated with FIOL in this study were maternal age, maternal residence, prime para, Bishop score four, indications for induction of labor: PROM and post-term pregnancy, and time from the start of induction to deliver, twelve hours.

Predicting factors of failed induction of labor in three hospitals of Southwest Ethiopia: a cross-sectional study

Introduction

Failed induction of labor affects maternal and neonatal outcomes as well as the cost of healthcare, especially in low-resource setting regions in which the prevalence of failed induction is higher despite the incidence of labor induction is low. This study aimed to assess the prevalence of failed induction of labor in southwest Ethiopia.

Method

A hospital-based cross-sectional study was conducted among 441 induced women from March 1 to August 30, 2018. A systematic random sampling technique was used to select study participants. Data were collected using a pretested and structured questionnaire. Bivariable and multivariable logistic regression models were done and fitted to identify predictors of failed induction. An adjusted odds ratio with 95% confidence interval (CI) was calculated to determine the level of significance.

Result

Premature rupture of membrane was the most common cause of labor induction and the commonly used method of labor induction were oxytocin infusion. Cesarean section was done for 28.1% of induced women. Failed induction of labor was found to be 21%. Primiparous [AOR = 2.35 (1.35–4.09)], analgesia/anesthesia [AOR = 4.37 (1.31–14.59)], poor Bishop Score [AOR = 2.37 (1.16–4.84)], Birth weight ≥ 4 k grams [AOR = 2.12 (1.05–4.28)] and body mass index [AOR = 5.71 (3.26–10.01)] were found to be significantly associated with failed induction of labor.

Conclusion

The prevalence of failed induction of labour was found to be high. Preparation of the cervix before induction in primi-parity women is suggested to improve the success of induction. To achieve the normal weight of women and newborns, proper nutritional interventions should be given for women of reproductive age. It is better to use analgesia/anesthesia for labor induction when it becomes mandatory and there are no other optional methods of no- pharmacologic pain management.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03862-x.

Failed induction of labor and its associated factors in Ethiopia: A systematic review and meta-analysis

Introduction

Failed induction increased maternal morbidity and mortality due to the associated complication which comes with cesarean section such as post partum hemorrhage and sepsis. The reports of previous articles on the proportion and associated factor of failed induction were variable and inconsistent. Therefore, this meta-analysis found out that the pooled proportion of failed induction and its associated factors in Ethiopia.

Methods

Systematic search was done by online databases (Pub Med, Web of Science, Google scholar and HINARI, and Ethiopian universities digital libraries). Unpublished studies that are found in the Ethiopian universities’ digital libraries were used for this systematic review and meta-analysis study. Data were entered into Microsoft Excel and then exported to STATA 11 version statistical software for analysis. Heterogeneity assessed using the I² statistic. The pooled proportion of failed induction and the odds ratio (OR) with a 95% confidence interval was showed using forest plots.

Result

The overall proportion of failed induction was 23.58 % (95% CI: 13.72–33.44). Unfavorable Bishop Score [OR = 4.45, 95CI:2.44,8.12 ] intermediate Bishop Score [OR = 8.87, 95CI:4.62,17.05 ] and being primiparous woman [OR = 3.04, 95CI:1.74,5.53 ] were factors associated with failed induction of labour.

Conclusion

The prevalence of failed induction was high in Ethiopia. Unfavorable Bishop Score, intermediate Bishop Score, and primiparous were significantly associated with failed induction. Proper pelvis assessment for Bishop Score will be considered prior to initiating the induction of labor. Beside to this, the health professionals shall be aware of the relevance of cervical ripening for intermediate and unfavorable Bishop Score for pregnant women's before induction of labor.

Health Related Quality of Life Post Labour Induction with Misoprostol Versus Dinoprostone At Muhimbili National Hospital in Dar Es Salaam, Tanzania: A cross Sectional Study

BACKGROUND

Labour induction using Misoprostol or Dinoprostone results to similar maternal and foetal clinical outcomes. However, the clinical outcome measures have rarely been combined with effects of interventions on patients' health related quality of life. This study aimed to assess postpartum health related quality of life of parturient after labour induction with vaginal administration of misoprostol versus dinoprostone.

METHODS

This was a comparative cross sectional study in which pregnant women who underwent labour induction with misoprostol and dinoprostone during the study period were included. Data were collected within 24 hours post-delivery using the 36 item short form health survey questionnaire which consists of 24 attributes distributed in five domains including bodily pains and physical performance three attributes each, mental health seven attributes, general health two attributes, social functioning six attributes and three attributes for labour induction satisfaction. We first estimated scores of all attributes in each domain using Likert scales and then the domain scores were converted into a 0 to 100 scales to express in percentage of total scores. Quality of life was compared in the two study groups using the independent samples T Test. Multivariate regression analysis was performed to control for marital status, gravidity, parity, baseline cervical status, time interval from induction to delivery and mode of delivery.

RESULTS

Women who received misoprostol reported better health related quality of life compared to those who received dinoprostone (mean score 92.89 vs. 87.25;P<.00). Misoprostol group had significantly higher scores in all domains of health related quality of life; reduced bodily pain (93.76 vs. 84.19;P<.00), physical performance (83.64 vs. 73.58;P<.00), mental health (96.40 vs. 93.55; P<.00), general health (93.78 vs. 90.23;P=.01), social functioning (94.81 vs. 91.25;P<.00) and satisfaction perceptions (94.96 vs. 90.71;P<.00).

CONCLUSION

Health related quality of life information is of particular value in routine care of natal and postnatal mothers. Current and updated guidelines should address the impacts of labour induction interventions on maternal health related quality of life, and encourage the use of quality of life information in provision of holistic natal and postnatal care services. Clinical trials are recommended to determine the effectiveness of labour induction with either of the two methods and address the historical adverse outcomes associated to the use of misoprostol.

Prevalence, outcomes and associated factors of labor induction among women delivered at public hospitals of MEKELLE town-(a hospital based cross sectional study)

BACKGROUND

Induction of labor refers to iatrogenic stimulation of uterine contractions before the onset of spontaneous labor as a therapeutic option when benefits of expeditious delivery outweigh the risks of continuing the pregnancy. This research was to study the prevalence, outcomes and associated factors of labor induction among women delivered at Ayder comprehensive specialized hospital and Mekelle general hospital in Mekelle town, Tigray, North Ethiopia.

METHODS

A hospital based cross sectional study was conducted on 346 laboring mothers who delivered after induction of labor, from January 1st, to July 31st, 2017. Using structured questionnaire and quota sampling techniques, all eligible participants were immediately enrolled upon admission until the desired sample size was achieved. SPSS windows version 23.0 was used for analysis and both descriptive and inferential statistics were conducted; statistical significance to declare relationship between the dependent and independent variables was set at p < 0.05.

RESULTS

Total of 3834 women delivered at the study area out of which 346 were induced making (9%) prevalence of induction. Out of this, 244 (70.5%) delivered vaginally, 19 (5.5%) were instrumental deliveries and 83 (24%) by Cesarean section, induction was successful in 263 (76%) while the failure rate was 25 (7.2%). All who failed induction (25) were delivered by cesarean section making a 3.3% contribution of failed induction into the overall rate of the institutions cesarean deliveries during the study period. Prolonged rupture of membranes was the commonest indication and Bishop's score after cervical ripening significantly predicted the success of induction [AOR = 8.150, 95% CI = (1.265, 52.526)].

CONCLUSION

Our prevalence of labor induction is very low compared to the rate of other institutions in developed countries, rate of successful inductions (76%) is slightly higher than the rate of similar institutions in Ethiopia but comparable to the regional rates while failed induction is very low in comparison to both local and regional institutions. Bishop's score significantly predicted the success of induction.

Poor prenatal service utilization and pregnancy outcome in a tertiary health facility in Southwest Nigeria

Introduction

Poor prenatal service utilization is common in developing countries. However, the predictors and pregnancy outcomes of poor utilizers have not been fully examined in our setting.

Methods

Poor and good prenatal service utilizers were compared with respect to demographic characteristics and pregnancy outcomes in Ado-Ekiti, Nigeria.

Results

Poor utilizers were significantly more likely to be single mothers, with unemployed husbands/partners, but less likely to have labour induction compared with good utilizers. Also, the women with fewer than four antenatal visits had significantly more babies with low birth weight (18% versus 9.8%, p = 0.003), and 5-minute Apgar scores less than 7 (17.9% versus 10.1%, p = 0.023). Multivariate regression analysis revealed that having an unemployed husband/partner (adjusted odds ratio (AOR): 2.33; 95% Confidence Interval (C.I.): 1.24 - 4.38; p = 0.009), with low birth weight babies (AOR: 1.66; 95% C.I.: 1.01 - 2.73; p = 0.045), and delivering without induction of labour (AOR: 4.27; 95% C.I.: 2.38 - 7.64; p < 0.001) were independently associated with poor prenatal service utilization.

Conclusion

Efforts devoted to identifying women who are likely to be non- and poor-utilizers of prenatal care are recommended. Scaling up awareness campaigns on maximizing the benefits of prenatal care, increasing the content quality of antenatal visits to give women a positive pregnancy experience and implementing a National Health Insurance package that strategically targets the most socially underprivileged classes are advocated to promote safe motherhood and the objectives of antenatal care.

Induction to delivery interval using transcervical Foley catheter plus oxytocin and vaginal misoprostol: A comparative study at Aminu Kano Teaching Hospital, Kano, Nigeria

Background:

Induction of labor (IOL) is an artificial initiation of labor before its spontaneous onset for the purpose of delivery of the fetoplacental unit. Many factors are associated with its success in postdatism.

Objective:

To compare the induction delivery intervals using transcervical Foley catheter plus oxytocin and vaginal misoprostol, and to identify the factors associated with successful induction among postdate singleton multiparae.

Materials and Methods:

The study was a prospective randomized controlled trial of singleton multiparous pregnant women. They were randomized into two groups, one group for intravaginal misoprostol and the other group for transcervical Foley catheter insertion as a method of cervical ripening and IOL. The data were analyzed using SPSS version 17 computer software (SPSS Inc., IL, Chicago, USA). Comparisons of categorical variables were done using Chi-squared test, with P < 0.05 considered as significant. Student's t-test was used for continuous variables.

Results:

The incidence of postdatism was found to be 136 (13.1%). The mean induction delivery time interval was shorter in the misoprostol group 70 (5.54 ± 1.8 h) than in the Foley catheter oxytocin infusion group 66 (6.65 ± 1.7 h) (P = 0.035). There was, however, no statistically significant difference in the maternal and neonatal outcomes when these two agents were used for cervical ripening and IOL. Higher parity and higher Bishop's score were the factors found to be associated with high success rate of IOL (P < 0.001).

Conclusion:

Vaginal misoprostol resulted in shorter induction delivery time interval as compared to transcervical Foley catheter. High parity and high Bishop's scores were the factors found to be associated with the success of IOL.

Methods for assessing pre-induction cervical ripening

BACKGROUND

Induction of labour is the artificial initiation of labour in a pregnant woman after the age of fetal viability but without any objective evidence of active phase labour and with intact fetal membranes. The need for induction of labour may arise due to a problem in the mother, her fetus or both, and the procedure may be carried out at or before term. Obstetricians have long known that for this to be successful, it is important that the uterine cervix (the neck of the womb) has favourable characteristics in terms of readiness to go into the labour state.

OBJECTIVES

To compare Bishop score with any other method for assessing pre-induction cervical ripening in women admitted for induction of labour.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2015) and reference lists of retrieved studies to identify randomised controlled trials (RCTs).

SELECTION CRITERIA

All RCTs comparing Bishop score with any other methods of pre-induction cervical assessment in women admitted for induction of labour. Cluster-RCTs were eligible for inclusion but none were identified. Quasi-RCTs and studies using a cross-over design were not eligible for inclusion. Studies published in abstract form were eligible for inclusion if they provided sufficient information.Comparisons could include the following.1. Bishop score versus transvaginal ultrasound (TVUS).2. Bishop score versus Insulin-like growth factor binding protein-1 (IGFBP-1).3. Bishop score versus vaginal fetal fibronectin (fFN).However, we only identified data for a comparison of Bishop score versus TVUS.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed the trials for inclusion, extracted the data and assessed trial quality. Data were checked for accuracy.

MAIN RESULTS

We included two trials that recruited a total of 234 women. The overall risk of bias was low for the two studies. Both studies compared Bishop score withTVUS.The two included studies did not show any clear difference between the Bishop score and TVUS groups for the following main outcomes: vaginal birth (RR 1.07, 95% CI 0.92 to 1.25, moderate quality evidence), caesarean delivery (RR 0.81, 95% CI 0.49 to 1.34, moderate quality evidence), neonatal admission into neonatal intensive care unit (RR 1.67, 95% CI 0.41 to 6.71, moderate quality evidence). Both studies only provided median data in relation to induction-delivery interval and reported no clear difference between the Bishop and TVUS groups. Perinatal mortality was not reported in the included studies.For the review's secondary outcomes, the need for misoprostol for cervical ripening was more frequent in the TVUS group compared to the Bishop score group (RR 0.52, 95% CI 0.41 to 0.66, two studies, 234 women, moderate quality evidence). In contrast, there were no clear differences between the Bishop scope and TVUS groups in terms of meconium staining of the amniotic fluid, fetal heart rate abnormality in labour, and Apgar score less than seven. Only one trial reported median data on the induction-delivery interval and induction to active phase interval, the trialist reported no difference between the Bishop group and the TVUS group for this outcome. Neither of the included studies reported on uterine rupture.

AUTHORS' CONCLUSIONS

Moderate quality evidence from two small RCTs involving 234 women that compared two different methods for assessing pre-induction cervical ripening (Bishop score and TVUS) did not demonstrate superiority of one method over the other in terms of the main outcomes assessed in this review. We did not identify any data relating to perinatal mortality. Whilst use of TVUS was associated with an increased need for misoprostol for cervical ripening, both methods could be complementary.The choice of a particular method of assessing pre-induction cervical ripening may differ depending on the environment and need where one is practicing since some methods (i.e. TVUS) may not be readily available and affordable in resource-poor settings where the sequelae of labour and its management is prevalent.The evidence in this review is based on two studies that enrolled a small number of women and there is insufficient evidence to support the use of TVUS over the standard digital vaginal assessment in pre-induction cervical ripening. Further adequately powered RCTs involving TVUS and the Bishop score and including other methods of pre-induction cervical ripening assessment are warranted. Such studies need to address uterine rupture, perinatal mortality, optimal cut-off value of the cervical length and Bishop score to classify women as having favourable or unfavourable cervices and cost should be included as an outcome.