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Cheng TS, Zahir F, Carolin SV, Verma A, Rao S, Choudhury SS, Deka G, Mahanta P, Kakoty S, Medhi R, Chhabra S, Rani A, Bora A, Roy I, Minz B, Bharti OK, Deka R, Opondo C, Churchill D, Knight M, Kurinczuk JJ, Nair M. Risk factors for labour induction and augmentation: a multicentre prospective cohort study in India. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 25:100417. [PMID: 38757059 PMCID: PMC11097080 DOI: 10.1016/j.lansea.2024.100417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/10/2024] [Accepted: 04/23/2024] [Indexed: 05/18/2024]
Abstract
Background Guidelines for labour induction/augmentation involve evaluating maternal and fetal complications, and allowing informed decisions from pregnant women. This study aimed to comprehensively explore clinical and non-clinical factors influencing labour induction and augmentation in an Indian population. Methods A prospective cohort study included 9305 pregnant women from 13 hospitals across India. Self-reported maternal socio-demographic and lifestyle factors, and maternal medical and obstetric histories from medical records were obtained at recruitment (≥28 weeks of gestation), and women were followed up within 48 h after childbirth. Maternal and fetal clinical information were classified based on guidelines into four groups of clinical factors: (i) ≥2 indications, (ii) one indication, (iii) no indication and (iv) contraindication. Associations of clinical and non-clinical factors (socio-demographic, healthcare utilisation and lifestyle related) with labour induction and augmentation were investigated using multivariable logistic regression analyses. Findings Over two-fifths (n = 3936, 42.3%, 95% confidence interval [CI] 41.3-43.3%) of the study population experienced labour induction and more than a quarter (n = 2537, 27.3%, 95% CI 26.4-28.2%) experienced augmentation. Compared with women with ≥2 indications, those with one (adjusted odds ratio [aOR] 0.50, 95% CI 0.42-0.58) or no indication (aOR 0.24, 95% CI 0.20-0.28) or with contraindications (aOR 0.12, 95% CI 0.07-0.20) were less likely to be induced, adjusting for non-clinical characteristics. These associations were similar for labour augmentation. Notably, 34% of women who were induced or augmented did not have any clinical indication. Several maternal demographic (age at labour, parity and body mass index in early pregnancy), healthcare utilization (number of antenatal check-ups, duration of iron-folic acid supplementation and individuals managing childbirth) and socio-economic factors (religion, living below poverty line, maternal education and partner's occupation) were independently associated with labour induction and augmentation. Interpretation Although decisions about induction and augmentation of labour in our study population in India were largely guided by clinical recommendations, we cannot ignore that more than a third of the women did not have an indication. Decisions could also be influenced by non-clinical factors which need further research. Funding The MaatHRI platform is funded by a Medical Research Council Career Development Award (Grant Ref: MR/P022030/1) and a Transition Support Award (Grant Ref: MR/W029294/1).
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Affiliation(s)
- Tuck Seng Cheng
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Oxford University, Oxford, UK
| | - Farzana Zahir
- Department of Obstetrics and Gynaecology, Assam Medical College, Dibrugarh, Assam, India
| | - Solomi V. Carolin
- Department of Obstetrics and Gynaecology, Makunda Christian Leprosy and General Hospital, Karimganj, Assam, India
| | - Ashok Verma
- Department of Obstetrics and Gynaecology, Dr Rajendra Prasad, Government Medical College, Kangra, Tanda, Himachal Pradesh, India
| | - Sereesha Rao
- Department of Obstetrics and Gynaecology, Silchar Medical College and Hospital, Silchar, Assam, India
| | - Saswati Sanyal Choudhury
- Department of Obstetrics and Gynaecology, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Gitanjali Deka
- Department of Obstetrics and Gynaecology, Tezpur Medical College, Tezpur, India
| | - Pranabika Mahanta
- Department of Obstetrics and Gynaecology, Jorhat Medical College and Hospital, Jorhat, Assam, India
| | - Swapna Kakoty
- Department of Obstetrics and Gynaecology, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam, India
| | - Robin Medhi
- Department of Obstetrics and Gynaecology, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam, India
| | - Shakuntala Chhabra
- Department of Obstetrics and Gynaecology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | - Anjali Rani
- Department of Obstetrics and Gynaecology, Banaras Hindu University Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
| | - Amrit Bora
- Department of Obstetrics and Gynaecology, Sonapur District Hospital, Assam, India
| | - Indrani Roy
- Department of Obstetrics and Gynaecology, Nazareth Hospital, Shillong, Meghalaya, India
| | - Bina Minz
- Department of Obstetrics and Gynaecology, Sewa Bhawan Hospital Society, Chattisgarh, India
| | - Omesh Kumar Bharti
- State Institute of Health and Family Welfare, Department of Health & Family Welfare, Government of Himachal Pradesh, India
| | - Rupanjali Deka
- MaatHRI Project, Srimanta Sankaradeva University of Health Sciences, Guwahati, Assam, India
| | - Charles Opondo
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - David Churchill
- Department of Obstetrics and Gynaecology, The Royal Wolverhampton NHS Trust, UK
- Research Institute for Healthcare Science, University of Wolverhampton, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Oxford University, Oxford, UK
| | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Oxford University, Oxford, UK
| | - Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Oxford University, Oxford, UK
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Chua JYX, Choolani M, Lalor JG, Yi H, Chong YS, Shorey S. Perceptions of healthcare professionals regarding labour induction and augmentation: A qualitative systematic review. Women Birth 2024; 37:79-87. [PMID: 37718194 DOI: 10.1016/j.wombi.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Labour induction and augmentation procedures are commonly used in maternity units with or without medical indications. Research shows that healthcare professionals play a significant role in women's childbirth decisions. AIM To consolidate healthcare professionals' perceptions about labour induction and augmentation. METHODS Seven electronic databases were searched from their inception dates till January 2023: PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus, ProQuest Dissertations, and Theses Global. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis and Sandelowski and Barroso's guidelines guided this review. Included studies' quality was appraised by the Critical Appraisal Skills Program tool. Data were thematically synthesised. Review findings were assessed using the Grading of Recommendations Assessment, Development, and Evaluation-Confidence in the Evidence from Reviews of Qualitative research approach. FINDINGS Three main themes were identified from the 17 included studies: 1) Making sense of the phenomenon, 2) Two sides of the coin, and 3) The enlightened path ahead. DISCUSSION Healthcare professionals' labour induction and augmentation decisions were affected by personal (knowledge and moral philosophies), and external factors (women, community members, colleagues, and healthcare institutions). Some clinicians were unfamiliar with the proper labour induction/augmentation procedures, while others were worried about their decisions and outcomes. CONCLUSION Suggestions for improvement include conducting labour induction/augmentation training for clinicians, having sufficient resources in facilities, and developing appropriate labour induction/augmentation clinical guidelines. Women and their partners, community members, and traditional healers could benefit from receiving labour induction/augmentation education. To improve health outcomes, healthcare professionals could deliver woman-centred care and collaborate.
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Affiliation(s)
- Joelle Yan Xin Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mahesh Choolani
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | | | - Huso Yi
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yap Seng Chong
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Pirnar Ž, Jager F, Geršak K. Characterization and separation of preterm and term spontaneous, induced, and cesarean EHG records. Comput Biol Med 2022; 151:106238. [PMID: 36343404 DOI: 10.1016/j.compbiomed.2022.106238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/30/2022] [Accepted: 10/22/2022] [Indexed: 12/27/2022]
Abstract
To improve the understanding of the underlying physiological processes that lead to preterm birth, and different term delivery modes, we quantitatively characterized and assessed the separability of the sets of early (23rd week) and later (31st week) recorded, preterm and term spontaneous, induced, cesarean, and induced-cesarean electrohysterogram (EHG) records using several of the most widely used non-linear features extracted from the EHG signals. Linearly modeled temporal trends of the means of the median frequencies (MFs), and of the means of the peak amplitudes (PAs) of the normalized power spectra of the EHG signals, along pregnancy (from early to later recorded records), derived from a variety of frequency bands, revealed that for the preterm group of records, in comparison to all other term delivery groups, the frequency spectrum of the frequency band B0L (0.08-0.3 Hz) shifts toward higher frequencies, and that the spectrum of the newly identified frequency band B0L' (0.125-0.575 Hz), which approximately matches the Fast Wave Low band, becomes stronger. The most promising features to separate between the later preterm group and all other later term delivery groups appear to be MF (p=1.1⋅10-5) in the band B0L of the horizontal signal S3, and PA (p=2.4⋅10-8) in the band B0L' (S3). Moreover, the PA in the band B0L' (S3) showed the highest power to individually separate between the later preterm group and any other later term delivery group. Furthermore, the results suggest that in preterm pregnancies the resting maternal heart rate decreases between the 23rd and 31st week of gestation.
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Affiliation(s)
- Žiga Pirnar
- Faculty of Computer and Information Science, University of Ljubljana, Večna pot 113, 1000 Ljubljana, Slovenia
| | - Franc Jager
- Faculty of Computer and Information Science, University of Ljubljana, Večna pot 113, 1000 Ljubljana, Slovenia.
| | - Ksenija Geršak
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; University Medical Center Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
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