Indications, methods and outcome of induction of labor at Muhimbili national hospital, Dar es salaam, Tanzania

Abstract

Background: Induction of labor is the process of initiating uterine contractions before the onset of spontaneous contractions in order to achieve vaginal delivery. Induction of uterine contractions leads to progressive effacement and dilatation of the cervix and birth of the baby. This includes both women with intact membranes and women with spontaneous rupture of membrane but who are not in labour. The different methods used for Induction of labour are mechanical surgical and pharmacological. Induction of labour includes a pre induction Bishop’s assessment, of which scores of seven and above indicates a favorable cervix and scores less than seven indicates an unfavorable cervix. Objectives: To determine indications, methods and outcome of induction of labor at Muhimbili National Hospital. Methodology: This was a hospital based retrospective descriptive study conducted from July 2014 to January 2015, at Muhimbili National Hospital, Dar-es-salaam involving 120 pregnant women. All women who meet the inclusion criteria with indications for induction of labor with gestation age 29 weeks and above were included in the study. The variables of interest included socio-demographic characteristics, obstetric history, and medical history, indication for induction of labour, maternal and neonatal outcomes. Data were collected by means of structured data collection tool. Data cleaning was followed by analysis using SPSS version 20. Demographic data and categorical variables were summarized into frequencies, means, standard deviations, proportions and cross tabulations. Data was presented in tables. Results: The total number of deliveries during the period of study was 5,373 out of which total of 120 women underwent induction of labour . This gave a rate for induction of labor of 2.3%. Mean maternal age was 28.72 (SD 5.47) years and the median gestational age was 38.76 (28-42) completed weeks. The main indications for induction of labour were postterm pregnancy 60 (50%), hypertensive disorders of pregnancy 38 (31.7%), premature rupture of membranes 21(17.5%).Out of these women, 74 (61.7%) had spontaneous vaginal delivery and 46 (38.3%) had emergency caesarean section deliveries. The common complication observed in the mothers was failed induction of labour. The neonatal outcome constituted all live births. The neonates admitted in neonatal ward for further management were 10 (8.3%). Mean induction delivery interval was 16.00(SD 11.15) hours. The most common method used for induction of labor was pharmacological method using vaginal dinoprostone with intravenous oxytocin. Conclusion: Induction of labor is safe and beneficial as there were minimal maternal and neonatal complications. Post-dated pregnancy accounted for the majority of indications for induction of labour at term at MNH. Recommendation: Further studies should be done to compare the best method of induction of labour. To encourage more induction of labour together with vigiliant monitoring of women during the process of induction and during labour, including a cardiotocograph.