Evaluation of Effectiveness and Safety of pharmacological and mechanical labor induction methods among Pregnant Women attending Public Referral Hospitals in Dar es salaam, Tanzania

Abstract

Background: Induction of labor aims to initiate or accelerate uterine contraction and cervical ripening for spontaneous vaginal delivery (SVD). Currently, balloon catheter, oxytocin and prostaglandin derivatives are the standard modes of labor induction used in Tanzania. However, to our understanding, there is scarcity of information in Tanzania on the effectiveness and safety of the different methods used to induce labor. Objectives: The study aimed to determine the effectiveness and safety of the different modes of labor induction among term and post-term pregnant women at referral hospitals in Dar es salaam. Methods: This was a hospital-based prospective cohort study carried out at referral hospitals in Dar es salaam. The study was conducted from March to June 2021. A total of 322 pregnant women were involved. A case report form (CRF) was used to collect participants' socio-demographic, obstetrics, and clinical characteristics. The primary outcome was the proportion of pregnant women who had SVD within 24 h after labor induction. The secondary outcome respiratory distress, neonatal care, apgar score and blood loss were also collected during 24 hours follow up time. Data were analyzed using a statistical package for social sciences (SPSS) version 23, whereby descriptive statistics were used to summarize study variables. Cox logistic regression analysis was used to show the association between the dependent and independent variables, and p-value of <0.05 was considered as significant. Results: Of the 322 pregnant women enrolled in the study, SVD was 95% in oxytocin, 80% in misoprostol, 80% in balloon catheter and 69% in dinoprostone groups. The median time from induction to SVD was significant with oxytocin compared to other modes of labor induction (5.42 h with p<0.001). Gravidity and comorbidities were significantly associated with SVD (p<0.05). Thirty-six (36%) pregnant women who were exposed to dinoprostone had poor neonatal outcomes (Apgar score <7 at 5 min, RDS) and maternal blood loss (>500 mL) was also highly presented in this group compared to other modes of induction. Conclusion: Induction of labor after exposure to four different modes of induction showed that oxytocin was most effective and safe in inducing labor with the shortest median time compared to misoprostol, dinoprostone and balloon catheter. The desirable maternal and neonatal outcomes were also significant in women who used the oxytocin compared to other modes of induction.