Magnitude, factors associated with failed induction of labour through dinoprostone tabs and maternal/fetal outcomes at Muhimbili National Hospital 2020 TO 2022

Abstract

ABSTRACT Background: The methods used in induction of labour (IOL) are both pharmacological and non-pharmacological. Vaginal dinoprostone has been shown as one of the pharmacological agents that are highly effective and successful in IOL even when the cervix is unfavourable. Despite its efficacy and advantages over other methods, cases of IOL failure have been reported in the literature. However, few studies on failed induction with vaginal dinoprostone and its associated factors have been conducted; there is still a scarcity of data in this area for a better understanding in our local settings. Aim of the study: The study assessed the magnitude, factors associated with failed induction of labor through dinoprostone tabs and maternal/fetal outcomes at Muhimbili National Hospital 2020 to 2022. Methods: This was a hospital-based retrospective cohort study conducted at Muhimbili National Hospital (MNH). A simple random sampling method was employed to retrieve patients case files numbers from the electronic database and case notes from medical records office for induced labour from January 2020 to December, 2022 until a sample size of 517 was attained. STATA version 15.1 was used for analysis. Results: A total of 517 pregnant women were enrolled in the study whereby, 69.2% (358/517) were from MNH-Upanga and 30.8% (159/517) from MNH-Mloganzila. An overall cumulative incidence of 33.1% (171/517) of failed induction of labor (FIOL) with vaginal dinoprostone was found and factors such as residence, chronic illness and pregnancy induced hypertension were independently associated with FIOL with vaginal dinoprostone (p<0.05). Also, non-reassurance foetal status, prolonged hospital stay and postpartum haemorrhage were reported as maternal outcomes while admission to NICU, low Apgar score and asphyxia as foetal outcomes. Conclusion: The cumulative incidence of FIOL with vaginal dinoprostone among pregnant women at MNH is high and it is associated with residence, chronic illness and pregnancy induced hypertension. Exploration of these factors and preparation for alternative delivery mode prior to IOL intervention is necessary to reduce adverse pregnancy outcomes related to emergency C/S delivery.