Fetomaternal outcomes for mothers undergoing labor induction at term at Moi Teaching and Referal Hospital, Eldoret, Kenya

Abstract

Background: Failed induction is an important reason for rising caesarian section worldwide. Global rates of induction of labor are rising and vary from 9.5 to 35.6 percent of all pregnancies. Women whose labor is induced have an increased incidence of caesarean delivery, chorioamnionitis, varied duration of labor, and risk of nonreassuring fetal status compared with those in spontaneous labor. There is limited local data on induction of labor and associated fetomaternal outcomes. The Quality health outcomes model was used in the study as a theoretical framework. Broad Objective: To determine the Fetomaternal outcomes for mothers undergoing labor induction at Moi Teaching and Referral hospital, Eldoret, Kenya. Methodology: A descriptive cross sectional study was done after IREC approval. Participants were sampled consecutively to achieve the calculated sample size and data collected using a semi-structured questionnaire. Singleton term pregnancies presenting in cephalic were included. Mothers with contraindications to vaginal delivery were excluded. Data was entered into an Excel database and analysis done with SPSS 17. Results: A total of 384 gravidas who met the inclusion criteria were treated according to protocol between July 2013 and May 2014; 185 (48%) were nulliparas and 199 (52%) were parous, average ANC visits were 3.6, average age was 26 years and the Bishops scores were poor(3). The leading indication for induction was post-term pregnancy at 58.6% (225/384). Sixteen percent of nulliparas and 10% of parous women were delivered by caesarean. The overall caesarean section rate was 12.8 %( 49/384). The mean duration of labour induction/cervical ripening to delivery time was 18 hours. The longest induction/cervical ripening-delivery time was 75hrs and the shortest was 5hrs. The mean 5 minute Apgar score was 9. Thirteen neonates (3%) were admitted to new born unit due to Respiratory distress syndrome. Of the thirteen 3 (2.3%) died within 72hrs. Of the neonates admitted to NBU, 76.9% had cervical ripening/induction to delivery time lasting more than 48hrs. Conclusion: The commonest reason for induction is post-term pregnancy. The mean induction to delivery time is 18 hours. The overall caesarean section rate following induction at MTRH is 12.8 %. The mean 5 minute Apgar score was 9. Fetal outcomes were poor for cervical ripening/induction to delivery time lasting more than 48hrs. Cervical ripening/induction of labour for all indications with poor Bishop Score is good. Recommendations: MTRH to continue use of existing protocol on induction in view of the current outcomes. The cervical ripening/labor induction to delivery interval should not exceed 48 hours. There is need for a comparative study to compare fetomaternal outcomes for spontaneous and induced labor.