Factors associated with failed induction of labour at the University Teaching Hospital, Lusaka

Abstract

Background: Induction of labour (IOL) is the artificial initiation of labour before its spontaneous onset for the purpose of delivery of the fetoplacental unit. It is done when the benefits of delivery outweighs continuing with pregnancy.Objective: to identify factors associated with failed induction of labor at UTH, Lusaka.Methodology: a cross sectional study conducted at the UTH, Lusaka. Data was collected on all women undergoing IOL at UTH who met the criteria of a live singleton pregnancy with gestation age of 28weeks or more and cephalic presentation from 3rd June to 13th September 2013 who provided informed consent. Various demographic and clinical information constituted independent variables and the dependent variable was mode of delivery. Dependent variable was mode of delivery. Data was entered in excel and analysed in SPSS. Multiple logistic regression analysis was used to determine factors independently associated with failure of IOL.Results A total number of 5892 deliveries were conducted during the period 3rd June 2013 to 13th September 2013 of which 156 were for IOL giving an induction rate of 2.65%. Of the 156, 127 met eligibility criteria and were analysed. The main indication for IOL was hypertensive disorders (69.3%), PROM (15%), and post dates (12.6%). The main method used was misoprostol (91, 71.7%) and a combination of misoprostol and subsequent oxytocin in 28 cases (22%). In two cases, only oxytocin was used and in the other six cases, only a catheter. The failed induction rate (i.e. failure to achieve vaginal delivery after induction) was 13.4%. Not having misoprostol as part of regimen was found to be independently associated with a failure of IOL, though nulliparity, presence of ruptured membranes and a Bishop’s score of <3 were not. Conclusions: Induction of labour does not always result in a vaginal delivery and if unsuccessful requires a caesarean section. Not having misoprostol as part of regimen was independently associated with a failed induction of labour.