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      Induction of Labour in a District Hospital of Rural Nepal: A Descriptive Cross-sectional Study

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          ABSTRACT

          Introduction:

          Induction of labour, a medical intervention before spontaneous onset, is employed when the risk of continuing pregnancy is elevated.Common indications include intrauterine growth restriction, preeclampsia, gestational diabetes, placental abnormalities, prelabor rupture of membranes, post-term pregnancy, and intrauterine foetal demise. The objective of this study was to find out the prevalence of induction of labour in a rural setting in Nepal.

          Methods:

          We conducted a descriptive cross-sectional study in the District Hospital Tehrathum using patients' record files from 14 January 2021 to 14 January 2023. Ethical approval was obtained from Nepal Health Research Council. Demographic variables were collected along with maternal outcomes which include indication of induction of labour, mode of delivery, indication of lower segment caesarean section and foetal outcomes include APGAR score at one and five minutes, birthweight and liquor colour. A total population sampling method was used in the study and 95% confidence Interval was used to calculate the point estimate.

          Results:

          Among 640 deliveries during the study period 118 (18.43%) (15.43-21.43, 95% Confidence Interval) underwent induction of labour. Sixty-three (53.4%) of the 118 patients who underwent induction of labour were primigravida.

          Conclusions:

          The prevalence of induction of labour was comparable with previous studies. Neonatal outcome, rate of vaginal and lower segment C-section deliveries after induction of labour using misoprostol is comparable with other studies.

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          Most cited references15

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          Methods of induction of labour: a systematic review

          Background Rates of labour induction are increasing. We conducted this systematic review to assess the evidence supporting use of each method of labour induction. Methods We listed methods of labour induction then reviewed the evidence supporting each. We searched MEDLINE and the Cochrane Library between 1980 and November 2010 using multiple terms and combinations, including labor, induced/or induction of labor, prostaglandin or prostaglandins, misoprostol, Cytotec, 16,16,-dimethylprostaglandin E2 or E2, dinoprostone; Prepidil, Cervidil, Dinoprost, Carboprost or hemabate; prostin, oxytocin, misoprostol, membrane sweeping or membrane stripping, amniotomy, balloon catheter or Foley catheter, hygroscopic dilators, laminaria, dilapan, saline injection, nipple stimulation, intercourse, acupuncture, castor oil, herbs. We performed a best evidence review of the literature supporting each method. We identified 2048 abstracts and reviewed 283 full text articles. We preferentially included high quality systematic reviews or large randomised trials. Where no such studies existed, we included the best evidence available from smaller randomised or quasi-randomised trials. Results We included 46 full text articles. We assigned a quality rating to each included article and a strength of evidence rating to each body of literature. Prostaglandin E2 (PGE2) and vaginal misoprostol were more effective than oxytocin in bringing about vaginal delivery within 24 hours but were associated with more uterine hyperstimulation. Mechanical methods reduced uterine hyperstimulation compared with PGE2 and misoprostol, but increased maternal and neonatal infectious morbidity compared with other methods. Membrane sweeping reduced post-term gestations. Most included studies were too small to evaluate risk for rare adverse outcomes. Conclusions Research is needed to determine benefits and harms of many induction methods.
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            Prevalence, outcomes and associated factors of labor induction among women delivered at public hospitals of MEKELLE town-(a hospital based cross sectional study)

            Background Induction of labor refers to iatrogenic stimulation of uterine contractions before the onset of spontaneous labor as a therapeutic option when benefits of expeditious delivery outweigh the risks of continuing the pregnancy. This research was to study the prevalence, outcomes and associated factors of labor induction among women delivered at Ayder comprehensive specialized hospital and Mekelle general hospital in Mekelle town, Tigray, North Ethiopia. Methods A hospital based cross sectional study was conducted on 346 laboring mothers who delivered after induction of labor, from January 1st, to July 31st, 2017. Using structured questionnaire and quota sampling techniques, all eligible participants were immediately enrolled upon admission until the desired sample size was achieved. SPSS windows version 23.0 was used for analysis and both descriptive and inferential statistics were conducted; statistical significance to declare relationship between the dependent and independent variables was set at p < 0.05. Results Total of 3834 women delivered at the study area out of which 346 were induced making (9%) prevalence of induction. Out of this, 244 (70.5%) delivered vaginally, 19 (5.5%) were instrumental deliveries and 83 (24%) by Cesarean section, induction was successful in 263 (76%) while the failure rate was 25 (7.2%). All who failed induction (25) were delivered by cesarean section making a 3.3% contribution of failed induction into the overall rate of the institutions cesarean deliveries during the study period. Prolonged rupture of membranes was the commonest indication and Bishop’s score after cervical ripening significantly predicted the success of induction [AOR = 8.150, 95% CI = (1.265, 52.526)]. Conclusion Our prevalence of labor induction is very low compared to the rate of other institutions in developed countries, rate of successful inductions (76%) is slightly higher than the rate of similar institutions in Ethiopia but comparable to the regional rates while failed induction is very low in comparison to both local and regional institutions. Bishop’s score significantly predicted the success of induction.
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              Labor induction versus expectant management for postterm pregnancies: a systematic review with meta-analysis.

              To compare routine labor induction with expectant management for patients who reach or exceed 41 weeks' gestation. Computerized databases, references in published studies, and textbook chapters in all languages were used to identify randomized controlled trials (RCTs) evaluating induction and expectant management of labor for postterm pregnancies. We identified RCTs that compared induction and expectant management for uncomplicated, singleton, live pregnancies of at least 41 weeks' gestation and evaluated at least one of the following: perinatal mortality, mode of delivery, meconium-stained fluid, meconium aspiration syndrome, meconium below the cords, fetal heart rate (FHR) abnormalities during labor, cesarean deliveries for FHR abnormalities, abnormal Apgar scores, and neonatal intensive care unit (NICU) admissions. The primary outcomes assessed were cesarean delivery rate and perinatal mortality. Sixteen studies met inclusion criteria for this review. For each study with binary outcomes, an odds ratio (OR) with 95% confidence intervals (CIs) was calculated for selected outcomes. Estimates of ORs for dichotomous outcomes were calculated using fixed and random-effects models. Homogeneity was tested across the studies. Compared with women allocated to expectant management, those who underwent labor induction had lower cesarean delivery rates (20.1% versus 22.0%) (OR 0.88; 95% CI 0.78, 0.99). Although subjects whose labor was induced experienced a lower perinatal mortality rate (0.09% versus 0.33%) (OR 0.41; 95% CI 0.14, 1.18), this difference was not statistically significant. Similarly, no significant differences were noted for NICU admission rates, meconium aspiration, meconium below the cords, or abnormal Apgar scores. A policy of labor induction at 41 weeks' gestation for otherwise uncomplicated singleton pregnancies reduces cesarean delivery rates without compromising perinatal outcomes.
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                Author and article information

                Journal
                JNMA J Nepal Med Assoc
                JNMA J Nepal Med Assoc
                J Nepal Med Assoc
                JNMA
                JNMA: Journal of the Nepal Medical Association
                Journal of the Nepal Medical Association
                0028-2715
                1815-672X
                March 2024
                31 March 2024
                : 62
                : 271
                : 170-173
                Affiliations
                [1 ]District Hospital Tehrathum , Myanglung, Tehrathum, Nepal
                [2 ]Nobel Medical College and Teaching Hospital , Biratnagar, Morang, Nepal
                Author notes
                Correspondence: Dr Raju Chapagain, District Hospital Tehrathum, Myanglung, Tehrathum, Nepal. Email: chapagainraju18@ 123456gmail.com , Phone: +977-9840265108
                Article
                10.31729/jnma.8491
                10924475
                f2f71791-ad37-4f4b-a139-432322ea47d4
                © The Author(s) 2018.

                This is an Open-Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Categories
                Original Article

                apgar score,induced,labour,misoprostol
                apgar score, induced, labour, misoprostol

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