Induction of Labor and Risk for Emergency Cesarean Section in Women at Term Pregnancy

Abstract

Background: Induction of labor has become one of the most common interventions in obstetrics, and because of this we have the increasing number of Cesarean sections. Identifying these risk factors which increase the risk of Cesarean section has become important so that we can induce patients putting them in lower risk of Cesarean section. Cesarean sections should be audited using the obstetrical concepts and parameters for induction of labor.

Methods: A prospective case-control study has been conducted among pregnant women between 37 - 42 weeks of gestation, who were recruited from the labor ward for a period of 1 year. All women enrolled for the study were clinically examined to assess for Bishops score, obstetric scan and cardiotocography (CTG). Induction was done using tab misoprostol 50 µg 6th hourly for a maximum of four doses in 24 h and augmented with oxytocin if required. In our tertiary hospital in Kolar district of Karnataka we decided to conduct a study with a sample size of 178 patients. We assessed the risk factors in term pregnancies and their delivery outcome following induction. Baseline demographic details along with pregnancy risk factors were taken into account. Induction agent as well as induction to delivery interval with those that underwent Cesarean section was also taken into account. Pregnancy outcome was determined.

Results: This study concluded that significant risk factor for Cesarean was primigravida with fetal distress due to oligohydramnios, compared to other risk factors such as preeclampsia, gestational hypertension, post-dated pregnancy and gestational diabetes mellitus. Bishops score prior to induction was < 6. Out of these women 43 underwent Cesarean after induction in view of fetal distress for non reassuring nonstress test (NST). Primigravida had a risk of 4.4 times for Cesarean after induction, and absence of oligohydramnios was a protective factor in the study with odds ratio of 0.2.

Conclusions: Induction of labor at term has reduced the number of Cesarean sections in our study with a single risk factor.




J Clin Gynecol Obstet. 2019;8(1):17-20
doi: https://doi.org/10.14740/jcgo433w