Determinants of successful labor induction in a teaching hospital in Nigeria: a 10-year review

Okunola, Temitope Omoladun; Bola-Oyebamiji, Sekinat Bolanle; Sowemimo, Oluwaseun; Ajenifuja, Kayode Olusegun

doi:10.1590/1806-9304202300000228-en

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Revista Brasileira de Saúde Materno Infantil

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 23 • 2023 • https://doi.org/10.1590/1806-9304202300000228-en copy

Determinants of successful labor induction in a teaching hospital in Nigeria: a 10-year review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to evaluate the success rate of labor induction and determinants of successful outcome.

Methods:

retrospective cohort study of parturients that undergone labor induction between 2006 and 2015. Data was retrieved from the medical records and multivariate logistic regression was used to evaluate the determinants of successful labor induction.

Results:

the rate of labor induction was 10.9%. Out of the 940 women analysed, six hundred and fifty-six women (69.8%) had successful vaginal delivery. Labor induction at 39-40 weeks (OR=2.70; CI95%=1.17-6.36), 41 weeks (OR=2.44; CI95%=1.14-5.28), estimated fetal weight between 2.5 and 3.4kg (OR=4.27, CI95%=1.96-5.59) and estimated fetal weight of 3.5-3.9kg (OR=5.45; CI95%=2.81-10.60) increased the odds of achieving vaginal delivery.

Conclusions:

our findings suggest that 39, 40 and 41 weeks are optimal gestational ages for labor induction with respect to successful vaginal delivery. Also, estimated fetal weight between 2.5kg and 3.9kg favours successful vaginal delivery.

Key words:
Cesarean section; Gestational age; Labor induction; Vaginal delivery

Characteristics	N	%
Age (years)	18	1.9
≤19	114	12.1
20-24	326	34.7
25-29	342	36.4
30-34	140	14.9
≥35
Marital status
Single	29	3.1
Married	911	96.9
Booking status
Booked	747	79.5
Unbooked	193	20.5
Schooling level
No formal schooling	65	6.9
Primary schooling	183	19.5
Secondary schooling	383	40.7
Higher education	309	32.9
Parity
0	582	61.9
1	149	15.9
2	101	10.7
3	78	8.3
≥4	30	3.2
Indications of labor induction
Postdated pregnancy	340	36.2
Pre-labor rupture of membranes	322	34.3
Hypertensive disorders of pregnancy	66	7.0
Intrauterine growth restriction	94	10.0
Intrauterine fetal death	66	7.0
Others	52	5.5
Methods of labor induction
Amniotomy	96	10.2
Oxytocin	194	20.7
Oxytocin and amniotomy	66	7.0
Foley’s catheter	80	8.5
Prostaglandin E1 analogue	504	53.6
Labor induction Interval (hours)
<3	32	3.4
3-12	860	91.4
>12	48	5.2
Complications
None	654	69.6
Postpartum Hemorrhage	246	26.2
Retained placenta	20	2.1
Uterine hyperstimulation	20	2.1

Factors	Vaginal delivery (N=656)		Cesarean section (N=284)		OR (CI95%)	p
Factors	n	%	n	%	OR (CI95%)	p
Age group (years)
≤19	18	100.0	0	-	0.00 (0.00)	0.44
20-24	54	47.4	60	52.6	0.75 (0.36-1.57)	<0.001
25-29	244	74.8	82	25.2	0.19 (0.11-0.35)	<0.001
30-34	282	82.5	60	17.5	0.28 (0.15-0.53)	<0.001
≥35	58	41.4	82	58.6	Ref	Ref
Booking status
Booked	505	67.6	242	32.4	Ref	Ref
Unbooked	151	78.2	42	21.8	0.65 (0.38-1.10)	0.11
Indications
Postdated Pregnancy	270	79.4	70	20.6	Ref	-
PROM	183	56.8	139	43.2	0.1 (0.03-0.34)	0.06
Hypertensive disorders	34	51.5	32	48.5	0.25 (0.06-1.04)	0.03
IUGR	64	68.1	30	31.9	0.24 (0.07-0.90)	1.00
IUFD	66	100.0	0	-	1.00 (0.27-3.89)	1.00
Others	39	75.0	13	25.0	1.00 (0.19-5.29)	<0.001
Induction agent
Misoprostol	418	82.9	86	17.1	Ref	-
Oxytocin	136	70.1	58	29.9	1.20 (0.48-2.97)	0.69
Oxytocin+Amniotomy	46	69.6	20	30.4	6.56 (3.20-13.40)	<0.001
Amniotomy	40	41.7	56	58.3	0.34 (0.29-5.14)	0.22
Foley’s catheter	16	20.0	64	80.0	0.69 (0.14-23.70)	0.28
Estimated Gestational Age (weeks)
<34	88	74.6	15	25.4	Ref	-
34-36	6	23.1	10	76.9	3.63 (0.48-8.16)	0.97
37-38	76	65.5	20	34.5	6.46 (0.93-45.40)	0.98
39-40	132	61.7	41	38.3	2.54 (0.44-3.86)	0.29
41	300	79.4	78	20.6	2.07 (0.67-98.71)	0.47
≥42	54	61.4	34	38.6	6.32 (0.57-16.32)	0.82
Parity
0	459	78.9	123	21.1	Ref	-
1	100	67.1	49	32.9	1.67 (0.95-2.98)	0.08
2	47	46.5	54	53.5	4.07 (2.21-7.52)	<0.001
3	39	50.0	39	50.0	3.23 (1.62-6.44)	0.001
≥4	11	36.7	19	63.3	8.48 (2.43-28.48)	0.001
Labor induction interval (hours)
<3	31	96.9	1	3.1	Ref	-
3-12	602	70.0	258	30.0	1.00 (0.54-1.98)	0.92
>12	23	47.9	25	52.1	0.12 (0.01-0.03)	<0.001
Estimated fetal weight (kg)
<2.5	84	85.7	14	14.3	Ref	-
2.5-3.4	220	78.0	62	22.0	8.26 (0.98-32.12)	0.07
3.5-3.9	318	78.3	88	21.7	6.09 (0.37-13.44)	0.91
≥4	34	22.1	120	77.9	2.04 (0.74-13.61)	0.76
Baby’s weight (kg)
<4	648	71.1	263	28.9	5.72 (1.73-18.91)	0.001
≥4	8	27.6	21	72.3	Ref	-
Apgar score at 1^st minute
<7	163	91.6	15	8.4	1.57 (1.46-1.69)	<0.001
≥7	493	64.7	269	35.3	Ref	-
Apgar score at 5^th minute
<7	96	92.3	8	7.7	1.49 (1.33-1.82)	<0.001
≥7	560	67.0	276	33.0	Ref	-
Neonatal intensive care admission
Yes	110	84.0	21	16.0	1.26 (1.08-3.92)	0.001
No	546	67.5	263	32.5	Ref	-

Predictors	OR (CI95%)	Adjusted OR (CI95%)	p
Induction agent
Misoprostol	Reference	Reference	-
Oxytocin	0.83 (0.34-2.07)	0.13 (0.04-1.93)	0.22
Oxytocin+Amniotomy	0.18 (0.05-1.13)	0.52 (0.14-1.96)	0.37
Amniotomy	0.11 (0.06-2.24)	0.09 (0.04-1.72)	0.34
Foley’s catheter	0.15 (0.08-0.31)	0.24 (0.15-5.48)	0.11
Estimated gestational age (weeks)
<34	0.23 (0.02-1.66)	0.11 (0.08-11.75)	0.36
34-36	0.17 (0.05-0.64)	0.32 (0.27- 6.38)	0.15
37-38	0.97 (0.45-2.12)	3.89 (0.97-15.64)	0.06
39-40	2.50 (1.30-4.82)	2.70 (1.17-6.36)	0.03
41	2.06 (1.05-4.03)	2.44 (1.14-5.28)	0.02
≥42	Reference	Reference	-
Estimated fetal weight (kg)
<2.5	2.04 (0.36-8.26)	4.26 (0.55-4.62)	0.44
2.5-3.4	2.47 (1.38-4.42)	4.27 (1.96-5.59)	0.001
3.5-3.9	3.36 (1.93-5.83)	5.45 (2.81-10.60)	0.001
≥4	Reference	Reference	-
Labor induction interval (hours)
<3	1.74 (0.41-6.62)	4.15 (0.72-7.18)	0.30
3-12	1.66 (1.11-2.48)	2.32 (0.13-4.03)	0.42
>12	Reference	Reference	-

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[1] Associated Editor: Alex Sandro Souza