A Comparison of Misoprostol and Dinoprostone Gel for Induction and Cervical Ripening

Introduction: Labour induction at term is a universal conventional obstetric interference with an objective to stimulate uterine contractions artificially to attain a spontaneous vaginal delivery. The current study was aimed to compare the efficacy and safety profile of low dose vaginal Misoprostol with Dinoprostone gel for induction of labour in term pregnancies with unfavorable cervix and intact membranes. Methodology: This Randomized Controlled Trial was conducted among pregnant women with term pregnancy with obstetrical or medical indication for induction of labour after institutional ethical committee approval. A detailed history, complete physical examination and investigations were done for all patients. Result: Misoprostol and Dinoprostone gel are equally effective inducing agents. Both are equally effective in Primigravida and Multigravida. Failure of induction rate for Misoprostol and Dinoprostone was statistically not significant. The need of Oxytocin augmentation, maternal complication rate, NICU admission rate, caesarean section rate and occurrence of meconium-stained liquor are statistically not significant in both the study groups. Our study was unable to demonstrate superiority of any single drug compared to other. Only the difference is cost, induction with Conclusion: considering the easy to preserve and administer, we recommend use of Misoprostol as a safe, effective, cheaper, and more convenient drug for induction of labour.

MATERNAL AND FOETAL OUTCOMES IN SPONTANEOUS VERSUS INDUCED LABOUR- A CROSS SECTIONAL STUDY

Introduction: Induction of labour is the artificial initiation of labour before its spontaneous onset for the purpose of delivery of the foetoplacental unit. The purpose of this study was to determine whether the current practice of elective labour induction was associated with differences in mode of delivery, demand for pain relief and foetal outcomes when compared with labour of spontaneous onset. Methods And Materials: This cross-sectional study carried out on 100 pregnant women with singleton pregnancy between 37 and 41 weeks of gestation with cephalic presentation delivering in labour room. This study included two groups: Electively induced (50) and spontaneous group (50). Results: In electively induced group 44% had normal vaginal delivery and 6% had instrumental delivery. With spontaneous labour, 78% had normal vaginal delivery and 4% had instrumental delivery. Postpartum hemorrhage (PPH) was 20% in electively induced group and 6% in the spontaneous group (p-0.038).Apgar scores, mean birth weights were comparable. Analgesia demand was 22% in the electively induced group when compared to 6% in the spontaneous group. Conclusion: The present study emphasizes that elective induction of labour in nulliparous women with a single cephalic presentation is associated with increased risk of caesarean section, which is predominantly related to an unfavorable cervix. Hence, elective induction is safe and efficacious. Caesarean delivery rate was more due to nulliparity or unfavorable cervix not due to elective induction itself.

Induction of labour practices at Botshabelo District Hospital: Assessing the institutional guidelines

Induction of labour (IOL) is defined as an artificial stimulation administered to initiate the delivery process before the onset of spontaneous labour. Setting-adapted guidelines need to be developed to promote safe maternal and neonatal care in line with the needs of a specific institution. This study aimed to describe and assess the current IOL practices at Botshabelo District Hospital, focusing on incidence, indications, induction methods, complications, and outcomes. A retrospective-descriptive study included all relevant data from IOL cases over six months between July and December 2017. From 168 attempted inductions of labour, 153 files were retrieved. The majority of cases (69.7%) were for post-dates. Normal vaginal delivery (NVD) was achieved in most patients (69.3%), while one patient had an assisted delivery. Thus, 30.1% of inductions failed and required caesarean sections. The incidence, indications, methods of induction, complications, and outcomes of IOL in BDH are in line with international guidelines; however, including the sweeping of membranes at term and balloon catheters as methods could improve the current guidelines.

Maternal and neonatal outcome in pregnancy bbeyond 41 Weeks of Gestation: Observational study

Background: Pregnancy beyond term is associated with adverse maternal and perinatal outcome. The aim of the study was to estimate the maternal and perinatal outcome in pregnancies at and beyond 41weeks of gestation. It was a prospective study of 140 patients with pregnancy beyond Methodology:41weeks fulfilling the eligibility criteria and admitted and delivered in department of obstetrics and gynaecology at a tertiary care hospital. We examined its association with following outcomes: age, parity, genetic factors, bishop's score at admission, mode of delivery, induction rate, meconium stained amniotic fluid, oligohydramnios, perinatal and neonatal morbidity, perineal tear, postpartum haemorrhage, maternal morbidity and mortality etc. Results:Out of 140 patients, majority was the age group of 21-25 years, 68 (48.6%) patients were primigravida while 72 (51.4%) patients were multigravida. Maximum patients 65% were not in labour whereas 35% were in labour. In 51 (36.4%) patients mode of delivery was caesarean section, in which most common indication being foetal distress in 25.5% followed by meconium stained amniotic fluid in 17.6%. In present study perinatal morbidity like stillbirth, RDS were 2.86% & 25.8% respectively. Maternal morbidity like PPH, tear and wound infection were 4.31%, 6.4%, 0.7% respectively. Conclusions: With Regular antenatal check-up, incidence of post term pregnancy can be decreased and labour induction should be considered at 41weeks to prevent maternal and perinatal complications.

Study of maternal and fetal outcome in pregnancy beyond 40 weeks: a prospective observational study at a tertiary institute

Background: Prolonged pregnancy is one that exceeds 42 0/7weeks. Management of prolonged pregnancy is very challenging in modern obstetrics.Methods: It is prospective observational study in department of Obstetrics and Gynecology, Shri B.M Patil medical college and Research center, deemed to be University, Vijayapur, North karnataka. Study period was from January 2018 to January 2019.Results: Total of 186 pregnant women were included in the study. Results in terms of age, gravidity, gestational age, time of induction, mode of delivery, neonatal outcome and maternal complications.Conclusion: Pregnancies beyond 40 weeks require early detection, effective fetal monitoring and proper planning of labour. In pregnancies beyond 40 weeks, decision of induction should be taken cautiously as early induction leads to failure of induction and increased rates of lower (uterine) segment Caesarean section (LSCS), while delayed induction leads to increased fetal complications.

Efficacy and safety of intracervical Foley’s in women receiving sublingual misoprostol for induction of labour: a randomized controlled trial

Background: Induction of labour can be carried out by medical or mechanical methods, used alone or in combination. This study is to evaluate the efficacy and safety of intracervical Foley’s in women receiving sublingual misoprostol for induction of labour.Methods: We randomized 230 primi gravidae at ≥37 weeks of gestation, with singleton pregnancy, cephalic presentation requiring induction, with Bishop score ≤4 using block randomization into study and control groups. Both groups received 50 µg sublingual misoprostol every fourth hourly till active labour was achieved or upto a maximum of 6 doses. The study group was induced simultaneously with intracervical Foley catheter.Results: Mean induction to labour interval in study and control groups was 11.191±7.14 hours and 11.758±6.26 hours while mean induction to delivery interval was 17.502±7.93 hours and 18.275±7.66 hours respectively with no significant difference between the groups (p=0.522 and 0.453). More women in study group than in the control (51.3% versus 33.9%) were in active labour within ten hours of induction (p=0.001). Caesarean section rate was 23.5% and 19.1% in study and control groups (p=0.497), the most common indication being foetal distress. Secondary outcomes like foetal heart rate abnormalities, oxytocin requirement were comparable between the two groups. APGAR scores and NICU admission rate were similar in both groups. There was no significant maternal or neonatal morbidity.Conclusions: Though there was no significant reduction in induction to labour or delivery interval with synchronous use of sublingual misoprostol and Foley’s, there was no increase in the complications encountered.

Comparative study of oral mifepristone and endocervical prostaglandin-E2 gel as pre-induction cervical ripening agents in parturition

Background: Intracervical instillation of prostaglandin E2 is a well-known and widely practiced method of pre-induction cervical ripening. Mifepristone, due to its anti-progesterone action has been found to be a potential cervical ripening agent. This study was conducted to compare the safety, efficacy and outcome of these two drugs in pre-induction cervical ripening.Methods: One hundred antenatal women were recruited for the study; 50 in mifepristone arm and 50 in PG-E2 gel arm. Any singleton term pregnancy in vertex presentation with intact membranes and bishop’s score of <4 was included in the study. Any contraindication for vaginal delivery and any contraindication for mifepristone or PG-E2 were considered as exclusion criteria. Participants in the mifepristone arm were given tablet mifepristone 200 mg orally and those in PG-E2 gel group received endocervical instillation of PGE2 gel 0.5 mg, two doses 6 hours apart (if necessary). Induction of labour was considered successful if the parturient delivered within 48 hours of administration of mifepristone or first dose of PG-E2 gel, with or without labour augmentation with oxytocin. Delivery after 48 hours and caesarean delivery were considered unsuccessful induction.Results: There was a significant improvement in bishop’s score in mifepristone group 5.0±1.55 as compared to PG-E2 gel group 3.64±2.14; p value 0.001.Conclusions: Oral administration of 200 mg mifepristone is a safe, effective and convenient alternative to intracervical instillation of prostaglandin-E2 gel for pre-induction cervical ripening.

Study of maternal and fetal outcome in postdate pregnancy in tertiary care hospital

Background: Fetal, neonatal and maternal complications associated with pregnancy beyond 40 weeks have always been underestimated. However emerging evidence demonstrates that the incidence of complications increases after 40 weeks of gestation. The present study was conducted to find out the fetomaternal outcome of such prolonged pregnancy.Methods: This was a prospective cross-sectional study of 70 patients with uncomplicated prolonged pregnancy fulfilling the inclusion and exclusion criteria and admitted in department of obstetrics and gynecology at a tertiary care hospital B. J. Medical College, Ahmedabad, Gujarat, India.Results: Out of 70 patients, majority of the subjects belongs to 26-30 years of age (50%). The gestational age of 90% of patients were between 40-42 weeks. About 42-44% of the foetus had a birth weight of 2.5-3.5 kgs. Maximum patients underwent vaginal deliveries in spontaneous group (57%) and 64% underwent LSCS in induced group. Mode of delivery is significantly associated with presence of adequate liquor.Conclusions: With regular antenatal check-up, incidence of postdate pregnancy can be decreased and it is important because of definite risk to fetus as pregnancy continuing beyond 40 weeks of gestation is associated with increased perinatal morbidity and mortality especially those who do not come for regular antenatal check-up.

Oral misoprostol solution in comparison to vaginal misoprostol for induction of labour in a randomized controlled trial

Background: With more than 15% of all gravid women requiring prostaglandins in cervical ripening and labour induction. However, evidence is not clear about the preferred route or dose of the drug. So, this study was designed with objectives to compare the induction delivery interval and safety of titrated oral misoprostol solution with vaginal misoprostol for labour induction in term primigravida women.Methods: This randomized controlled clinical trial was conducted on a total of 100 patients randomly selected among primigravida at term women undergoing induction of labour for obstetric or medical indication for labour induction in Ain Shams University Maternity Hospital. They were divided into two Groups: Group I: patients undergoing induction of labour using misoprostol oral solution and Group II: patients undergoing induction of labour using vaginal misoprostol.Results: Oral misoprostol solution has less induction delivery duration and less side effects than vaginal misoprostol. The induction-delivery time with the oral route compared to the vaginal one (15.2 versus 20.3 hours respectively) with significant p-value (<0.001).Conclusions: Titrated oral misoprostol is safe and effective for labour induction in primigravida patients with unfavorable cervix.

Comparative Study of Vaginal Misoprostol and Intracervical Dinoprostone Gel for Induction of Labour.

Induction of labour is an intervention to artificially stimulate uterine contractions leading to progressive dilation and effacement of cervix. This results in delivery of foetus before the onset of spontaneous labour. Dinoprostone gel and Misoprostol are commonly used drugs for cervical ripening. We wanted to compare the efficacy and safety of Dinoprostone with Misoprostol for cervical ripening and induction of labour in women with unfavourable cervix. METHODSThis is a prospective study conducted among 200 antenatal women who required induction of labour for different indications. 100 patients with an indication for induction were given 25 mcg of intravaginal misoprostol and repeat dose up to a maximum of 3 doses every 4 hours as needed. The other 100 patients were given 0.5 mg of intracervical dinoprostone gel and repeated for a maximum of 3 doses every 6 hours as needed. Progress of labour was monitored. Bishop score was determined. RESULTSPostdatism was the most common cause of induction (45% and 58%) in both the groups. The difference in values of mean induction delivery time in both primipara and multipara was not significant statistically for both the drugs. Study showed that the number of caesarean sections was significantly (p value 0.028) reduced with the use of misoprostol for induction of labour. The most common indication for operative delivery was foetal distress (11% in the misoprostol group and 17% in the dinoprostone group). Maternal and foetal complication rate in both the groups was similar. CONCLUSIONSCaesarean rate was significantly less with intravaginal misoprostol group compared to dinoprostone group. Other factors had no statistical significance. Vaginal misoprostol is thus a better option for induction of labour.

A comparative study of the effect of induction of labour with vaginal misoprostol versus prostaglandin E2 gel on the incidence of pathological cardiotocography tracing

Background: The objective of the present study was to compare the two most commonly used agents for induction of labor-vaginal misoprostol and intracervical dinoprostone gel in terms of the incidence of cardiotocography (CTG) abnormalities and its correlation with fetal distress and fetomaternal outcome.Methods: This is prospective case-control study conducted in department of obstetrics and gynecology, RIMS, Ranchi over a period of 15 months. 112 women requiring induction were randomly assigned to two groups of 56 each, Group M received vaginal misoprostol and Group D received intracervical dinoprostone E2 gel. 56 women with spontaneous labor served as control group. Groups were compared in terms of the incidence of suspicious or pathological CTG tracings, fetal distress, induction to vaginal delivery time, vaginal delivery rates, dose requirements, rate of emergency cesarean.Results: Misoprostol was associated with shorter induction to delivery time (9.54 hours) than dinoprostone gel (13.54 hours), higher vaginal delivery rates (80.35% versus 62.5%), higher delivery rates (73.9%) with single dose itself unlike Group D, where 47.22% required more than one dose. Incidence of suspicious CTG was higher in group M (15.68%) versus 10.25% in Group D. Incidence of pathological CTG was also highest in Group M (7.8%) followed by Group D (2.56%) and Group C (7.8%). Dinoprostone gel lead to failed induction in 25% women, and hence higher caesarean rates.Conclusions: While misoprostol is a better agent for induction when compared with dinoprostone E2 gel in terms of induction-delivery time, higher vaginal delivery rates, less dose requirement, it is associated with greater incidence of non-reassuring/pathological CTG. There was justified improvement in perinatal outcome due to preparedness beforehand with use of CTG.

A comparative study of vaginal misoprostol versus oral misoprostol for induction of labour

Background: Induction of labour defined as artificial initiation of uterine contractions before the onset of spontaneous labour, after the period of viability, by any methods. The successful outcome depends on the Bishop Score, maternal age and parity. Authors compared the most preferred two routes; vaginal and oral for induction and outcome, adverse events and side effects were noted.Methods: This was a prospective comparative study carried out at SVPIMSR, Ahmedabad, from January 2019 to June 2019, Gujarat, 100 patients who required induction were randomly divided in two groups- Group A received 25µg oral misoprostol, Group B - received 25µg vaginal misoprostol repeated 4 hourly up to maximum five doses in both groups. The induction to delivery interval, mode of delivery, maternal and neonatal outcome and complications were observed.Results: The mean induction to delivery interval was less in vaginal group than oral (18.7 hours in vaginal versus 22.4 hours in oral). Vaginal delivery and caesarean section rates were comparable in both groups. 60% patients in Group A required more than two doses as compared to 36% in Group B. No major complications or adverse events were observed.Conclusions: Both oral misoprostol in a dose of 25μg and vaginal misoprostol 25μg every four hours, to a maximum of five doses, have safety and efficacy for induction. With The vaginal route, delivery occurs in less time and few doses required as compared to oral.

A comparative study of misoprostol oral versus vaginal route for induction of labour

Background: Induction of labour at term is a common obstetric intervention. Prostaglandin E2 has been the agent of choice for pre-induction of cervical ripening for several decades. In recent time, prostaglandin E1 analogue (misoprostol) is a preferred new agent for pre-induction cervical ripening and labour induction owing to inexpensive, stable in room temperature, administrable through several routes. The ideal dose, route, and frequency of administration of misoprostol are still under investigation.Methods: A double blind parallel group placebo control randomized clinical trial was done in the department of obstetrics and gynecology of Agartala Govt. Medical College among 130 pregnant women those required induction of labour. In this clinical trial, the women were allocated by lottery to receive oral misoprostol (25 μg) and vaginal placebo (same dosage) or vaginal misoprostol (25 μg) and oral placebo (same dosage. Both active and placebo drug (25 mcg) were repeated at 4 hours. interval till the parturient reached active labour (not exceeding 5 doses). Both primary (induction delivery interval) and secondary outcomes (failed induction, vaginal/caesarean delivery rate, maternal and foetal complications) were statistically analyzed.Results: The mean induction delivery interval (primary outcome) differences were insignificant among both groups (oral versus vaginal). Success rate of induction (56.9% versus 75.4%), mean dosage (misoprostol 90.5 mcg versus 96 mcg) requirement, maternal and foetal complications was indifferent among two groups. The rate of vaginal delivery (within 24 hours of induction) was significantly higher when misoprostol was used through vaginal route. Caesarean section rate trends to be higher when misoprostol was administered orally.Conclusions: Low dose of misoprostol (25 mcg) offer an additional statistically significant clinical advantage in successful vaginal delivery when used vaginally.

Evaluation of induction of labour in a tertiary care hospital

Background: The objective is to evaluate the preferred methods for labor induction, including incidence of caesarean section, operative and normal vaginal delivery rate, need for oxytocin augmentation, and Apgar score at 1 and 5 min.Methods: This was a hospital-based study carried out in 110 inductions of labour during the study period. misoprostol 50 mcg was inserted in posterior fornix of vaginal in cases with PROM and intracervical 0.5 mg Dinoprostone for other causes in whom induction was decided. Maternal and neonatal outcomes were observed. collected data were analyzed using SPSS and MS excel.Results: Most preferred methods of induction of labour were observed to be Dinoprostone and Misoprostol, augmentation was done by oxytocin. normal delivery rate was 54% in Dinoprostone gel and 58.3% in misoprostol group. Caesarean and operative vaginal delivery rates were 42.8%, 3% in Dinoprostone gel group and 33.3%, 8.3% respectively in misoprostol group. Mean Apgar scores were observed to be similar in both methods of induction at 1st and 5th minutes.Conclusions: It was found that misoprostol had higher percentage of normal and operative vaginal delivery and need for oxytocin augmentation than Dinoprostone. Neonatal outcome as predicted by Apgar score were similar in both groups.

Oxytocin versus Misoprostol used as an induction of labour in term in early rupture of Amniotic membranes

Background: Pre labor Rupture of membranes is a common obstetrical problem, significant event as it transforms an ordinary pregnancy into a high risk one. Majority of cases of PROM - of about 60% occur after 37 completed weeks Induction of labour is artificial. Misoprostol is receiving attention as a cervical modifier and labour induction agent. This study compares the safety and efficacy of Misoprostol with Oxytocin in labour induction in term pre labour rupture of membranes. Objective of this study was to compare the safety and efficacy of Misoprostol with that of Oxytocin in labour induction in PROM. The effects were compared between primipara and multipara in a selected sample.Methods: General condition is assessed by pulse rate, blood pressure, height, weight with particular attention to pedal odema, anemia. Cardiovascular and respiratory systems were examined, rule out cephalo pelvic disproportion and for Bishop’s scoring. USG for foetal maturity, Liquor status and for foetal well-being. Admission CTG.Results: There is no significant difference was observed between two groups either in vaginal delivery or in incidence of LSCS. Mean induction delivery interval in misoprostol group for nullipara is 8.5 hours. For multipara it is 6.6 hours. And in oxytocin group for nullipara is 10:4 hours. In multipara it is 6.5 for primipara it was significantly reduced in misoprostol group compared to syntocinon group.Conclusions: Misoprostol is an effective, cheap, safe, stable at room temperature and easy to use if it is used in appropriate dosage for induction of labour in pre-labour rupture of membranes at term.

Maternal and fetal outcomes with the use of prostaglandins E2 as a cervical ripening agent for induction of labour

Background: In modern medicine induction of labour is required in patients for a good feto-maternal outcome. PGE2 is a prostaglandin analogue which has been used as a cervical ripening agent to improve bishops score. Objective of this study was to evaluate the efficacy of intravaginal PGE2 gel as a cervical ripening agent in unfavourable cervix for induction of labor and any complications associated with its use.Methods: This study comprised of 90 women who required labor induction. Singleton pregnancy above 37 weeks, live intrauterine fetus, Cephalic presentation, Bishop score of 1-6, reactive FHR pattern were included. Women who required only single induction were categorized as Group 1. Those requiring more than one dose after reassessment of bishops scoring at 6, 12 and 18 hours belonged to Group 2.Results: Group1 had more of younger population below 30 years consisting more primigravidas with > 80% women having gestational age of > 39 weeks. Most common indication for induction of labour in both groups was post-dated pregnancy. 65 patients received one dose of cerviprime gel forming Group 1. In Group 2, 72% received 2 doses and 28%, 3 doses of gel. Initial bishops score mean was 4.2 in Group 1 and 4.1 in Group 2. Mean change in bishop score was analysed after 6, 12, and 18 hours of instillations of PGE2 gel. Significant p value was obtained in all groups requiring one, two and three doses of gel. In Group 1, 12.3% and in Group 2, 16% had LSCS. Maternal side effects were minimal and neonatal outcome was good.Conclusions: The study showed that intravaginal application of PGE2 is effective, safe and acceptable method as a cervical ripening agent for labor induction in women with poor bishops score. It reduces caesarean delivery rate without increasing maternal and neonatal morbidity.

Induction of labour at term: 25 mcg 2 hourly oral misoprostol or 6 hourly intracervical cerviprime, safety and efficacy

Background: There are various methods for induction of labour, both mechanical and pharmacological. Prostaglandins in induction have been commonly used. Studies have been done using vaginal and sublingual use of misoprostol. This study analyses efficacy of both oral misoprostol used in low frequent doses as per FIGO 2017 guidelines and intracervical prostaglandins for induction of labour.Methods: A total 159 consecutive pregnant term mothers with singleton pregnancy, intact membranes and unfavorable cervix were subdivided into two subgroups, first subgroup was administered 25 mcg oral misoprostol at 2 hourly interval and those in subgroup B were given intracervical PGE2. Both these subgroups were prospectively followed to assess efficacy in induction of labour at term and outcome in foetus and mother. Statistical analysis was done using chi square test.Results: It was found that the induction to delivery interval was significantly lesser in the cerviprime group (19.31 hours) compared to the misoprostol group (25.19 hours). However, there was no significant difference in the rate of vaginal delivery and mean duration of labour, rates of caesarean section, maternal and neonatal complications in both the groups. More women in the cerviprime group required augmentation with oxytocin. However, on comparing the cost of induction as per the mean doses used, the cost of induction with misoprostol was much lesser than that of cerviprime use.Conclusions: Oral use of Tab. misoprostol was not more efficacious than the use of cerviprime gel in induction of labour.

Induction of Labour Audit At Labasa Hospital – From December 2017 to July 2018

Introduction@#Induction of labour is carried out worldwide for a broad range of maternal and foetal indications, so as to improve pregnancy outcomes. The various methods of induction have different success rates and there is preferential use of the different modes by institutions, regions and countries. Induction of labour in Fiji is only carried out in the three divisional hospitals. This study was carried out to review the induction rate, methods used, indication and the outcomes of induction of labour in Labasa hospital.@*Methods@#A retrospective study of cases of induced labour at Labour ward, Labasa Hospital, Fiji, between December 1, 2017 and July 31, 2018 was carried out. This is also the first study to be done in Labasa Hospital in regards to induction of labour. Data was collated from the maternity and delivery records from the medical records department.@*Results@#Out of the 1436 deliveries recorded in the study period, 131 (9.1%) of patients had induction of labour. The methods of induction used included misoprostol (58.1%), syntocinon (with amniotomy) (13.7%), foleys (3.4%), misoprostol + syntocinon (12%), misoprostol + foleys (3.4%), Foleys + syntocinon (3.4%) and lastly misoprostol + foleys + syntocinon (6%). Postdatism was the commonest indication for labour at 36.8%. Seventy percent of induced parturients had successful induction of labour that led to vaginal deliveries. Misoprostol had the highest success rate at 75%. A little over half of participants, 63 (53.8%) booked in the second trimester and 21 (17.9%) participants booked late.@*Conclusion@#Induction of labour is a safe and effective means of expediting delivery for the benefit of either the mother or the baby. Despite discrepancies in dosages and combination of methods used by different obstetricians, the outcome generally is positive. A larger population study that includes the other two divisional hospitals would give us more feedback on induction of labour.

Maternal factors affecting outcome of induction of labour

Background: Induction of labour is a common procedure in modern obstetrics and accounts for 20% among all deliveries. This study aims to assess the factors associated with success/failure of induction of labour.Methods: This is a cohort study involving 220 women who underwent induction of labour in the department of obstetrics and gynaecology, MGMCRI from December 2016 to May 2018. After obtaining informed consent, patients were recruited into the study. Maternal parameters like age, parity, gestational age, BMI, Bishop score, indication of induction, method of induction, mode of delivery, maternal complications and neonatal parameters like Apgar score, birth weight and NICU admission were analyzed. Association of all parameters with mode of delivery was done by chi square test or Fisher exact test.Results: Out of 220 women who were induced, vaginal delivery rate was 56.4%. Vaginal delivery rate was high in young women of age 20-25 years (65.2%), multiparous women (65.1%), gestational age of > 40-42 weeks (64.7%), with normal BMI (67.7%), with Bishop score ≥ 5(94.6%), induced for PROM and postdates (68.6%) and induced with single agent (74%). Most common indication of caesarean section was fetal distress (43.7%) followed by meconium stained liquor (30.2%). There were no adverse perinatal outcomes.Conclusions: Women of age 20-25 years, normal BMI and induced with single agent showed statistically significant successful induction of labour.

Evaluation of Outcomes after Implementation of Induction of Labour Protocol at the Georgetown Public Hospital Corporation

Objective:To evaluate the incidence of failed induction of labour (FIOL), and determined whether this resulted from non-adherence to the induction of labour protocol.Design and Methods:This study was a retrospective cohort analysis of all term patients who underwent induction of labour from 1st January to 30th June 2018. Materials:GPHC IOL protocol, inpatient charts, nurses and theatre log books, electronic handing over records, Microsoft Excel, Word and www.medcalc.org/calc/odds_ratio.php.Results:They were 388 patients induced that met the eligibility criteria outlined, 298 were included in the study while 90 were excluded because of failure to locate the patient records. 77,5% ofthe term patients induced achieved spontaneous vaginal delivery and 21,8% delivered by cesarean section, the nulliparous patients had a higher incidence of cesarean delivery at 33,1% (P=0,0514), compared with the multiparous patients 10,6% (P=0,0158). Therate of FIOL was 10,4% (31 patients). 48,4% of these diagnosis were not in accordance with the labour induction protocol (P=<0,0001).Conclusions:The incidence of FIOL was 10,4%, of which 48,4% was not in accordance to the protocol. Standardization of management and adherence to the labour induction protocol decreases the time to delivery and cesarean section rate. Recommendations:The diagnosis of FIOL should be made in accordance with the international guidelines adapted by GPHC’s induction protocol.