Determinants of failed induction of labor among induced pregnant mothers in mettu karl hospital oromia regional state, south west, Ethiopia: case control study

Abstract

Background: Induction of labor refers to techniques for stimulating uterine contractions to accomplish delivery prior to the onset of spontaneous labor. It is common obstetric procedure primarily employed when the benefits of delivery outweigh the risks of continuing the pregnancy. Higher rates of induction of labor may also contribute to lowering caesarean section rates without increasing other adverse pregnancy outcome. Minimizing caesarean section rates without increasing other adverse pregnancy outcomes is a priority consideration in low income countries where available resources need to be judiciously utilized Elective induction of labor refers to the initiation of labor for convenience in an individual with a term pregnancy that is free of medical or obstetrical indications. Objective: To Identify Determinants of failed Induction of labor among induced pregnant mothers at Mettu Karl Hospital 2018. Methods: Institutional based case control study was conducted among 270 induced mothers. From which 90 cases (failed induction) and 180 controls(successful induction) were selected by consecutive sampling technique in which the data was collected by structured questionnaire and analyzed by SPSS v. 21 to identify frequency distributions, mean with standard Deviation and multivariate logistic regressionwhich wasused to identify Determinants of failed induction. A 95 %confidence interval and 5% level of precision was utilized to declare presence of association between dependent and independent variables in final model. Result: For a total of 90 cases and 180 controls, Hypertensive disorders of pregnancy was the most common cause of induction in both case (35%) and control (46.7%) groups. post term pregnancy is the second common cause of induction for cases (27.8%) whereas premature rupture of membranes (31.7%) was for controls. Out of 90 cases and 180 controls 75.6% of controls and 83.3% of cases had an unfavorable bishop score. Most of the women 89.4% and 95.6% of controls and cases respectively were induced by oxytocin. During induction process, cervical ripening was done in 72.8 % of controls and in 81.1% of cases with different techniques, of which majority, 66.7 % and 74.4% was with misoprostol for controls and cases respectively. More than half 65.6% of cases and 57.8% of controls were primigravida. Bishop score, AOR=16.813(1.526- 185.226), Gestational age, AOR=15.190 (6.487-35.570) and Duration of labor AOR=15.190 (6.487-35.570) had been shown to be the main predictor of Failed induction. Conclusion and recommendation; The study revealed that BishopScore, Gestational age and Duration of labor had association with failed induction and it recommended to assess the cervical status (using the Bishop score) before induction was commenced and the hospital should have quality assurance programs and induction policies to ensure that inductions are performed in the best possible quality.