Induction of labour in Unfavourable cervix at Government Maternity Hospital, Tirupathi
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2019, Vol 18, Issue 3
Abstract
Induction of labour is one of the most common obstetric interventions. The incidence of induction varies from setting to setting ranging from 5% to 22% of all labour room admissions and depends upon the institutional protocol1 . Aims: 1.To compare the risk of caesarean delivery after induction of labour in women with unfavourable cervix to that of women with favourable cervix. 2.To compare the efficacy of induction methods used in women with unfavourable cervix. Methodology: This study was performed on 324 mothers,who fulfilled the inclusion criteria mentioned who were admitted to Government Maternity Hospital affiliated to the Department of Obstetrics and Gynaecology,Sri Venkateswara Medical College Tirupathi.The mothers with favourable cervix(Bishop score >=5) were included in Group 1,which consisted of 162 mothers.The mothers with unfavourable cervix (Bishop score <5) were included in Group 2 which were further classified in to 3 sub groups.Group 2A consisted 54 mothers in whom induction was done using Foley catheter.Group 2B consisted of 54 mothers in whom induction was Dinoprost Gel was used as a cervical ripening agent.Group 2C consisted of 54 mothers in whom Tab.Misoprostol was used. Results: The cesarean delivery is 16% in favourable cervix and 29.6% in unfavourable cervix which is statistically significant. The estimated Relative risk for cesarean delivery in unfavourable cervix group is 1.96 times compared to favourable cervix group which is statistically significant. The change in Bishop Score (before and after induction) in Group 2A was 3.31 ± 0.567 ,in Group 2B was 3.08 ± 0.83,in Group 2C was 5.93 ± 1.071 and the change was statistically significant.The change in Bishop score was high in Group 2C and statistically significant. The Induction to Active phase Interval in Group 2A is 7.09 ± 3.638hrs(Range 2.33 - 24.00hours) ,in Group 2B is 8.01 ± 1.412hrs (Range 5.00 - 10.83hours) ,in Group 2C is 8.55 ± 2.707hrs (Range 3.00 - 15.00hours) .Thus Group 2A had shorter Induction to Active phase interval than Group 2B and Group 2C and the difference was statistically significant.The Induction to Delivery Interval in Group 2A is 13.42 ± 3.659 hrs(Range-5.17 - 28.00 hours) ,in Group 2B is 15.42 ± 3.253 hrs (Range-7.00 - 20.50hours) ,in Group 2C is 15.94 ± 5.995 hrs (Range-4.00 – 29.00 hours) .Thus Group 2A had shorter Induction to Delivery interval than Group 2B and Group 2C and the difference was statistically significant. The neonatal complications were higher in Group 2(26%) compared to those in Group 1(16%),but the difference was not statistically significant. The neonatal complications were highest in Group 2C(44.4%) and least in Group 2A(24.1%).The maternal complications were higher among Group 2(10.5%) compared to those in Group 1(9.9%). Maternal complications were highest among Group 2B(13%) and lowest among Group 2A(7.4%). Conclusion: There is a significant increase in the risk of cesarean delivery in induction of labour with unfavourable cervix compared to those with favourable cervix. Induction with Foley catheter found to be effective method in unfavourable cervix in terms of lesser Induction to active phase interval,Induction to delivery interval,neonatal and maternal complications. ,Misoprostol found to be effective in terms of significant change in pre and post induction Bishop scores and lesser cesarean delivery rate.Further research is needed with larger sample size involving different institutions and research on the preventive aspects of cesarean section in unfavourable cervix .
Authors and Affiliations
Dr. G. S. Kumuda, Dr. K. Sunitha
Keywords
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- EP ID EP554802
- DOI 10.9790/0853-1803060114.
- Views 51
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