International Journal of Clinical Obstetrics and Gynaecology

Author(s): Garima Kumari, Kuldeep Poonia and Devika Rani

Abstract: Background: Childbirth is the period from the onset of regular uterine contraction until expulsion of placenta. The process by which this normally occurs is called labour. Induction of labour is the artificial initiation of uterine contraction prior to their spontaneous onset, leading to progressive dilatation and effacement of the cervix and delivery of the baby. Labour induction is indicated where the benefits to either the mother or the fetus outweighs the benefit of continuing pregnancy. The aim and objectives of the study was to study the progress of labour in nulliparous women who are having spontaneous labour and in those with induced labour in terms of augmentation of labour, mode of delivery, neonatal outcome and maternal complication. Methods: Women recruited into the study in labour room of Cosmopolitan hospital. Case recruited when they came for elective induction and controls when they came in spontaneous labour after considering inclusion and exclusion criteria. The study included information after signature of a consent form from the women who came in the labour room for induction of labour during my study period (June 2013- December 2014). Low risk primigravida of age <35 years at 37 weeks to 42 weeks of gestation with elective labour inductions included. Mother and baby followed up after delivery in the wards or in NICU for outcome upto the time of discharge. We studied for the following maternal outcomes: method of induction, mode of delivery, duration and complications of stages of labour, postpartum hysterectomy; admission to the ICU; duration of postpartum stay in hospital; and maternal status at discharge. We assessed the following perinatal outcomes: at 5th minute Apgar score; birth weight; birth injuries; respiratory distress syndrome; admission to the NICU; number of days in NICU; neonatal deaths taking place in hospital within the first week of life; stillbirth or intrauterine death; neonatal jaundice and need for phototherapy. Results: Mean duration of 1^st stage in induced group was 15.33 hours (SD=7.41) and in spontaneous group was 10.73 hours (SD=3.79). Median time was 13 hour for induced group and 10 hour for spontaneous group. This difference was statistically significant (p <0.0001).Mean duration of 2^nd stage in induced group was 1.53 hours (SD=0.94) and in spontaneous group was 1.22 hours (SD=0.51). Median time was 1.5 hours for induced group and 1 hour for spontaneous group. This difference was statistically significant (0.007). Mean duration of 3^rd stage in induced group is 6.21 minutes (SD 5.147) and in spontaneous group is 5.38 minutes (SD 2.675). Median time was 5 minutes for induced group and spontaneous group. This difference was not statistically significant (p = 0.51). 14.8% of induced group had Protracted latent phase compared to 4.9% in spontaneous group. This difference was statistically significant (p=0.017). 9.9% of induced group had meconium stained liquor compared 9.9% of induced group had fetal distress compared 3.7% in spontaneous group. This difference was not statistically significant (p=0.076). 7.4% of induced group had fetal distress compared to 3.1% in spontaneous group. This difference was not statistically significant (P = 0.187). 4.9% of induced group had shoulder dystocia compared to 1.2% in spontaneous group. This difference was not statistically significant (0.097). 61.7% induced patients had normal delivery compared to 87% in spontaneous patients. This difference was statistically significant (p<0.0001). In induced group cesarean section is higher (33.3%) than in spontaneous group (11.1%). This difference was statistically significant (p<0.0001). In induced group ≤7 APGAR SCORE at 1 minute is higher (8.6%) than in spontaneous group (3.1%). This difference was not statistically significant (P = 0.116). It was found that in induced group duration of 1^st stage and 2^nd stage is more than spontaneous group. Induction of labour had higher incidence of protracted latent phase and cesarean section which were statistically significant (<0.05). Conclusions: Duration of 1^st stage and 2^nd stage of labour was significantly longer in induced group compared to spontaneous group. Protracted latent phase and Cesarean section were significantly higher in induced group compared to spontaneous group. Most common indication for cesarean section was protracted latent phase. Complications of 1^st stage other than protracted latent phase, complications of 2^nd stage and 3^rd stage were higher in induced group than in spontaneous group but it was not statistically significant. Neonatal outcome like APGAR SCORE ≤7 at 5 minutes, RDS, Admission to NICU and neonatal jaundice were high in induced group but difference was not statistically significant

DOI: https://doi.org/10.33545/gynae.2018.v2.i3b.78

Pages: 68-72 | 2294 Views | 1058 Downloads

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