Evaluation of the Outcomes of the Low-risk Pregnant Women on the Induction of Labour at Full Term Seen at the Kenyatta National Hospital

Abstract

Introduction: In the recent past there has been increased evidence supporting improved birth outcomes with non-medically indicated induction of labour at 39 weeks gestation. These supportive details were established in two recent randomized control trials. However, concerns have been raised as to whether these studies can apply to the focused group in high-income countries vis-à-vis in low-income countries. Induction of labour is among the most common obstetric interventions. In high-income countries, up to 25% of all deliveries at term involve the induction of labour as compared to low-income countries where the rates are generally lower, though, in some settings, they can be as high as those observed in other high-income countries. The World Health Organization (WHO) recommends Induction of labour for women who are known with certainty at 41 weeks (>40 weeks + 7 days) of gestation. In these earlier Randomized Clinical Trials (RCT) of Induction Versus Expectant Management (ARRIVE), reported that mothers who were induced at 39 weeks were prone to a lower rate of cesarean sections compared to those assigned to expectant management (19%: 22%) and therefore had a lower chance of developing pregnancy-induced high blood pressure (9% versus 14%). The American College of Obstetricians and Gynecologists (ACOG) together with the Society of Maternal and Fetal Medicine (SMFM) found out that babies born at or after 39 weeks have the best chance of health outcomes compared to those born before 39 weeks. Little is known on the recommendation of labour induction at full term in low-income countries. Broad Objective: To evaluate the incidence, indications, and outcomes for induced births among low-risk pregnant women at full term at Kenyatta National Hospital. Methodology: A retrospective descriptive cohort research comprising minimal risk pregnant women at full term who underwent induction of labour, aiming to evaluate the incidence, indications of neonatal and maternal results of induction of labour. A sum of 394 women at full-term gestation and eligible were enrolled in the study; they were women admitted from the clinic and in the maternity unit. Data analysis: This was analyzed using SPSS version 23. The incidence of childbirth induction at full period, taking all the women who underwent induction of labour in the study period were the denominator, the socio-demographic and clinical characteristics of patients were described and the perinatal outcomes calculated. Results: The incidence of induction of labour at 39 to 40 weeks + 6 days is 59%. There was less admission to the neonatal unit with less respiratory distress syndrome, meconium aspiration syndrome, asphyxia, umbilical cord related accidents, neonatal resuscitations prevention of macrosomia and foetal distress, all below 10%. There were low hyperstimulation, premature deliveries, and uterine rupture, however, there were high CS rates of more than 96% and failed inductions 67.84% in the maternal arm. Conclusion: The study concludes that IoL at 39 to 40 weeks + 6 days has a high Cs rate, for instance, there were very few deaths all below 5% in both groups.