Obstetrics & Gynaecology Forum Volume 29 | Issue 3 | 2019

O&G Forum 2019; 29: 25 - 28 ORIGINAL rupture, post-term and hypertension disorders of pregnancies. 19 In addition, oral and vaginal misoprostol was used for IOL enabling patients to have vaginal deliveries (59.8%) and caesarean section (CS) (40.2%). 19 Mbele et al., (2007) found IOL of 9.6% at Kalafong Hospital in Pretoria over one year (2004-2005). 20 In developed countries, it is estimated that one in four deliveries occur as a result of IOL. 21 Interestingly, the WHO global survey on maternal and perinatal health established that lower rates of IOL are seen in African countries in comparison to Asian and Latin American countries. 22 e WHO recommends the use of oral misoprostol in the dose of 25µg every two hours. 23 Mahatma Gandhi Memorial Hospital (MGMH) in Durban, SA, o en induce labour based on the patients clinical presentation. e induction regimen entails 20µg of misoprostol orally every two hours (four doses) for women with parity of 1 and more. If the patient has not responded 24 hours a er the last dose, the regimen is repeated, up to a maximum of two cycles (i.e. eight doses). However, there are those who will fail to initiate labour but improve their Bishop score allowing for arti cial rupture of membranes (AROM) and oxytocin infusion culminating in a successful vaginal delivery. A failed induction is deemed in someone who did not initiate contractions a er 48 hours of the procedure or failed to improve their Bishop scores for AROM and oxytocin administration, or ends up with a CS for any reason. is study aimed to establish factors associated with a successful IOL with oral misoprostol in term or post-term pregnancies amongst parous women. Methods is retrospective descriptive study was conducted at MGMH, Durban, SA. e study included all obstetric patients 16 years and older with parity ≥1, gestational age of ≥37 weeks with a viable singleton pregnancy and fetus in cephalic presentation who underwent IOL with oral misoprostol from 01 December 2015 to 16 December 2016. e exclusion criteria were induction with methods or drugs other than oral misoprostol, fetus in a non-cephalic presentation and gestation <37 weeks. Nulliparous patients were excluded because the regimen entails vaginal misoprostol administration at the time of the study. From the maternity records, all les belonging to women who had undergone IOL were collected, examined and those who met the criteria were identi ed (Figure 1). Patients’ information was obtained from medical charts which included the demographic details, obstetric history, current pregnancy, IOL details including indications, outcomes, outcomes of IOL and neonatal outcomes. e standard clinical protocol for IOL at the study site was followed as described above. For the purpose of this study, vaginal deliveries were considered as successful IOL and CS as unsuccessful IOL. Ethical approval was obtained from the Biomedical Research and Ethics Committee (BE 300/16) at University of KwaZulu-Natal. Figure 1. Schematic representation of patients included in the study Statistical analysis Descriptive statistics including means, medians, standard deviations, interquartile ranges, frequencies and percentages were used to summarize the results. Statistical analysis was conducted using IBM SPSS so ware, v25 (IBM Corp., Armonk, NY, USA). Statistical signi cance was set at p < 0.05. Results During the study period, there were a total of 7430 deliveries at MGMH and 1082 cases of IOL, resulting in an incidence of 14.6%. Two hundred and five (18.9%) of the 1082 inductions met our inclusion criteria with complete information for analysis. IOL was successful in one hundred and four (104/205 or 50.7%). One hundred and seventy four (n=174) patients were induced solely with misoprostol with 85 (48.9%) achieving a vaginal delivery, which increased to 61.3% for the 19/31 women who required oxytocin infusion. Demographic data Patient demographics are shown in Table 1. The mean (SD) age of the patients was 29.5±5.9 years. Majority of the patients with successful and failed induction occurred in 26-30 years and 31-35 years respectively. The mean (SD) parity was 1.7±0.8. In addition, the mean (SD) of body mass index (BMI) was 30.5±6.4. The mean (SD) gestational age was 39.7±1.6 weeks with the highest proportion (n=71; 34.6%) of the women at 41 weeks of gestational age. Table 1. Patient demographics Variables Number of patients Mean±SD Age (years) Age groups <20 20-25 26-30 31-35 36-40 >40 Ethnicity Black Asian Parity Parity groups 1 2 3 4 BMI BMI groups <18.5 18.5–24.9 25–29.9 ≥ 30 Gestational age at induction (weeks) 37 38 39 40 41 42 205 9 (4.4%) 47 (22.9%) 64 (31.2%) 52 (25.4%) 27 (13.2%) 6 (2.9%) 189 (92.2%) 16 (7.8%) 205 98 (47.8%) 73 (35.6%) 30 (14.6%) 4 (2.0%) 205 0 (0%) 43 (21.0%) 66 (32.2%) 96 (46.8%) 205 27 (13.2%) 33 (16.1%) 26 (12.7%) 31 (15.1%) 71 (34.6%) 17 (8.3%) 29.5±5.9 1.7±0.8 30.5±6.4 39.7±1.6 205 patients induced with oral misoprostol: • ≥ 37 weeks gestation • singleton pregnancy 104 patients with successful IOL (vaginal delivery) • Maternal Factors associated with successful IOL identified • Induction-to-vaginal delivery period determined Maternal factors associated with failed IOL identified 101 patients with failed IOL (caeserean section) OBSTETRICS & GYNAECOLOGY FORUM 2019 | ISSUE 3 | 26