Obstetrics & Gynaecology Forum Volume 29 | Issue 3 | 2019

O&G Forum 2019; 29: 25 - 28 ORIGINAL Table 2. Indication for induction of labour Indications Total number Total successful inductions Successful inductions (%) Post-date pregnancy 86 47 54.7 Post-term pregnancy 15 7 46.7 Bad obstetrical history 12 4 33.3 Hypertensive disorders of pregnancy 48 18 37.5 Chronic hypertension 3 1 33.3 Diabetes (chronic and gestational) 11 3 27.3 Pre-labour rupture of membranes 20 15 75 Reduced liquor 9 8 88.9 Prolonged latent phase 1 1 100 Table 5. Neonatal outcome Neonatal details Vaginal delivery Caesarean section Gender Male Female Apgar scores Good Poor Birthweight (grams)(±SD) 57 47 104 0 3250.3±478.6 59 42 98 3 3287.2±470.04 Table 4. Comparison of maternal variables in successful and failed induction of labor with oral misoprostol Variable Successful induction Failed induction p -value Correlation coefficient (r) p -value Age (years) 28.9±5.9 30.08±5.9 0.15 0.19 0.78 Parity 1.7±0.7 1.8±0.9 0.32 0.13 0.14 Body mass index 29.2±5.7 31.9±6.8 0.002* 0.142 0.04* Gestational age (weeks) 39.8±1.6 39.6±1.8 0.40 0.008 0.90 Table 3. Number of doses of misoprostol for induction Number of doses Number (n=205 ) Number failed (%) (n=101; 49.3%) Number Successful (%) (n=104; 50.7%) 1 9 (4.4) 6 (5.9) 3 (2.9) 2 22 (10.7) 4 (3.9) 18 (17.1) 3 3 (1.5) 0 (0) 3 (2.9) 4 76 (37.1) 32 (31.7) 44 (41.9) 5 4 (2.0) 2 (1.9) 2 (1.9) 6 2 (1.0) 1 (0.9) 1 (0.9) 7 3 (1.5) 0 (0) 3 (2.9) 8 86 (42.0) 56 (55.4) 30 (28.6) Indication for IOL Post-date pregnancy, hypertensive disorders of pregnancy and pre- labour rupture of membranes were the major indications for IOL. Other indications found in our study are also listed (Table 2). Dosage regimen of misoprostol The mean (SD) number of doses of misoprostol was 5.4±2.4 for all patients. Patients with successful induction, had a mean (SD) number of misoprostol doses of 4.8±2.3 compared to 6.0±2.4 amongst those who were unsuccessful (Table 3). Sixty five percent (65.4%) of the successful inductions required up to four doses, compared to success rate of 37.8% when additional doses were required. Comparison between the maternal variables in successful and failed inductions with oral misoprostol There was a significant difference in BMI in patients with successful induction compared to those with failed induction (29.2±5.7 vs 31.9±6.8; p =0.002). Also, a highly significant correlation between BMI and dose of misoprostol (r=0.142; p =0.04) was seen. The higher the patient’s BMI, the more doses of misoprostol was required for IOL. All other comparisons were non-signi cant (Table 4). Mode of delivery and indications for caesarean deliveries One hundred and four (50.7%) patients had normal vaginal deliveries and 101 (49.3%) patients had caesarean deliveries. irty nine (38.6%) of CS were for patients who failed to respond to oral misoprostol and were delivered by elective CS. Whereas 62 (61.4%) had emergency CS. Of the emergency CS, n=62, 45 (44.6%) were for fetal distress and 17 (16.8%) for cephalopelvic disproportion. Labour duration and time interval from induction to vaginal delivery e mean (SD) duration of labour was 442.2±242.2 minutes (n=146), with the mean (SD) time interval from IOL to delivery of 30.9±29.1 hours. Fi y ve (52.9%) delivered within 24 hours and 27 (49.1%) of the 55 patients delivered within 12 hours. Maternal outcomes ere were no major maternal complications related to IOL during the study period. No maternal deaths or uterine rupture was documented. ere was poor documentation of uterine hyperstimulation. However, 8 patients had their entire labour process lasting less than 3 hours. In these patients, labour duration ranged from 50 minutes to 168 minutes in keeping with precipitous labour. e hyperstimulation rate was 3.9% (8/205) as indicated by the number of women who experienced precipitous labour. In 4 patients, the entire labour duration lasted between 3 and 4 hours. Ten (4.9%) patients su ered postpartum haemorrhage due to uterine atony but no surgical intervention was required. ere was no major genital trauma that required repair in theatre in this study. Neonatal outcomes A total of 3 (1.5%) babies had low 1 and 5 minute Apgar scores warranting NICU admission. All babies with low Apgar scores were delivered by CS. Majority of babies delivered had a good Apgar score (Table 5). Approximately 94.64% and 99.5% of the babies had 1-minute and 5-minute Apgar scores of at least 7 respectively, indicating the safety of misoprostol use for IOL. Apgar scores of less than 7/10 at 1 minute and 5 minutes were described as poor while those 7 and above were de ned as good. OBSTETRICS & GYNAECOLOGY FORUM 2019 | ISSUE 3 | 27