Factors and outcomes associated with the induction of labour in Latin America

Abstract

Objective To describe the prevalence of labour induction, together with its risk factors and outcomes in Latin America.Design Analysis of the 2005 WHO global survey database.Setting Eight selected Latin American countries.Population All women who gave birth during the study period in 120 participating institutions.Methods Bivariate and multivariate analyses.Main outcome measures Indications for labour induction per country, success rate per method, risk factors for induction, and maternal and perinatal outcomes.Results Of the 97 095 deliveries included in the survey, 11 077 (11.4%) were induced, with 74.2% occurring in public institutions, 20.9% in social security hospitals and 4.9% in private institutions. Induction rates ranged from 5.1% in Peru to 20.1% in Cuba. The main indications were premature rupture of membranes (25.3%) and elective induction (28.9%). The success rate of vaginal delivery was very similar for oxytocin (69.9%) and misoprostol (74.8%), with an overall success rate of 70.4%. Induced labour was more common in women over 35 years of age. Maternal complications included higher rates of perineal laceration, need for uterotonic agents, hysterectomy, ICU admission, hospital stay >7 days and increased need for anaesthetic/analgesic procedures. Some adverse perinatal outcomes were also higher: low 5-minute Apgar score, very low birthweight, admission to neonatal ICU and delayed initiation of breastfeeding.Conclusions In Latin America, labour was induced in slightly more than 10% of deliveries; success rates were high irrespective of the method used. Induced labour is, however, associated with poorer maternal and perinatal outcomes than spontaneous labour.

Induction of Labor by Prostaglandin: A Review for Indications and Risk for Cesarean Section

“…Dean Leduce and Jarson Gardosi recorded postdates as highest indication for induction of labor [16,40]. Similarly, frequent indication for induction was postdates observed by Guerra et al [10,26,41] Along with postdates, the hypertensive diseases of pregnancy are many times become the main indications for induction of labor [21]. Whereas…”

“…Similarly, Sanchez-Ramos et al observed 80% of indications for post-term pregnancies and rest for pregnancy induced hypertension and PROM [42]. Mozurkewich et al and Abdul and Guerra et al reported both postdated and PROM are the common indications for induction with high-quality evidence from various studies, whereas oligohydramnios was found with moderate evidence [26,43]. The induction of labor is commonly indicated in prevention of prolonged pregnancy, prelabor rupture of membranes after 34 weeks, intrauterine fetal death, placental abruption, chorioamnionitis, and hypertensive disorders as stated by NICE and ACOG [44,45].…”

“…Another frequently cited indication is term premature rupture of membrane [12,13,23,24]. Nevertheless, the hypertensive disorder remains a rare indication, rather this requires induction in higher rate [14,20,21,25,26]. The less frequent indications are oligohydramnios, IUGR, gestational diabetes, fetal distress, macrosomia, fetal death, decreased fetal movement, uncomplicated twins, polyhydramnios, Rh isoimmunization, chorioamnionitis, heart disease, and other fetal indications [9][10][11][12][13][14].…”

Does a policy of earlier induction affect labour outcomes in women induced for postmaturity? A retrospective analysis in a tertiary hospital in the North of England

“…The start time of induction was recorded from the first induction intervention of either insertion of prostaglandins or amniotomy. Secondary outcomes were also investigated in the main sample to consider some adverse maternal and neonatal effects which have been associated with induction (Phillip et al, 2004;Guerra et al, 2009). These included postpartum haemorrhage (estimated blood loss of > 500mls) and admission to newborn intensive care.…”

“…There is also a 5% risk of excessive uterine activity, known as tachysystole, which can reduce placental blood flow resulting in fetal heart rate abnormalities and eventual fetal hypoxia if untreated (Thomas et al, 2014). Observational studies have suggested that induction compared with spontaneous labour is associated with increased risk of caesarean delivery (Ehrenthal et al, 2010), postpartum haemorrhage (Phillip et al, 2004), increased admission to newborn intensive care and increased use of analgesia/anaesthetics (Guerra et al, 2009). However, there are concerns that using spontaneous labour as a comparison group may be inappropriate as this is not a choice available for clinicians and may lead to exaggerated estimates by excluding planned caesarean sections (Danilock et al, 2016).…”