Induction of labour for post-term pregnancies at Charlotte Maxeke Johannesburg academic hospital: a one year review
Background: Post-term pregnancy has been associated with adverse maternal and neonatal outcomes. There is controversy regarding optimal management and timing of induction. Objective: To determine maternal and neonatal outcomes of induction of labour (IOL) for post-term pregnancies in a tertiary hospital over one year. Methods: A retrospective review of clinical records of all patients induced for post-term pregnancies in 2018. A total of 137 patients were induced; only 105 files contained the required information. Results: Oral misoprostol was used as the induction agent. Of 105 patients, 61 (58.09%) achieved successful normal vaginal delivery (NVD) and 44 (41.90%) delivered by caesarean section (CS). Eight-four patients (80%) had one cycle of misoprostol and 21 (20%) had two cycles. The greatest number of doses was 24 in 11 patients (10.38%) and the lowest was 2 in six (5.66%). The highest Bishop score (BS) was 5 in 35 patients (33.02%) and the lowest 2 in three (2.83%). The mean time of delivery was 22 hours standard deviation (SD) (16.6) for mothers who had one cycle, and 83.5 (SD 36.6) for those with two cycles. There was no major maternal or neonatal adverse event. Conclusion: IOL with misoprostol is associated with successful NVDs with no major maternal or neonatal adverse events. A high BS, artificial rupture of membranes (AROM) and using syntocinon (synto) were associated with high likelihood of successful delivery. A second cycle of induction resulted in a diminished chance of successful NVD.
A research report submitted in partial fulfilment of the requirements for the degree of Master of Medicine in Obstetrics and Gynaecology to the Faculty of Health Sciences, School of Clinical Medicine, University of Witwatersrand, Johannesburg, 2022