Induction of Labour: A Prospective Study of Drugs, Doses, and Routes

Abstract

This study sought to determine the safety and effectiveness of various pharmacological labour induction techniques, dosages, and administration routes. Prospective study conducted from January 1 2017, to the end of Jan 2019 at the obstetric and gynaecological department at AL Bayda Medical Center. All women admitted for induction of labour who had a singleton pregnancy and a non-scarred uterus in their third trimester. Before induction, cervical ripening was assessed by Bishop score, induction of labour started by the use of dinoprostone, prostaglandin gel, and misoprostol (vaginal, oral). Data collected directly from patients' files and tabulated on the SPSS software program. The study includes 656 women that admitted for induction of labour during a period of two years. The rate of induction of labour was 5.9%. The mean age of women involved in the study was 29.57±5.89 years, and the mean gestational age was 39.8 ±2.2 weeks. Most of the women induced by vaginal misoprostol (90.7%) had successful vaginal delivery, followed by dinoprostone (85.7%), then oral misoprostol (81.8%) and prostaglandin gel (75%) with p-value =0.05. There were significant association between the method used for induction and for induction and number of doses, time needed to achieve delivery. This study shown significant association between the route of administration of misoprostol and Appearance (color), Pulse, Grimace (reflexes), Activity (muscle tone) (APGAR) score at first 5 minutes. There were significant association between the indication of induction and the mode of delivery.  Mode of delivery and maternal and fetal complication not significantly affected by fetal presentation, but the APGAR score was significantly affected by fetal presentation. In conclusion, the most effective and safe pharmacological method of induction of labour was dinoprostone. The safety of vaginal and oral misoprostol was dose-dependent. Bishop's score at the time of induction was a good predictor of successful vaginal delivery. Indication of induction had an impact on the mode of delivery, maternal, fetal, and neonatal complications. Fetal presentation had no impact on mode of delivery, maternal and fetal complications, but fetal presentation had an impact on APGAR score at first 5 minutes.