Induction of labour at a regional hospital in KwaZulu-Natal, South Africa

Abstract

Background. Clinicians working in maternity units must recognise the risks associated with induction of labour (IOL. They need to analyse the indications for IOL, methods used and outcomes on a regular basis to reduce complications.

Objective. To determine the indications for IOL and outcomes of current methods at a regional hospital in rural KwaZulu-Natal, South Africa.

Methods. Clinical data for all patients who had IOL over an 8-month period were collected and analysed.

Results. There were 6 649 deliveries, and of these patients 532 had IOL (induction rate 8.0%); 502 patient files had complete information for analysis. The main indications for IOL were hypertensive disorders (43.6%, n=219), post-dates pregnancy (25.9%, n=130) and pre-labour rupture of the membranes (14.7%, n=74). Other indications accounted for 15.7% of cases (n=79). The most common methods of IOL were oral misoprostol (63.5%, n=319) and vaginal misoprostol (30.3%, n=152). Vaginal deliveries were achieved in 59.8% of patients (n=300), and 40.2% (202) had caesarean sections (CSs); 69.7% of patients (n=350) delivered within 24 hours (this includes CSs and vaginal deliveries). Normal vaginal births within 24 hours accounted for 44.4% of total deliveries (n=223), and CSs within 24 hours for 24.3% (n=122). There were 34 babies (6.8%) admitted to the neonatal intensive care unit. Prematurity accounted for 10 of these admissions (2.0% of all babies), hypoxic ischaemic encephalopathy for 9 (1.8%), and congenital pneumonia for 7 (1.4%). There was 1 early neonatal death.

Conclusion. Current methods of IOL at the rural study site are associated with outcomes similar to those in a report from an urban regional hospital in South Africa.