Gynecology & Obstetrics
Open Access

Outcome of Labor Induction and its Associated Factor among Laboring Women at Dilchora Referral Hospital, Dire Dawa, Eastern Ethiopia

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Introduction

Induction of labor refers to the iatrogenic stimulation of uterine contractions before the onset of spontaneous labor to accomplish vaginal delivery [1]. It is usually performed by administering oxytocin or prostaglandins to the pregnant woman, or by artificially rupturing the amniotic membranes [2]. and it is indicated only when the risk of continuing the pregnancy to the mother and or fetus exceeds the risk associated with the induced labor and birth [3]. Induction of Labor is not risk-free, and many women find it uncomfortable. the incidence of inducing labor Over the past several decades has continued to rise. In developed countries, the proportion of infants delivered at term following induction of labor can be as high as one in four births. In low- and middleincome countries the rates are generally lower, but in some lowincome countries, they can be as high as those observed in highincome countries [2].

An increased rate of induction of labor for post-term pregnancies over 15 years was associated with decreased stillbirth rates in Canada [4]. For a long period, many health care providers have recommended the use of induction of labor in circumstances in which the benefit of continuing a pregnancy must be outweighed the potential maternal and fetal risk associated with the procedure and waiting for the onset of spontaneous labor. These circumstances generally include gestational age of 41 completed weeks or more, pre-labor rupture of amniotic membranes, hypertensive disorders, maternal medical complications, fetal death, fetal growth restriction, chorioamnionitis, multiple pregnancies, vaginal bleeding, and other complications. Following this condition, many neonates and mothers die each hour throughout the world to prevent maternal and neonatal death WHO designed and implement a strategy in the area of improving and availing comprehensive emergency obstetric services. one of the strategies is the induction of labor [2].

In Dire Dawa, there was an area with a high rate of maternal mortality and morbidity MMR calculated for the two periods (2013-2015) was 511and 505 per 100,000 live births during baseline and trial periods, respectively [5]. That maternal mortality is due to poor access to comprehensive emergency obstetric care. Knowing labor outcome and associated factors following induction is crucial. To the investigator's knowledge, there is no study conducted in the Dilchora referral hospital. Therefore, this study aimed to determine the outcomes of induction of labor and factors associated with induction of labor at Dilchora referral hospital.

Identifying the magnitude and factors associated with labor induction outcomes will emphasize improvements in access to qualified care for laboring women that are necessary for a reduction in maternal life-threatening conditions. Since the labor induction outcomes, exploring and analyzing the severity of factors provides important information for laboring women as well as for health care providers in setting priorities for in-depth assessments and health care improvements in maternal health. Furthermore, studies on labor induction outcomes-related events in the study area are crucial to further understanding associated issues and provide an evidence-based platform for appropriate interventions.

Since the study will explain factors associated with labor induction outcomes, study results will serve as an input for the health bureaus, health offices/departments, local NGOs, and other stakeholders working in Dire Dawa city administration in the planning and implementation of preventive and intervention strategies to improve maternal and neonatal health. Moreover, the study can also be used as a baseline framework for researchers for further studies that will be conducted in similar setups.

Material and Methods

Study setting

A hospital-based cross-sectional study was carried out from May 15 up to June 1, 2020, in Dilchora referral hospital. The hospital gives a referral service for different parts of the Oromiya and Somalia region. According to data from the hospitals' labor ward registration book more than 400 inductions has been conducted in 2018. The average monthly delivery service on Dilchora referral hospital in 2018 GC is about 325. So far, there have not been any properly documented studies to show induction of labor, its associated factor, and labor outcome.

Population sampling

The source population was All women who had induction of labor and gave birth after 28 weeks of gestation in Dilchora referral hospital and the study population was All women who had an induction and gave birth after 28 weeks of gestation in the Dilchora referral Hospital during the study period. All registered women who delivered through induction of labor after a period of viability (28 weeks) were included in this study.

Sampling size and sampling technique

The sample “size of outcome variable” for induction of labor is calculated using single population proportion formula considering the following assumptions: the level of confidence of 95%, the margin of error of 4%, proportion of success of labor induction from the previous study to be 78% [7], By adding 10% of the non-response rate the final sample size will be 404+40 =444. A systematic random sampling procedure was used to choose the study participants using the delivery registration book k=Sampling interval from the first selected sample to the next to be selected in the registration book, N=total population (1334), n=sample size (444). The sampling interval (k) was calculated by dividing the total population to sample size (K=3), the sample was picked every three charts from the registration book. When there was a missing chart for the selected sample, we picked the next. The lottery method was used to select the first sample from the first three.