Study of the Risk Factors for Cesarean Delivery among Pregnant Women Requiring Induction of Labor in a Tertiary Care Institute

Abstract

Background: Labor induction is the most commonly performed intervention in obstetrics and is usually carried out for maternal, fetal, and placental conditions when the benefits to either mother or fetus outweigh those of continuing the pregnancy. Labor induction process in itself is not without complications and is associated with a higher risk of maternal and fetal complications. However, in carefully selected high-risk pregnant women, labor induction is associated with higher chance of vaginal delivery with least maternal and fetal complications. The present study was conducted to identify the factors which determine the risk of failed induction and to compare the maternal and fetal outcome between spontaneous and induced labor pregnant women. Materials and methods: This retrospective study was done in a teaching institute of Chennai for a period of 6 months. The required medical and obstetrical details were obtained from case records. Chi-square test was used to compare the proportions of various clinical parameters between cesarean and vaginal deliveries. Binary logistic regression method was applied for estimating factors that were associated with higher chances of cesarean delivery. Results: Among 292 deliveries, 35.95% women required labor induction and 27.73% women had spontaneous labor; 50% of labor-induced women had successful vaginal delivery compared to 79% of women who had spontaneous labor with insignificant maternal and neonatal complications. Women with unfavorable preinduction Bishop score were at higher risk for cesarean delivery in labor-induced women. The risk factors such as advanced age, nulliparity, neonatal birth weight >3.5 kg, and labor induction for oligohydramnios, glucose intolerance, hypertension, premature rupture of membranes, and low-risk pregnancy at 40 weeks were not associated with higher chance of cesarean delivery. Conclusion: To curtail the increase in cesarean delivery rate, there is definite need for labor induction. Labor induction should be considered in pregnant women with medical and obstetric complications after assessing the clinical condition. Mechanical methods and sweeping of membranes may be attempted in women with unfavorable Bishop score prior to pharmacological methods of cervical ripening.