Majallah-i Dānishgāh-i ̒Ulūm-i Pizishkī-i Bābul (Aug 2009)
Effects of Elective Labor Induction and Spontaneous Onset of Labor on Caesarian Section Rate beyond Term
Abstract
BACKGROUND AND OBJECTIVE: Treatment intervention due to increasing of maternal and neonatal morbidity is necessary in prolonged pregnancy. Induction of labor is common treatment for reduction of these complications. Because induction of labor may increase cesarean section (C.S) and increasing of cesarean section rate is one of the most important problems of health’s services, though the aim of this study was to determine the rate of C.S after labor induction among nuliparous patients with cephalic presentation without medical complications with gestational age of more than 41 weeks in comparison with spontaneous labor.METHODS: This clinical trial study was done as simple sampling on160 women in Yahyanejad hospital of Babol University, Iran. Gestational age of all patients was more than 41 weeks (according to last menstruation period and ultrasonography before the 26th weeks of pregnancy). Patients divided into two groups, induction (case group) and spontaneous labor (control group). All women were singleton, cephalic and nuliparous women. Cases with fetal anomaly, diabetes, twins and multiparity excluded in the study. Ultrasonography was done after 40 weeks for all patients. In case group bishop score were determine for all patients after admission and induction was performed with vaginal suppository of prostaglandin (3mg) and oxytocin in induction group and cesarean was done in patients without progression of labor. No intervention was done in spontaneous labor group.FINDINGS: The mean (±SD) age of women in case and control group was 23.3±4.1 and 23.8±4.4 years, respectively. The mean (±SD) gestational age in case and control were 41.3±0.3 and 41±0.5 weeks, respectively. The most patients in both groups had 5 bishop score (85% in control and 96.3% in case). The mean (±SD) birth weight in case and control were 3.6±0.3 and 3.5±0.4 Kg respectively (p=0.342). The rate of cesarean section after induction in both groups was 48 cases (60%). The commonest etiology of cesarean in control group was meconium 34 case (70.8%) and in case group was no response to induction 19 case (39.6%) (p=0.000). Type of delivery was not significant between case and control groups according to weight and age stratification.CONCLUSION: Result show although induction of labor doesn increase rate of cesarean in post term patients. But for reduction of cesarean section measure of pH in fetus can be necessary in spontaneous labor.
