Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 13 , ISSUE 5 ( September-October, 2021 ) > List of Articles

ORIGINAL RESEARCH ARTICLE

Analysis of Classification Systems and Outcome of Labor in Women Undergoing Induction of Labor in South Indian Population

Seetha Panicker

Keywords : Cesarean section, Labor induction, Neonatal outcome, Obstetric complications, Obstetric outcome, Preinduction cervical ripening

Citation Information : Panicker S. Analysis of Classification Systems and Outcome of Labor in Women Undergoing Induction of Labor in South Indian Population. J South Asian Feder Obs Gynae 2021; 13 (5):306-310.

DOI: 10.5005/jp-journals-10006-1940

License: CC BY-NC 4.0

Published Online: 22-12-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Aim and objective: To identify women undergoing induction of labor (IOL) for 1 year in our tertiary care hospital, apply the classification systems, correlate with the maternal and fetal outcomes, and determine the ease and effectiveness of audit of the IOL practice. Materials and methods: All patients who delivered in the year 2019 were analyzed, and the cohort of women who underwent IOL was identified. The age, parity, gestational age at induction, indication for induction, and the maternal and fetal outcomes were analyzed. The two classification systems were applied and the results were analyzed. Results: The total number of deliveries for the year was 3,668, and the number of women undergoing IOL was 1,450, with an incidence of 39.5%. The maximum number of women, 1,212, (83.5%) were in the 20–30-year age-group; in that, 1107 (76.34%) were primiparous and 343 (23.66%) were multiparous. The commonest indication for IOL was postdates, with the commonest mode being PGE2 gel in 699 (48.2%) women. Of 1,450 women induced, 1,083 (74.69%) had a vaginal delivery and 367 (25.31%) delivered by a cesarean section. This was similar to the rate seen in women with spontaneous labor. Further, a 10-group classification system according to Nippita et al. and classification of IOL according to the indication for induction proposed by Mahomed et al. was applied to this cohort. Conclusion: The classification systems are useful to determine whether the induction is done according to the established guidelines and makes our audit easier. A prospective audit would better identify some of the adverse maternal and fetal outcomes. Clinical implications: The safety of IOL in modern obstetrics should not give us a false sense of security, and regular audits of the practice of IOL are useful to ensure that the adherence is according to the established guidelines.


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  1. World Health Organisation. WHO recommendations for induction of labour. Geneva: WHO; 2010.
  2. Nippita TA, Khambalia AZ, Seeho SK, et al. Methods of classification for women undergoing induction of labour: a systematic review and novel classification system. BJOG 2015;122(10):1284–1293. DOI: 10.1111/1471-0528.13478.
  3. Mahomed K, Ying HE, Holland L. Induction of labour classification – can we explain variation in induction rates? Obstet Gynecol Int J 2018;9(3):164–166. DOI: 10.15406/ogij.2018.09.00324.
  4. Leduc D, Biringer A, Lee L, et al. Induction of labour. J Obstet Gynaecol Can 2013;35(9):840–857. DOI: 10.1016/S1701-2163(15)30842-2.
  5. Esposito P, Dal Canton A. Clinical audit, a valuable tool to improve quality of care: general methodology and applications in nephrology. World J Nephrol 2014;3(4):249–255. DOI: 10.5527/wjn.v3.i4.249.
  6. Mousa HA, Mahmood TA. Do clinical practice guidelines guide practice? A prospective audit of induction of labour – three years experience. Acta Obstet Gynecol Scand 2000;79(12):1086–1092. PMID: 1130093.
  7. O'Dwyer S, Raniolo C, Roper J, et al. Improving induction of labour – a quality improvement project addressing Caesarean section rates and length of process in women undergoing induction of labour. BMJ Qual Improv Rep 2015;4(1):u203804.w4027 DOI: 10.1136/bmj quality.u203804.w4027.
  8. Health and Social Care Information Centre. NHS Maternity Statistics, England, 2013–14. Available from: https://digitals.nhs.uk/catalogue/PUB16725.
  9. Osterman M, Martin J. Recent declines in induction of labour by gestational age. NCHS Data Grief 2014;(155): 1–8. PMID: 24941926.
  10. Ananth CV, Wilcox AJ, Gyamfi-Bannerman C. Obstetrical interventions for term first deliveries in the US. Paediatr Perinat Epidemiol 2013;27(5):442–451. DOI: 10.1111/ppe.12068.
  11. Grobman WA, Rice MM, Reddy UM, et al. Labour induction versus expectant management in low risk nulliparous women. N Engl J Med 2018;379(6):513–523. DOI: 10.1056/NEJMoa1800566.
  12. Mast K, Mieke LG, Bloemenkampis KWM, et al. Chapter 13. Induction of labour: who, when, how and where? In: Ledger W, Clark J, editors. Recent advances in obstetrics and gynaecology: 26. New Delhi: JP Publishers; 2015. p. 135–147.
  13. Betrán AP, Vindevoghel N, Souza JP, et al. A systematic review of the Robson classification for caesarean section: what works, doesn't work and how to improve it. PLoS One 2014;9(6):e97769. DOI: 10.1371/journal.pone.0097769.
  14. ACOG Committee on Practice Bulletins: Obstetrics. ACOG Practice Bulletin no 107: induction of labor. Obstet Gynecol 2009;114(2 Pt 1):386–397. DOI: 10.1097/AOG.0b013e3181b48ef5.
  15. Norman JE, Stock SJ. Chapter 24 Induction and augmentation of labour. In: Edmonds DK, Lees C, Bourne T, editors. Dewhurst's textbook of obstetrics and gynecology. Wiley Blackwell Publishing Ltd; 2018. p. 326–335.
  16. Mishanina E, Rogozinska E, Thatthi T, et al. Use of labour induction and risk of cesearean delivery: a systematic review and meta-analysis. CMAJ 2014;186(9):665–673. DOI: 10.1503/cmaj.130925.
  17. Poma S, Scudeller L, Gardella B, et al. Outcomes of induced versus spontaneous labor. J Matern Fetal Neonatal Med 2017;30(10):1133–1138. DOI: 10.1080/14767058.2016.1205028.
  18. Gulmezoglu AM, Crowther CA, Middleton P, et al. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database Syst Rev 2012;6(6):CD004945. DOI: 1002/14651858.CD004945.pub3.
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