Induction Of Labor Among Singleton Pregnancies In Six Palestinian Governmental Hospitals: A Population-Based Cohort Study

Sahar Hassan, Katariina Laine, Erik Fosse, Niveen Me Abu-Rmeileh, Hadil Y Ali-Masri, Mohammed Zimmo, Kaled Zimmo, Åse Vikanes, Khaled M Ismail, Sahar Hassan, Katariina Laine, Erik Fosse, Niveen Me Abu-Rmeileh, Hadil Y Ali-Masri, Mohammed Zimmo, Kaled Zimmo, Åse Vikanes, Khaled M Ismail

Abstract

Objective: To explore rates and review practices regarding induction of labor (IOL) among singleton pregnancies in Palestine.

Design: A prospective population-based cohort study.

Setting: Six secondary and tertiary governmental hospitals located in the two regions of Palestine: West Bank and Gaza.

Participants: Singleton pregnancies who had IOL in participating units during the study period were included (n=8290). Women having multiple gestations (1004), planned cesarean births (703), those admitted with cervical dilation >6cm (11228), and pregnancies with no record of cervical dilation and/or gestational age on admission (219) were excluded.

Primary outcome measure: Rates of IOL in participating units and regions.

Results: There were a total of 33,402 singleton births during the study period with an IOL rate of 24.8%. Rates of IOL significantly varied between units, ranging from 12.9% to 45.6% (P-value <0.05). The majority of women with no previous uterine scar were induced at gestational ages ≤40 weeks where 43.8% were induced at 39-40 gestational weeks (29.9% multiparous; 13.9% nulliparous) and 17.7% were induced between 37 and 38 gestational weeks (11.9% multiparous; 5.8% nulliparous).

Conclusion: Significant variations in IOL practices between Palestinian hospitals and regions suggest overuse of IOL among singleton pregnancies in some units with the majority of these being performed before 40 weeks' gestation. These findings indicate a gap between implementation of best evidence and current clinical practice.

Keywords: Palestine; childbirth; cohort study; induction of labor; singleton; variations.

Conflict of interest statement

The authors report no conflicts of interest in this work.

© 2019 Hassan et al.

Figures

Figure 1
Figure 1
Study flowchart.

References

    1. World Health Organization, Department of Reproductive Health and Research. WHO Recommendations for Induction of Labour: Evidence Base. Geneva: WHO; 2011.
    1. Leduc D, Biringer A, Lee L, Dy J. Induction of labour: SOGC Clinical Practice Guideline No. 296. J Obstet Gynaecol Can. 2013;35(9):S1–S18. doi:10.1016/S1701-2163(15)30699-X
    1. Ruhl C, Bingham D. Midwives and nonmedically indicated induction of labor. J Midwifery Womens Health. 2014;59(3):233–236. doi:10.1111/jmwh.12197
    1. Bonsack CF, Lathrop A, Blackburn M. Induction of labor: update and Review. J MidwiferyWomens Health. 2014;59(6):606–615.
    1. Mozurkewich E, Chilimigras J, Koepke E, Keeton K, King VJ. Indications for induction of labour: a best-evidence review. BJOG. 2009;116(5):626–636. doi:10.1111/j.1471-0528.2008.02065.x
    1. Gulmezoglu AM, Crowther CA, Middleton P, Heatley E. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database Syst Rev. 2012;6:Cd004945.
    1. The American College of Obstetricians and Gynecologists: Women’s Health Care Physicisns. Induction of labor: clinical management guidelines for obstetrician –gynecologists number. 107. Obstetrics Gynecology. 2009;114(2):386–397.
    1. Vogel JP, Souza JP, Gulmezoglu AM. Patterns and outcomes of induction of labour in Africa and Asia: a secondary analysis of the WHO Global Survey on Maternal and Neonatal Health. PLoS One. 2013;8(6):e65612. doi:10.1371/journal.pone.0065612
    1. Lydon-Rochelle MT, Cárdenas V, Nelson JC, Holt VL, Gardella C, Easterling TR. Induction of labor in the absence of standard medical indications: incidence and correlates. Med Care. 2007;45(6):505–512. doi:10.1097/MLR.0b013e3180330e26
    1. Declercq ER, Sakala C, Corry MP, Applebaum S, Herrlich A. Listening to MothersSM III: Pregnancy and Birth. New York: Childbirth Connection; May 2013.
    1. Grobman WA, Rice MM, Reddy UM, et al. Labor induction versus expectant management in low-risk nulliparous women. N Engl J Med. 2018;379(6):513–523. doi:10.1056/NEJMoa1800566
    1. Mozurkewich EL, Chilimigras JL, Berman DR, et al. Methods of induction of labour: a systematic review. BMC Pregnancy Childbirth. 2011;11(84):1–19.
    1. Tillett J. Elective induction of labor prior to 39 weeks: initiating a change in culture. J Perinat Neonatal Nurs. 2012;26(3):190–192. doi:10.1097/JPN.0b013e3182611bb7
    1. Hassan S, Wick L, DeJong J. A glance into the hidden burden of maternal morbidity and patterns of management in a Palestinian governmental referral hospital. Women Birth. 2015;S1871-5192(1815):00272–00273.
    1. Ministry of Health, UNFPA. Obstetric Guidelines and Labour Ward Protocols. 4th ed. State of Palestine, Ramallah: Minsitry of Health; 2017.
    1. Ministry of Health, PHIC. Health Status, Palestine, 2017. Ramallah: Ministry of Health; 2018.
    1. Ministry of Health, PHIC. Health Status, Palestine 2015. Ramallah, Palestine: Ministry of Health;2016.
    1. Hassan S, Vikanes A, Laine K, et al. Building a research registry for studying birth complications and outcomes in six Palestinian governmental hospitals. BMC Pregnancy Childbirth. 2017;17(1):112. doi:10.1186/s12884-017-1296-6
    1. World Health Organization. WHO Recommendations: Intrapartum Care for a Positive Childbirth Experience.; 2018. Geneva: World Health Organization; 2018.
    1. 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
    1. World Health Organization. WHO (1985) Appropriate technology for birth. Lancet. 1985;(August 24):436–437.
    1. Olesen AW, Westergaard JG, Olsen J. Perinatal and maternal complications related to postterm delivery: a national register-based study, 1978-1993. Am J Obstet Gynecol. 2003;189(1):222–227. doi:10.1067/mob.2003.446
    1. Biro MA, East CE. Using the Nippita classification system for women undergoing induction of labour in a large metropolitan maternity service: bringing simplicity and certainty to an important quality improvement process. Aust N Z J Obstet Gynaecol. 2017;57(2):228–231. doi:10.1111/ajo.12598
    1. Nippita TA, Trevena JA, Patterson JA, Ford JB, Morris JM, Roberts CL. Variation in hospital rates of induction of labour: a population-based record linkage study. BMJ Open. 2015;5(9):e008755. doi:10.1136/bmjopen-2015-008755
    1. Heazell AE, Green M, Wright C, Flenady V, Froen JF. Midwives’ and obstetricians’ knowledge and management of women presenting with decreased fetal movements. Acta Obstet Gynecol Scand. 2008;87(3):331–339. doi:10.1080/00016340801902034
    1. Nippita TA, Trevena JA, Patterson JA, Ford JB, Morris JM, Roberts CL. Inter-hospital variations in labor induction and outcomes for nullipara: an Australian population-based linkage study. Acta Obstet Gynecol Scand. 2016;95(4):411–419. doi:10.1111/aogs.12854
    1. The American College of Obstetrciians and Gynecologists: Women’s Health Care Physicisns. Committee opinion No. 629. Clinical guidelines and standardization of practice to improve outcomes. Obstet Gynecol. 2015;125(629):1027–1029. doi:10.1097/01.AOG.0000462932.18418.7a
    1. Danilack VA, Triche EW, Dore DD, Muri JH, Phipps MG, Savitz DA. Comparing expectant management and spontaneous labor approaches in studying the effect of labor induction on cesarean delivery. Ann Epidemiol. 2016;26(6):405–411. doi:10.1016/j.annepidem.2016.04.009
    1. Little SE, Caughey AB. Induction of labor and cesarean: what is the true relationship? Clin Obstet Gynecol. 2015;52(2):269–281. doi:10.1097/GRF.0000000000000112
    1. Guerra GV, Cecatti JG, Souza JP, et al. Factors and outcomes associated with the induction of labour in Latin America. BJOG. 2009;116(13):1762–1772. doi:10.1111/j.1471-0528.2009.02348.x
    1. Zhao Y, Flatley C, Kumar S. Intrapartum intervention rates and perinatal outcomes following induction of labour compared to expectant management at term from an Australian perinatal centre. Aust N Z J Obstet Gynaecol. 2017;57(1):40–48. doi:10.1111/ajo.12576
    1. Gatward H, Simpson M, Woodhart L, Stainton MC. Women’s experiences of being induced for post-date pregnancy. Women Birth. 2010;23(1):3–9. doi:10.1016/j.wombi.2009.06.002

Source: PubMed

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