COMPARATIVE STUDY OF INDUCTION TO DELIVERY INTERVAL USING TRANSCERVICAL FOLEY’S CATHETER PLUS OXYTOCIN AND VAGINAL MISOPROSTOL IN AMINU KANO TEACHING HOSPITAL, KANO, NIGERIA

Abstract

Background: Induction of labour is an artificial initiation of labour before its
spontaneous onset for the purpose of delivery of the feto placental unit.
Various agents can be used for induction of labour. These include: the
prostaglandins (PG) e.g. PGE1 analogue like misoprostol, PGE2, e.g.
dinoprostone or PGf2alpha, e.g. dinoprost can also be used. These together with
oxytocin are termed pharmacological labour induction agents. Others are
Foley’s Catheter (transcervical), amniotomy, membrane stripping, lamicel
and Dilapan (made from synthetic hygroscopic material) and also laminaria
tent (hygroscopic dilator made from dried seaweed), these are termed
mechanical methods for cervical ripening and labour induction agents.
Objective:
To compare the induction delivery intervals using transcervical Foley’s catheter
plus oxytocin and vaginal misoprostol, and to identify the factors associated
with successful induction among postdate singleton multiparae in Aminu Kano
Teaching Hospital (AKTH).
Materials and Methods
The study was a prospective randomized controlled trial of singleton
multiparous pregnant women, who were admitted from Antenatal Clinic at a
GA of 41 weeks 3 days with unfavorable cervix for induction of labour.
Patients were randomized into two groups, one group for intravaginal
misoprostol at a dose of 50mcg, and the other group for transcervical Foley’s
catheter insertion as a method of cervical ripening and induction of labour
(IOL).
Computer generated random numbers were used to allocate the study groups
into either Foley’s catheter insertion or vaginal misoprostol. The data was
analyzed in a computer using SPSS version 17 computer software. Comparisons
of categorical variables were done using chi-square test, with P < 0.05
considered as significant. Student’s t test was used for continuous variables.
Tables and chart were also used.
RESULTS: During the period of the study 140 participants were recruited for
the study, one hundred and thirty six fully filled questionnaires were analysed,
four were not analysed due to insufficient information after delivery.
The participants were comparable in their demographic and socio- economic
characteristics.
The incidence of postdatism among pregnant multiparous women with
singleton pregnancy within the study period was found to be 13.1%.
The mean induction delivery time interval was shorter in the misoprostol group
(5.54 ± 1.8hours) while in the Foleys’s catheter oxytocin infusion group was
6.65 ± 1.7hours the difference was statistically significant (p = 0.035).
The rate of spontaneous vaginal delivery was found to be 90.9% in the Foley’s
catheter oxytocin infusion group, while it was 80% in the misoprostol group.
The difference was statistically not statistically significant (p = 0.073).
Higher parity and higher Bishop’s score were the factors found to be associated
with high success rate of induction of labour, the difference was strongly
statistically significant (p < 0.001).
The rate of uterine tachysystole was found to be 2.9% among the patients who
had misoprostol for IOL, while none was found in the Foley’s catheter plus
oxytocin infusion group. No participant was found to have primary postpartum
hemorrhage..Greenish meconium stained liquor was seen in 5.7% of neonate
delivered by mothers who had their labour induced with misoprostol. No
meconium stained liquor was seen from the amniotic fluid of neonates delivered
from the mothers who’s labour was induced by Foley’s catheter plus oxytocin
infusion. The need for intensive care admission was seen in 2.9% of neonates in
the misoprostol group, while no neonate was admitted among the babies
delivered by the mothers who had their labour induced by Foley’s catheter plus
oxytocin infusion.
CONCLUSION: The incidence of postdatism among pregnant women
carrying a singleton pregnancies in AKTH, was found to be 13.1% . Vaginal
misoprostol resulted in shorter induction delivery time interval , as compared to
transcervical Foley’s catheter. High parity and high Bishop’s scores were the
factors found to be associated with success of induction of labour.

COMPARATIVE STUDY OF INDUCTION TO DELIVERY INTERVAL USING TRANSCERVICAL FOLEY’S CATHETER PLUS OXYTOCIN AND VAGINAL MISOPROSTOL IN AMINU KANO TEACHING HOSPITAL, KANO, NIGERIA