A CASE CONTROL STUDY TO IDENTIFY THE RISK FACTORS FOR CESAREAN DELIVERY IN NULLIPAROUS WOMEN WITH INDUCED LABOR AT TERM

Dr. Mamta Mahajan*, Dr. Suman Meena, Dr. Anjali Soni

ABSTRACT

Introduction: Induction of labor (IOL) is the most common intervention in obstetrics. The objective of this study
was to assess the risk factors in term pregnancies and their delivery outcome following IOL. The purpose of the
study of risk factors is that it adds more prognostic information to the counselling and planning process of IOL.
Method: We conducted this case control study to compare caesarean section (CS) rate among nulliparous women
with and without risk factors who were induced with similar labor induction protocol (tablet misoprostol 25 mcg,
per vaginally, 4 hours apart, maximum 5 doses). A total of 200 nulliparous women at term with singleton
pregnancy, who fulfilled inclusion and exclusion criteria were recruited after taking informed consent. The study
was conducted over a period of 1 year in labor ward of obstetrics department of Dr RPGMC Tanda H.P. Result:
Our study results demonstrated that maternal age ≥ 35 years, BMI ≥ 25kg/m2, pre-induction bishop score < 5 and
hypertensive disorders of pregnancy are significantly associated with CS in patients after IOL. Further logistic
regression was performed, to ascertain the effect of variables that were found to be statistically significant on
univariate analysis, and on binominal logistic regression also BMI, bishop score and hypertensive disorders of
pregnancy were found to have a statistically significant association with CS with AOR of 2.57 (1.24-5.33), 0.19
(0.09-0.39) and 0.28 (0.12-0.68) respectively. Conclusion: The present study emphasizes that both medical and
elective IOL is associated with an increased risk of CS predominantly related to unfavourable Bishop score,
increases BMI and hypertensive disorders of pregnancy. Patient should be counselled about these risk factors
before IOL.

Keywords: Induction of labor, Bishop score, Caesarean section.