Maternal and perinatal outcomes of induction of labor at term in the university clinics of Kinshasa, DR Congo


Objective: This paper aims at assessing outcomes following induction of labor and characteristics likely to predict vaginal delivery. Study design: This is a descriptive retrospective cohort study including all women with singleton pregnancies who delivered at term in the university clinics of Kinshasa, DR Congo, from January 01, 2006 until December 31, 2010. Induction was initiated regardless of cervical status. Methods of induction included: oxytocin perfusion, vaginal Misoprostol, intracervical insertion of the Foley catheter and amniotomy. Results of induction were compared in terms of failure of labor, cesarean section, fetal distress, and neonatal distress. Logistic regression was used to seek for independent contributing factors for adverse outcomes. Results: During the period of the study 115 patients at term (3.2%) were concerned with induction of labor. Means for maternal age, gestational age and weight at confinement were 30.5 ± 5.7 years, 37.95 ± 1.54 weeks and 69.3 ± 15.1 kg, respectively. The mean parity and gravidity were 2.4 ± 1.9 and 2.9 ± 1.9, respectively. The mean Bishop score was 6.2 ± 1.5 at the first induction, with 66 women (57.3%) having less than 7. Indications for induction were: preeclampsia (52 = 54.1%), premature rupture of membranes (34 = 29.5%), post term (17 = 14.6%), gestational diabetes (5 = 4.3%), stillbirth (5 = 4.3%), polyhydramnios (3 = 2.6%) and cardiopathy (1 = 0.8%). Methods of induction at the first attempt included: oxytocin (86 = 74.7%), vaginal misoprostol (20 = 17.3%), transcervical Foley catheter balloon (14 = 12.1%), and amniotomy (1 = 0.8%). Failure to induce uterine contraction at the first attempt was noted in 9/115 (7.8%) women. Vaginal delivery occurred in 78 (66.9%) women, and cesarean section in 34 (29.6%). The majority of cesarean sections were performed at the primary induction, most of them (29/34 = 85.3%) in women with bad Bishop score. Failure of induction was more likely to occur in association with high maternal weight (OR 6.8; CI 1.2 - 39.7), and somewhat birth weight (OR 2.1 but CI containing 1). Risk for cesarean section was increased in association with induction of labor in cases of high maternal weight (OR 10.3, CI 16.0 - 67.0), and somewhat of high birth weight (OR 2.3, but CI containing 1). Fetal distress was associated only with maternal weight (OR 15.7, CI 1.3 - 187.8), and neonatal distress only with Bishop score (OR 10.9, CI 1.1 - 108.0). Conclusion Induction of labor in our setting in order to get vaginal delivery is affected of a high risk of adverse outcomes such as failure of induction, cesarean delivery, fetal and neonatal distress. This risk is significantly influenced by maternal weight, birth weight and Bishop score. Lack of worse outcomes between the first and the subsequent attempts to induce labor can be regarded as a reason to try induction even in the presence of unfavorable cervix.

Share and Cite:

Tandu-Umba, B. , Tshibangu, R. and Muela, A. (2013) Maternal and perinatal outcomes of induction of labor at term in the university clinics of Kinshasa, DR Congo. Open Journal of Obstetrics and Gynecology, 3, 154-157. doi: 10.4236/ojog.2013.31A029.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Xenakis, E.M.-J., Piper, J.M., Conway, D.L. and Langer, O. (1997) Induction of labor in the nineties: Conquering the unfavorable cervix. Obstetrics & Gynecology, 9, 235-239. doi:10.1016/S0029-7844(97)00259-7
[2] Caughey, A.B., Sundaram, V., Kaimal, A.J., Cheng, Y.W., Gienger, A., Little, S.E., et al. (2009) Maternal and neonatal outcomes of elective induction of labor. AHRQ Publication No. 09-E005, Evidence Report/Technology Assessment, 9, 1-257.
[3] Stock, S.J., Ferguson, E., Duffy, A., Ford, I., Chalmers, J. and Norman, J.E. (2012) Outcomes of elective induction of labour compared with expectant management: population based study. British Medical Journal, 344, e2838. doi:10.1136/bmj.e2838
[4] Fofie, C.O. and Baffoe, P. (2010) A two-year review of uterine rupture in a regional hospital. Ghana Medical Journal, 44, 98-102.
[5] Nyengidiki, T.K. and Allagoa, D.O. (2011) Rupture of the gravid uterus in a tertiary health facility in the Niger delta region of Nigeria: A 5-year review. Nigerian Medical Journal, 25, 230-234. doi:10.4103/0300-1652.93794
[6] Vikram, T.S. and Sabaratnam, A. (2011) Failed induction of labor: Strategies to improve the success rates. Obstetrical & Gynecological Survey, 66, 717-728. doi:10.1097/OGX.0b013e31823e0c69
[7] Park, K.H., Hong, J.S., Shin, D.M. and Kang, W.S. (2009) Prediction of failed labor induction in parous women at term: Role of previous obstetric history, digital examination and sonographic measurement of cervical length. Journal of Obstetrics and Gynaecology Research, 35, 301-306. doi:10.1111/j.1447-0756.2008.00929.x
[8] Crane, J.M. (2006) Factors predicting labor induction success: A critical analysis. Clinical Obstetrics and Gynecology, 49, 573-584. doi:10.1097/00003081-200609000-00017
[9] Tandu-Umba, N.F.B., Pentuala, N.F. and Sengeyi, M.A.D. (2000) Induction of labor by oxytocin without cervix ripening: Experience of the university clinics of Kinshasa. Congo Médical, 2, 911-914.
[10] Kangudia, M.J. (2000) Comparative study of three protocols of induction of labor: Foley catheter, oxytocin, and misoprostol. Mémoire, Faculty of medicine, University of Kinshasa, Kinshasa.
[11] Fawole, B., Nafiou, I., Machoki, M., Wolomby-Molondo, J.J., Mugerwa, K., Neves, I., et al. (2012) Unmet need for induction of labor in Africa: Secondary analysis from the 2004-2005 WHO global maternal and perinatal health survey. BMC Public Health, 12, 722-738. doi:10.1186/1471-2458-12-722
[12] Beckmann, M. (2007) Predicting a failed induction. Australian and New Zealand Journal of Obstetrics and Gynaecology, 47, 394-398. doi:10.1111/j.1479-828X.2007.00763.x
[13] Park, K.H. (2007) Transvaginal ultrasonographic cervical measurement in predicting failed labor induction and cesarean delivery for failure to progress in nulliparous women. Journal of Korean Medical Science, 22, 722-727. doi:10.3346/jkms.2007.22.4.722
[14] Tajik, P., van der Tuuk, K., Koopmans, C.M., Groen, H., van Pampus, M.G., van der Berg, P.P., et al. (2012) Should cervical favorability play a role in the decision for labor induction in gestational hypertension or mild preeclampsia at term? An exploratory analysis of the Hypitat trial. International Journal of Obstetrics and Gynaecology, 119, 1123-1130. doi:10.1111/j.1471-0528.2012.03405.x

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.