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Currently used oxytocin regimen outcome measures at term & postterm. II: Outcome indicators in relation to Bishop
1Hawassa University, Faculty of Medicine, Department of Obstetrics and Gynaecology. yifrub@yahoo.com
Background:
The effect of Bishop Score on labour induction outcome is extensively studied and partly known. However, the length of induction before failed induction declared is a controversial issue. Furthermore, to our knowledge, stratified Bishop Score in relation with stratified mode of delivery, induction initiation to vaginal delivery time, and variable cervical dilatation change among failed inductions were not assessed before. In literature, the maximum oxytocin in milliunit/minute also does vary from 20 to 42 milliunit/minute. Lack of published study assessing the separate oxytocin dose regimen for nulliparas and multiparas in Ethiopia, for which we could not find such regimen in literature, motivated us to review a two year case-series at term and post term.
Objective:
To evaluate the relation of Bishop Score and induction outcome measured by length of induction initiation-vaginal delivery time and modes of delivery in Gandhi and St. Paul's hospitals.
Methods:
Time lapsed to deliver vaginally or to declare failed induction, the maximum oxytocin level in milliunit/ minute infused before subjecting for abdominal delivery, length of induction and mode of delivery were some of the variables assessed.
Result:
The Bishop score of 42.0% and 42.4% of the 552 women medically induced were assessed to have 0-5 and 6-8, respectively. Over all, among the 0-5 Bishop Score group, 45.7% were induction failures. To be specific, out of 157 total failures, 0-5 Bishop Score group accounted for 67.5% (P < 0.0001). Bishop score was found to have an inverse relation with failed induction, and negative correlation (r = -0.22) with length of labour among vaginal deliveries. Failure to bring about cervical dilatation and unable to establish adequate uterine contractions (45.2% and 54.8%, respectively) were the two reasons for failed inductions. Although the range was wide (2:50 - 21:0), the mean length of induction in hours in both nulliparas and multiparas prior to decision for failed induction was comparable (9:45 +/- 3:20 vs 9:25 +/- 2:55). The maximum oxytocin infused in mu/min for nulliparas and multiparas was 73.4 and 36.7 but was not linear; stepwise increase with each increase in the infusion rate was not the finding.
Conclusion:
currently used oxytocin regimen protocol was associated with high induction failure.
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