CAESAREAN SECTION RATE IN SPONTANEOUS VERSUS INDUCED LABOUR: A PROSPECTIVE COHORT STUDY

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Abstract

ABSTRACT
Background: The rate of induced labour is rapidly increasing all over the world. Induced labour is reported to be associated
with high rates of caesarean section (C-section). However, data is limited in high volume tertiary care centres
from developing countries.
Objectives: The aim of this study was to compare C-section rate in spontaneous versus induced delivery in a prospective
manner.
Methods: This is a prospective cohort study where we selected patients who either had a spontaneous or an induced
labour between July 2016 and June 2017. We recorded patient age, parity, gestational age at the time of labour, body
mass index (BMI), overall Bishop Score and comorbidities or obstetric complications. We analysed the data for C-section
rate and association between various clinical factors and the mode of delivery.
Results: 488 patients with 240 (49.2%) spontaneous onset labour and 248 (50.8%) with induced labour. The mean age
was 27.7 ± 5.6 years with 299 (61.3%) nulliparous and 189 (38.7%) multiparous women. The mean gestational age
was 39.8 ± 0.6 weeks (range: 38.5 – 41.5) and mean BMI was 23.3 ± 2.9. A total of 50 C-sections were performed, out
of which 19 (3.9%) in patients with spontaneous onset labour while 31 (6.4%) in patients with induced labour (Fisher’s
exact p = 0.095). Significant mean difference (MD) of age between multiparous and nulliparous women (MD = 8.8,
95% CI: 8.2 to 9.5), t = 25.7, p < 0.0001) as well as the BMI (MD = 0.92, (95% CI: 0.401 to 1.434), t = 0.968, p =
0.001) was found. Additionally, patients who underwent C-section had significantly higher BMI (mean: 27.6 ± 1.9) as
compared to those who did not (mean: 22.9 ± 2.5) and this difference was significant (MD: 4.8, (95% CI: 4.1 to 5.5),
t = 12.9, p < 0.0001).
Conclusion: Higher rates of C-section are associated in patients with induced labour; however, there is no statistically
significant difference as compared to spontaneous onset labour. Higher body mass index and lower Bishop Scores
are associated with increased rates of induction and eventual C-section.
Keywords: spontaneous Labour, induction of labour, C-section.

Authors: 
Farhat Nasreen2,
Sharafat Bibi1
Anjum Mahmood3
Hafsa Tariq
Jibran Tariq

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