Evaluation of Labor Induction Versus Spontaneous Labor Outcomes at Kigali University Teaching Hospital and Muhima Hospital

BACKGROUND: Labor induction may be associated with risks such as higher rates of fetal distress, Newborn Special Care Unit admissions, Cesarean section, and postpartum hemorrhage (PPH) compared to spontaneous labor. Currently, little data is available on these risk rates for resource-limited countries.
This study's main was to evaluate maternal and perinatal outcomes of labor induction versus spontaneous labor in Kigali, Rwanda.
METHODS: A prospective comparative study was conducted at two large referral hospitals in Kigali, Rwanda over a six-month period. Women who met the inclusion criteria of being at term or post-term without any underlying medical or surgical conditions and who were admitted for a scheduled induction of labor or spontaneous labor were included in the study. Women with obstetric complications, abnormal fetal growth, and oligohydramnios were excluded from the study.
RESULTS: There were 1,790 women who met the study criteria. Of these women, 1,543 had spontaneous labor (86.2%) and 247 were induced (13.8%). Among women admitted for a spontaneous labor, 1,399 (90.67%) delivered vaginally and 144 (9.33%) delivered by Cesarean section. In the induction group, 185 (74.89%) delivered vaginally and 62 (25.11%) delivered by Cesarean section (p < 0.001). Postpartum hemorrhage was more common in the induction group (3.2% versus 1.1 %; p=0.008). An Apgar score of <7 after one (1) minute occurred at a rate of 6.9% in the induction group and 4% in the spontaneous labor group (p = 0.036). There were no differences in five (5) minute Apgar scores or Newborn Intensive Care Unit admissions between the groups.
CONCLUSIONS: Induction of labor was associated with higher rates of Cesarean section and postpartum hemorrhage. There were also increased rates of low Apgar scores after 1 minute but no difference in neonatal complications. Health care providers should anticipate possible complications when inducing labor and consider the proper selection of candidates. An appropriate setting should always be considered prior to induction.