The study was conducted in Axum St.Marry hopsital found in Aksum town. Aksum is the most ancient town of Ethiopia, found in Tigray national regional state about 1024 km from Addis Ababa and 247 km from Mekelle, which is the capital city of Tigray regional state. In the town, there were one referral and teaching hospital, one Zonal hospital (Axum St. Marry), two health centers, and nine different level private clinics. Axum St. Mary hospital is a governmental zonal hospital established in 1966 G.C. The hospital has four main department’s internal medicine, pediatric, gynecologic/ obstetric and surgery. It has also dental, physiotherapy and psychiatric departments.
Study Design And Period
A retrospective cross-sectional study with analytic component was employed. The study was conducted from April 9, 2017- April 8, 2018. The data collection period was from March 10- May 9, 2018.
The source population of the study was all women who undergone IOL after 28 weeks of gestation at Axum St. Marry hospital from April 9, 2017- April 8, 2018.
The study population was all systematically selected women who undergone induction of labor after 28weeks of gestation in Axum St.Marry hospital from April 9, 2017- April 8, 2018.
All registered women who had IOL after 28weeks of gestation in Axum St.Marry hospital maternity ward from April 9, 2017- April 8, 2018.
All registered women who had induction of labor without full documentation. Development of non-reassuring fetal heart rate pattern (NRFHRP) after initiation of induction of labor (n = 380).
Sample Size Calculation And Sampling Technique
A cross-sectional study was conducted by reviewing records of term post-term delivers from April 9, 2017- April 8, 2018(n = 380). All samples were taken from this period. Consecutive sampling technique was employed to select the study participants.
Induction of labor (IOL)
Refers to the iatrogenic stimulation of uterine contractions before the onset of spontaneous labor to accomplish vaginal delivery after 28 weeks of gestation [1, 4].
A scoring system devised by Dr Virginia Apgar based on five criteria (heart rate, respiration, color, muscle tone and response to stimulation) and used as a marker of a newborn baby’s need for resuscitation at birth. A score of 0, 1 or 2 is awarded for each criterion, with a total score out of ten. The score is assessed at 1 and 5 minutes after birth. It is stratified as very low Apgar scores (0–3), low Apgar scores (4–6) and normal range (> 7) .
Failed induction of labor
Failure to generate regular contractions (i.e. every 3 minute) and cervical change with oxytocin administration for 12 hours after rupture of membranes. Cesearean section (CS) was done if there was a failure to go into active phase labor or fetal distress / maternal risk exceeded the induction process benefits [13, 20, 21]. And also it was the dependent variable in this study and this information was obtained from medical record. It was categorized as ‘’yes’’ and ‘’no’’ with code of 1 and 0 respectively.
Is calculated from the last normal menstrual period (LNMP) that was documented on the card or ultrasound estimation if not from the duration of amenorrhea documented from mother’s recall & is rounded to the nearest weeks. Amenorrhea of 9 months was taken as 40 weeks’ gestation for all mothers .
Post term pregnancy
A pregnancy lasting > 42weeks .
Fetus delivered after 28 weeks of gestation for Ethiopia.
Data Collection Tools And Quality Control
The data were collected by secondary data sources (document review) using a structured questioners composed of socio demographic and obstetric variables of women who undergone induction of labour. The questionnaires were prepared in English version from similar study [10, 11, 14, 24]. A pre-tested questioner was used on 5% of the sample size in (i.e. Wukro Maray primary hospital) and necessary intervention was done before the data collection. The data collectors were two BSc midwife and supervised by one BSc midwife to follow the data collection process. The investigators and supervisor were checked data accuracy, consistency and completeness daily.
The collected data were entered and analyzed using SPSS version 21. The data were cleaned before analysis.
Descriptive statistics such as frequency and mean were used to describe the study participants. Crude and adjusted odds ratios (95%) confidence intervals were utilized to assess the determinant factors with the failed induction of labour. The criterion for selecting independent variables was set at p-value less than 0.25 in bivariable analysis for final model model. To control for potential confounder, a multivariable binary logistic regression was performed. A two tailed p-value < 0.05 was performed to show statistical significant. Model fitness was performed with Hosmer- Lemshow test. And also multicollinearity was checked using at < 10 variance inflation factor (VIF). There were no variables that have VIF greater than 10.