Safety and effectiveness of different modes of labor induction among pregnant women delivering at referral hospitals in Dar es Salaam, Tanzania: a cohort study.

Background: Induction of labor is a medical procedure used to stimulate uterine contractions and promote cervical ripening, facilitating spontaneous vaginal delivery (SVD). Various induction methods are used globally, but data on their safety and effectiveness, especially in developing countries, are limited. This study evaluated the safety and effectiveness of different labor induction methods among pregnant women delivering at referral hospitals in Dar es Salaam, Tanzania.

Methods: This cohort study enrolled pregnant women who underwent labor induction at referral hospitals in Dar es Salaam from April to May 2021. The induction methods assessed were oxytocin, dinoprostone, misoprostol, and balloon catheter. Data were collected on the proportion of women achieving SVD, median time to delivery, and maternal and neonatal outcomes. Data were analyzed using SPSS version 23, presenting findings as frequencies, percentages, and medians. Cox regression modelling assessed factors associated with SVD and delivery outcomes.

Results: Of the 322 women included, 198 (61.5%) were at term, and 210 (65.2%) had comorbidities. Overall, 80% of women achieved SVD following induction. Among women induced with oxytocin, 95% achieved SVD, compared to 69% for dinoprostone, 72% for misoprostol, and 77% for balloon catheter. The median time to SVD was 5.42 h (IQR: 4.50-6.00) for oxytocin, 13 h (IQR: 12.00-14.00) for dinoprostone, 8.5 h (IQR: 7.00-9.00) for misoprostol, and 9.0 h (IQR: 8.00-10.00) for the balloon catheter. Maternal blood loss was significantly lower for oxytocin-induced women (p < 0.001), compared to misoprostol, dinoprostone, and balloon catheter. Neonatal outcomes were better for oxytocin-induced women (p < 0.01) and poorer for those induced with misoprostol (p < 0.01). Factors associated with achieving SVD included multigravidity (AoR = 1.57, p = 0.004), comorbidities (AoR = 1.47, p = 0.007), and use of oxytocin (AoR = 3.13, p < 0.001) or dinoprostone (AoR = 0.58, p = 0.003).

Conclusion: Oxytocin was the most effective and safest method for labor induction within 24 h, resulting in favorable maternal and neonatal outcomes. Healthcare workers should prioritize oxytocin for timely deliveries, while considering alternatives like dinoprostone, misoprostol, and balloon catheter based on individual patient needs and clinical circumstances.