REPEAT INDUCTION VERSUS EXPECTANT MANAGEMENT AFTER FAILED PRIMARY LABOR INDUCTION AT TERM: A RANDOMISED CLINICAL TRIAL AT KENYATTA NATIONAL HOSPITAL. - Trial PACTR201805002872322

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Summary

BACKGROUND: While the rates of labor induction have increased globally,occurring in about 20% of almost all settings, Africa reports of an average rate of 4.4% (Kenya 3.9%) with a high rate of unmet need (66.0 ¿80.2%), which is a clear indicator for poor quality obstetric care as well as inadequate access to reproductive health care. Despite it being a common obstetric procedure, criteria for successful and failed induction of labor (IOL) have not been standardized and no universal consensus has been reached to date hence caesarean delivery is often erroneously perceived to be the solution to failed labor induction. Primary caesarean delivery (CS) rate due to failed IOL in Kenyatta National Hospital (KNH) is reported at 51.5% in contrast to 10% in the United States (U.S) and 3% in Australia. The need for uniformity in its definition and management in creating standards on both the duration and number of times the induction can be attempted emerges within this contextual framework and this creates necessity to study the value of repeat induction after failed primary labor induction. BROAD OBJECTIVE: To determine the efficacy of repeat induction versus expectant management after failed primary labor induction on reducing rates of subsequent failed induction at KNH. SPECIFIC OBJECTIVES:1)To compare the final mode of delivery between women randomized to repeat induction and those randomized to expectant management following failed primary induction of labor at KNH.2)To compare time from induction to active phase of labor, time from induction to second stage (induction-delivery interval) and time from induction to decision for CS between women undergoing repeat induction versus expectant management at KNH following failed primary induction of labor.3)To compare the rates of adverse maternal and perinatal outcomes between women undergoing repeat induction versus expectant management at KNH following failed primary induction of labor.

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