Induction of labor outcomes: Insights from a single-center experience from Yemen
Authors: Thabet Anessa , Dajenah Menawar , Ahmed Faisal , Ghabisha Saif , Dajenah Zaid , Al-Hagri Abdulghani , Badheeb Mohamed 
Published: February 2025

Background: Induction of labor (IOL) is the iatrogenic stimulation of uterine contractions before the onset of spontaneous labor, and it is used as a therapeutic option when the potential maternal and/or fetal benefits outweigh the associated risks. Given that IOL as an intervention can be detrimental to both mother and child, it is crucial to ensure that the benefits of the shift in clinical practice exceed the risks. Since little is known about IOL in Yemen, this study was conducted to identify the predictive factors of IOL success or failure.

Methods: A retrospective cross-sectional study was conducted on laboring mothers who gave birth following IOL at Al-Thora General Hospital, Ibb, Yemen, over a three-year period, from June 2019 to January 2022. All eligible participants were enrolled at admission using structured questionnaires and quota sampling techniques until the desired sample size was achieved. Data on the parturient’s sociodemographic characteristics, induction methods, and outcomes were taken from personal case files and the hospital’s maternity/delivery register. The factors influencing IOL outcomes were determined using a logistic regression analysis.

Results: The average age of the 505 individuals induced into labor was 26.99 ± 6.24 years, and the majority of them (46.1%) were in the 25–34 age range. A significant proportion (74.3%) lived in urban areas, and the majority (66.1%) regularly attended perinatal care. Premature rupture of membranes (PROM) was the main cause of IOL at 65.1%. Following IOL, 444 women (87.9%) gave birth vaginally. A total of 61 (12.1%) cases had cesarean deliveries. Multivariate logistic regression analysis revealed that the odds ratio (OR) for significantly predicting IOL success for mothers aged 25–34 years was 0.46 (95% CI: 0.26–0.84, p = 0.013). The adjusted OR (AOR) indicated that multiparity (AOR: 0.24; 95% CI: 0.12–0.49, p < 0.001), misoprostol use for induction (AOR: 0.34; 95% CI: 0.18–0.65, p < 0.001), PROM (AOR: 0.34; 95% CI: 0.15–0.78, p = 0.011), and oligohydramnios cases (OR: 0.19, 95% CI: 0.04–1.00, p = 0.050) significantly predicted IOL success. Conversely, maternal complications (OR: 1.41; 95% CI: 0.13–15.13), maternal age exceeding 34 years (OR: 1.23; 95% CI: 0.48–3.19), gestational age between 37 and 40 weeks (OR: 1.28; 95% CI: 0.48–3.41) or beyond 40 weeks (OR: 1.42; 95% CI: 0.36–5.53), baby weight between 2 and 4 kg (OR: 1.39; 95% CI: 0.64–3.04), and post-term pregnancies (OR: 1.07; 95% CI: 0.32–3.49) all increased the risk of IOL failure.

Conclusion: Mothers between the ages of 25 and 34 years, those with multiparity, misoprostol users, PROM cases, and oligohydramnios cases had higher rates of IOL success. In contrast, advanced maternal age, advanced gestational age, advanced baby weight, and post-term pregnancies were all associated with IOL failure. Therefore, in order to provide safe IOL care, healthcare professionals should take these factors into account. The majority of failed IOL determinants were associated with unjustified and inconsistent IOL indications. Therefore, developing well-established practical guidelines and avoiding unjustified case selection may help reduce IOL failure rates.