Reducing Caesarean Rates in Qatar: A Pressing Public Health Imperative – Policy adjustments in Labour Inductions.

Background

Caesarean rates have doubled in 15 years, increasing 4% annually with disastrous public health consequences from associated maternal and perinatal morbidity and mortality. A policy adjustment favouring second cycle Prostaglandin inductions could reduce these rates. Although research studies support this proposal, efficacy and safety data are limited. A review of the efficacy and safety of Prostaglandin induction between 2020-2022 was proposed.

Methods

An electronic patient record review of Al Wakra Hospital labour inductions, maternal and perinatal outcomes in women who required a second cycle of Prostaglandin induction was conducted. Outcome data obtained in this cohort included parity, successful labour induction, mode of delivery, and significant maternal and neonatal morbidity.

Results

There were 1,707 labour inductions during the two-year audit period, 790 were Prostaglandin inductions, 100 requiring a second induction cycle. Among primiparae, 44% had a vaginal delivery while 56% had a Caesarean section. 75% of multiparae had a vaginal delivery with 25% needing Caesarean section. The risk of Caesarean was higher among primiparae compared to multiparae (Figure 1). Postpartum haemorrhage occurred in 12 %, and postpartum pyrexia in 28%, 13% of whom had a positive blood culture result to various organisms. Notably, 87% of newborns had a 5-minute Apgar ≥ 9, and no cases were reported with a 5-minute Apgar score below 7. Maternal and neonatal morbidity did not increase compared to baseline unit data, and 50% of the women achieved a vaginal delivery, reducing the number of Caesarean sections.

Conclusion

The use of a second cycle of vaginal Prostaglandin E2 (PGE2 ) for induction of labour was effective and safe as reflected by the absence of birth asphyxia, and low rates of comparable times to delivery without significant complications (Figure 2). Randomized controlled trials are needed to identify ideal dosage regimens from a clinical and cost?effectiveness perspective.