Vaginal Delivery Following Induction of Labor Among Women With Preeclampsia at Kenyatta National Hospital

Abstract

Background: Preeclampsia in Kenya is prevalent at 6.1%, with a 0.3% incidence. Placental delivery is the only cure. This can be achieved through induction of labor (IOL) or spontaneous labor(SL), both of which can result in vaginal birth (VD), an emergency cesarean section (CS), or by performing an elective CS. According to earlier research, women with preeclampsia are less likely to deliver vaginally after IOL than women without preeclampsia, and emergency CS after IOL results in worse maternal and neonatal outcomes for mothers with preeclampsia than elective cesarean section or VD after IOL. This study aimed to establish the incidence of and factors associated with VD following IOL in women with preeclampsia at Kenyatta National Hospital (KNH). Methods: The study reviewed preeclampsia-related births at KNH from Jan 1, 2020, to Dec 31, 2021, using an unmatched case-control design. Records of 458 preeclampsia-related births were retrieved, divided into cases (254) and controls (204). Seventy-two cases and 72 controls were chosen at random from each group The data from both the cases and controls was collected, then imported, processed, and examined using SPSS version 26. Descriptive statistics were summarized as percentages, frequencies, means, and standard deviations The study compared cases and controls to identify variables related to VD after IOL using Chi-square tests, t-tests, Mann-Whitney U tests, and multivariable logistic regression. A p-value of <0.05 was considered significant for all statistical tests. Results: The incidence of VD following IOL among women with preeclampsia was 56% (254/458), 95% CI (50.0%-60.7%)). On multivariate logistic regression analysis only multiparity, favorable Bishop scores were significantly associated with increased odds of vaginal delivery. Multiparity (aOR 10.53, 95% CI:2.82-39.37), p= <0.001), Favorable Bishop score (aOR 5.34, 95% CI:1.66-17.22), p=0.05). Conclusions: The incidence of VD following IOL among women with preeclampsia at KNH women is 56%, with favorable Pre-Induction Bishop score and multiparity significantly increasing odds of VD.