Induction of labour at district hospitals in the Cape Winelands District of South Africa : a quality of care audit

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Stellenbosch : Stellenbosch University
ENGLISH SUMMARY: Introduction: Induction of labour (IOL) is when the process of labour is artificially initiated before the onset of spontaneous labour. Evidence suggests that IOL can improve obstetric outcomes, especially in the context of prolonged pregnancy, hypertensive disorders and prolonged rupture of membranes. Limited information is available on the quality of care received during IOL at district hospitals in South Africa. Aim: To audit the quality of care provided during IOL at district hospitals in the Cape Winelands District (CWD) of South Africa. Methods: An audit of the structure, process and outcomes of IOL performed at three district hospitals in the CWD. Retrospective data was collected from records of patients who underwent IOL at the district hospitals between 1 July 2021 and 31 December 2021. Results: This audit included 147 IOL cases. The IOL rate was 6.8 %. The most common indication for IOL was prolonged pregnancy (57.8%). Misoprostol was the induction agent of choice in 70,1 % of cases while mechanical IOL was performed in only 6.1% of cases. After IOL, 39.8 % of patients had a caesarean delivery. Vaginal delivery within 24-hours after starting IOL was achieved in 47.6% of cases. No cases of maternal or neonatal morbidity were recorded. Conclusion: Adequate structures were in place at the district hospitals to perform IOL, including the availability of medication, equipment and surgical capacity. The process of IOL did not fully align with the South African Maternity Care Guidelines regarding the correct use of the Bishop score and mechanical methods of IOL. Maternal and neonatal outcomes were satisfactory, however the high caesarean delivery rate after IOL and the low delivery rate within 24 hours after IOL were concerning.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.
Thesis (MFamMed)--Stellenbosch University, 2023.