Prevalence of Labor Induction, its Indication, and Feto-Maternal Outcomes in Ethiopia: A Systematic Review and Meta-Analysis.

Abstract

Labor induction (IOL) is a common obstetric intervention to stimulate uterine contractions before the spontaneous onset of labor, with the goal of achieving vaginal delivery. It is indicated for various reasons, including post-term pregnancy, premature rupture of membranes (PROM), maternal medical conditions, and fetal growth restriction. This study aims to evaluate the prevalence of labor induction, its indications, and the associated maternal and fetal outcomes in Ethiopia. A comprehensive search for relevant articles was conducted using widely recognized databases such as Google Scholar, Cochrane, PubMed, HINARI, Web of Science, African Online, and institutional repositories from Ethiopian universities. Data were extracted using the standard format provided by the Joanna Briggs Institute. The Cochran <i>Q</i> test and <i>I</i>² statistics were employed to assess the heterogeneity of the studies. Publication bias was evaluated using a Funnel plot and Egger's test. A Forest plot was used to present the pooled prevalence of labor induction in Ethiopia. This systematic review and meta-analysis revealed that the overall pooled prevalence of induction of labor in Ethiopia was 14.4% (95% CI: 11.09-17.70; <i>I</i>² = 95.7%, <i>P</i> < .01). The primary indications for labor induction included premature rupture of membranes (33.91%), intrauterine fetal death (8.8%), intrauterine growth restriction (4.85%), post-term pregnancy (21.49%), oligohydramnios (12.2%), and hypertensive disorders (30.7%). Maternal complications related to induction of labor included postpartum hemorrhage (9.47%), cesarean section (28.68%), instrumental delivery (18.82%), and vaginal tears (14.45%). Adverse fetal outcomes included low Apgar scores at 1 min, fetal death, and neonatal intensive care unit (NICU) admission, with respective rates of 48.2%, 6.11%, and 15.5%. According to this systematic review and meta-analysis, the estimated overall prevalence of induction of labor in Ethiopia is 14.4%. The indications for induction of labor include premature rupture of membranes (PROM), intrauterine fetal death (IUFD), intrauterine growth restriction (IUGR), post-term pregnancy, oligohydramnios, and hypertensive disorders. Maternal complications of labor induction include postpartum hemorrhage (PPH), cesarean section, instrumental delivery, and vaginal tear. Adverse fetal outcomes associated with induction of labor include a low first-minute Apgar score, fetal death, and admission to the neonatal intensive care unit (NICU). Careful consideration and balancing of risks are essential when deciding to induce labor. Additionally, clear national protocols and follow-up on induction of labor are crucial to mitigate these risks. Registration number: reviewregistry2051.