DISCUSSION
Labour induction is carried out in 20% pregnancies in developed countries.11 It is an important option when continuation of the pregnancy increases the risk on the mother and baby, but the induction of labour itself increases the risks as well as there are chances of its failure. The safety and effectiveness of labor induction depends on the health of the woman and her baby. In this study most of the pregnant women 83 (60.14%) presented between 21-30 years of age and were prim gravid 78(56.5%), in comparison with Nigerian study12 wherein common age of the women were between 25-29 years (30.4%) and nulliparous women were 39.1%, this difference could be due to the early marriage and high frequency of hypertensive disorders in prim gravid women.
The gestational period was between 35-38 weeks in majority of the women 71(51.4%), this is tertiary care hospital receiving all the referred cases, these were the women with gestational hypertension and with associated problems, considering the health of the women and her baby labour induction was decided. Comparing with other studies13,14 pregnant women with gestational hypertension having induction of labour between 38-39 weeks leading to lowest chances for maternal and neonatal morbidity and mortality as well as lower in cost and decrease Caesarean section rate. Despite the lack of evidence that would justify intervention, many obstetricians induce labour in women at term with pregnancy-induced hypertension or preeclampsia. Such a policy may increase the risk of assisted vaginal delivery and caesarean section, thus generating additional morbidity and costs.15 Proper antenatal cares and hospitalization in case of need at appropriate time with careful fetomaternal monitoring will help in continuation of pregnancy till term and it will lead to improvement in maternal condition and fetal outcome.
Presenting complaints with gestational hypertension were oedema 119(86.23%), headache 90(65.21%), pain in epigastrium 78(56.52%), blurring of vision 65(47.1%), severity of the gestational hypertension is associated with retinopathy.16 In this study 15(10.9%) women had fits in comparison with other national study the frequency of eclampsia was 3/100.17 This difference could be due to various reasons like un-booked status, late referral, and non-availability of proper labour analgesics (Epidural). The severity of pregnancy induced hypertension is assessed with the extent of symptoms.18 Cervix was unfavorable in majority of the cases and labour induction was performed with prostaglandins in 81(58.7%) women, other methods were syntocinon infusion, intracervical foley, scatheter. These all are the recommended methods for the induction of labour.19 Labour induction outcome resulted in normal vaginal deliveries in 89(64.49%) women, instrumental vaginal deliveries in 10(7.2%) women. Caesarean section was performed in 39(28.3%) women due to failed induction or with maternal or fetal reasons, this is consistent with Zaiba Sher et al. study.20
In this study maternal morbidities and fetal morbidities as well as fetal mortality rate was higher. This can be due to the unbooked status, severity of the condition, and limited intensive care facilities for the new born, low birth weight, and poor fetal reserves. The clinical course of pregnancy induced hypertension is progressive as its severity increases the chances of fetomaternal complications that can only be stopped by delivery therefore the frequency of labour induction and related fetomaternal morbidity is high considering all these factors early detection of the risky cases and with timely, early appropriate management will overcome this.21,22
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