Cervical Ripening and Induction of Labor: Awareness, Knowledge, Perception and Attitude of Antenatal Care-Seeking Women at Zagazig University Hospital, Zagazig, Egypt

Ahmed Mohamed Nooh^1*, Mohamed El-Sayed Mohamed²

¹Obstetrics and Gynecology Department, Zagazig University Students’ Hospital, Zagazig, Egypt.
²Obstetrics and Gynecology Department, Zagazig University Faculty of Medicine, Zagazig, Egypt.

DOI: 10.4236/ojog.2015.511088                

Abstract

To assess awareness, knowledge and perceptions of antenatal care-seeking women about cervical ripening (CR) and induction of labor (IOL), and their attitude towards these interventions. Methods: An observational descriptive cross-sectional study which was conducted at an Egyptian teaching hospital. A questionnaire-based interview covered items on women’s demographic and clinical data, as well as their awareness, knowledge, perception and attitude towards specific methods of CR and IOL. Results: A total of 853 questionnaires were analyzed, and 442 respondents (51.8%) were aware of CR and IOL. Knowledge of Oxytocin use was noted in 215 participants (48.6%), of membrane sweeping in 85 (19.2%), of Foley’s catheter in 110 (24.9%) and of Misoprostol in 84 (19.0%). The procedures were perceived to prevent cesarean section in 219 respondents (49.5%). History of previous IOL was a predictor of awareness (OR: 5.19, 95% CI: 1.6 – 11.23, p = 0.001*). Conclusion: This study showed that only a slightly more than 50% of participants were aware of CR and IOL, and the overall knowledge and perception were sub-optimal. Nevertheless, the attitudes towards the procedures were positive. Improved counselling is required in order to further increase knowledge about CR and IOL, and also correct misbelieves particularly in women at risk of undergoing IOL.

Keywords

Cervical Ripening, Induction of Labor, Awareness, Knowledge, Perception, Attitude

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Stephenson, M.L. and Wing, D.A. (2015) A Novel Misoprostol Delivery System for Induction of Labor: Clinical Utility and Patient Considerations. Drug Design, Development and Therapy, 9, 2321-2327.
[2]	Enabor, O.O., Olayemi, O.O., Bello, F.A., et al. (2012) Cervical Ripening and Induction of Labour-Awareness, Knowledge and Perception of Antenatal Attendees in Ibadan, Nigeria. Journal of Obstetrics and Gynaecology, 32, 652-656. http://dx.doi.org/10.3109/01443615.2012.657271
[3]	Carbone, J.F., Tuuli, M.G., Fogertey, P.J., et al. (2013) Combination of Foley Bulb and Vaginal Misoprostol Compared with Vaginal Misoprostol Alone for Cervical Ripening and Labor Induction: A Randomized Controlled Trial. Obstetrics & Gynecology, 121, 247-252.
[4]	Austin, S.C., Sanchez-Ramos, L. and Adair, C.D. (2010) Labor Induction with Intravaginal Misoprostol Compared with the Dinoprostone Vaginal Insert: A Systematic Review and Meta-Analysis. American Journal of Obstetrics and Gynaecology, 202, 624.e1-624.e9. http://dx.doi.org/10.1016/j.ajog.2010.03.014
[5]	Hofmeyr, G.J. (2003) Induction of Labour with an Unfavourable Cervix. Best Practice and Research Clinical Obstetrics and Gynaecology, 17, 777-794. http://dx.doi.org/10.1016/S1521-6934(03)00037-3
[6]	Olson, D.M. (2003) The Role of Prostaglandins in the Initiation of Parturition. Best Practice and Research Clinical Obstetrics and Gynaecology, 17, 717-730. http://dx.doi.org/10.1016/S1521-6934(03)00069-5
[7]	Talaulikar, V.S. and Arulkumaran, S. (2011) Failed Induction of Labor: Strategies to Improve the Success Rates. Obstetrical & Gynecological Survey, 66, 717-728. http://dx.doi.org/10.1097/ogx.0b013e31823e0c69
[8]	Mealing, N.M., Roberts, C.L., Ford, J.B., et al. (2009) Trends in Induction of Labour, 1998-2007: A Population-Based Study. Australian and New Zealand Journal of Obstetrics and Gynaecology, 49, 599-605. http://dx.doi.org/10.1111/j.1479-828X.2009.01086.x
[9]	Kolas, T., Hofoss, D., Daltveit, A.K., et al. (2003) Indications for Cesarean Deliveries in Norway. American Journal of Obstetrics & Gynecology, 188, 864-870. http://dx.doi.org/10.1067/mob.[phone]
[10]	Spong, C.Y., Berghella, V., Wenstrom, K.D., et al. (2012) Preventing the First Cesarean Delivery: Summary of a Joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop. Obstetrics & Gynecology, 120, 1181-1193.
[11]	Abdel-Ghani, R.M. and Berggren, V. (2011) Parturient Needs during Labor: Egyptian Women’s Perspective toward Childbirth Experience, a Step toward an Excellence in Clinical Practice. Journal of Basic and Applied Scientific Research, 1, 2935-2943.
[12]	Abdel-Aleem, H. (2011) Misoprostol for Cervical Ripening and Induction of Labour: RHL Commentary. The WHO Reproductive Health Library, World Health Organization (WHO), Geneva.
[13]	Nooh, A., Baghdadi, S. and Raouf, S. (2005) Induction of Labour: How Close to the Evidence-Based Guidelines Are We? Journal of Obstetrics and Gynaecology, 25, 451-454. http://dx.doi.org/10.1080/01443610500160121
[14]	Hamilton, B.E., Martin, J.A. and Ventura, S.J. (2013) Births: Preliminary Data for 2012. National Vital Statistics Reports, 62, 1-20.
[15]	Dowswell, T., Kelly, A.J., Livio, S., Norman, J.E. and Alfirevic, Z. (2010) Different Methods for the Induction of Labour in Outpatient Settings. Cochrane Database of Systematic Reviews, No. 8, Article ID: CD007701. http://dx.doi.org/10.1002/14651858.cd007701.pub2
[16]	Afolabi, B.B., Oyeneyin, O.L. and Ogendengbe, O.K. (2005) Intravaginal Misoprostol versus Foley Catheter for Cervical Ripening and Induction of Labour. International Journal of Gynaecology and Obstetrics, 89, 263-267. http://dx.doi.org/10.1016/j.ijgo.2005.02.010
[17]	Al-Ateeq, M.A. and Al-Rusaiess, A.A. (2015) Health Education during Antenatal Care: The Need for More. International Journal of Women’s Health, 7, 239-242. http://dx.doi.org/10.2147/IJWH.S75164
[18]	Alfirevic, Z., Kelly, A.J. and Dowswell, T. (2009) Intravenous Oxytocin Alone for Cervical Ripening and Induction of Labour. Cochrane Database of Systematic Reviews, No. 4, Article ID: CD003246. http://dx.doi.org/10.1002/14651858.cd003246.pub2
[19]	Kelly, A.J. and Tan, B. (2001) Intravenous Oxytocin Alone for Cervical Ripening and Induction of Labour. Cochrane Database of Systematic Reviews, No. 3, Article ID: CD003246. http://dx.doi.org/10.1002/14651858.cd003246
[20]	Abdellah, M.S., Hussien, M. and Aboalhassan, A. (2011) Intravaginal Administration of Isosorbidemononitrate and Misoprostol for Cervical Ripening and Induction of Labour: A Randomized Controlled Trial. Archives of Gynecology and Obstetrics, 284, 25-30. http://dx.doi.org/10.1007/s00404-010-1572-4
[21]	Habib, S.M., Emam, S.S. and Saber, A.S. (2008) Outpatient Cervical Ripening with Nitric Oxide Donor Isosorbidemononitrate Prior to Induction of Labor. International Journal of Gynecology & Obstetrics, 101, 57-61. http://dx.doi.org/10.1016/j.ijgo.2007.09.027
[22]	Elati, A. and Weeks, A. (2009) The Use of Misoprostol in Obstetrics and Gynaecology. BJOG, 116, 61-69. http://dx.doi.org/10.1111/j.1471-0528.2009.02329.x
[23]	Goel, K., Gedam, J.K., Rajput, D.A. and Bhalerao, M.V. (2014) Induction of Labor: A Review. Indian Journal of Clinical Practice, 24, 1057-1064.
[24]	Abdel-Barr, T., Elshalakany, N.A. and Shafik, Y.M. (2014) Single Dose Spinal Analgesia: Is It a Good Alternative to Epidural Analgesia in Controlling Labour Pain? Egyptian Journal of Anaesthesia, 30, 241-246. http://dx.doi.org/10.1016/j.egja.2014.02.003
[25]	Shetty, A., Burt, R., Rice, P. and Templeton, A. (2005) Women’s Perceptions, Expectations and Satisfaction with Induced Labour—A Questionnaire-Based Study. European Journal of Obstetrics & Gynecology and Reproductive Biology, 123, 56-61. http://dx.doi.org/10.1016/j.ejogrb.2005.03.004
[26]	Simpson, K.R. and Atterbury, J. (2003) Trends and Issues in Labour Induction in the United States: Implications for Clinical Practice. Journal of Obstetric Gynaecological and Neonatal Nursing, 32, 767-769. http://dx.doi.org/10.1177/0884217503258528
[27]	Heimstad, R., Romundstad, P.R., Hyett, J., Mattsson, L.-A. and Salvesen, K.A. (2007) Women’s Experiences and Attitudes towards Expectant Management and Induction. Acta Obstetrics and Gynaecology Scandinavia, 86, 950-956. http://dx.doi.org/10.1080/00016340701416929
[28]	Chigbu, C.O. and Ezenyeaku, C.C. (2008) Women’s Opinions and Experiences with Induction of Labour and Caesarean Delivery on Request in South Eastern Nigeria. International Journal of Gynaecology and Obstetrics, 103, 158-161. http://dx.doi.org/10.1016/j.ijgo.2008.06.006
[29]	Aziken, M., Omo-Aghoja, L. and Okonofua, F. (2007) Perceptions and Attitudes of Pregnant Women towards Caesarean Section in Urban Nigeria. Acta Obstetrics and Gynaecology Scandinavia, 86, 42-47. http://dx.doi.org/10.1080/00016340600994950
[30]	Angeja, A.C., Washington, A.E., Vargas, J.E., Gomez, R., Rojas, I. and Caughey, A.B. (2006) Chilean Women’s Preferences Regarding Mode of Delivery: Which Do They Prefer and Why? BJOG, 113, 1253-1258. http://dx.doi.org/10.1111/j.1471-0528.2006.01069.x