Prevalence and Risk Factors for Caesarean Section Delivery Following Labour Induction at Mbarara Regional Referral Hospital

Atukunda Sandra

Faculty of Clinical Medicine and Dentistry Kampala International University Western Campus Uganda.


Labour induction is one of the most common obstetric interventions. According to most current studies, the rate varies from 9-33% of all pregnancies annually. According to American Congress of Obstetricians and Gynecologists, one-fifth of all pregnancies are terminated with the induction method. The aim of induction is to prevent maternal and fetal disorders such as preeclampsia, premature rupture of membranes, intrauterine growth retardation and prolonged pregnancy. Since the purpose of induction is vaginal delivery, a number of authors consider successful induction as vaginal delivery without regarding to the time limits. Induction failure is defined as failure of induction leading to cesarean section. The aim of this study was to determine the relationship between induction and risk of cesarean section delivery for women with term pregnancies who were admitted to Mbarara Regional Referral Hospital. A hospital based retrospective cohort study was conducted using maternally-linked data from MRRH birth registry. The study was restricted to deliveries intervened by labor induction at Mbarara Regional Referral Hospital during the year 2019 to 2021. Study samples size were 180 cases using convenience sampling among eligible pregnant women admitted to MRRH for induction. Data analysis was performed using SPSS version 21. Chi-square and t-test were used to compare groups with significant levels of less than 0.05, and logistic regression test was used to determine odds ratio with 95% confidence level. The mean age of those who underwent induction were 26.7 ± 5.6 years. In terms of education, 63.3 % were at the elementary level, the majorities (94.6%) were housewives or unemployed prior to delivery, and 57.4% were nulliparous.  The prevalence of cesarean section was 22.21%. The mean gestational age was 39.3 ± 2.6 weeks and post-term pregnancies (40.63%), and PROM (24.12%) were among the most common causes for induction. Dilatation and birth weight were factors predicting labour induction success. Furthermore, performing Induction in dilatation 3 cm or less was associated with an increased risk of cesarean delivery. The prevalence of caesarean section after induction of labour in this study was 22.1%. Cervical dilatation (3 cm or less) prior to induction and increasing birth weight could be the major factors leading to caesarean section, hence predicting labor induction success. More funding is necessary by the hospital to further give more light to the all-time prevalence of cesarean section following labor induction within MRRH.

Keywords: Labour induction, vaginal delivery, Cesarean section, Maternal and fetal disorders, Premature rupture of membranes.


Pregnancy and delivery are normal physiological phenomena that occur in women [1]. The majority of pregnant women give birth by spontaneous vaginal delivery often achieved through labor induction [2]. However, approximately 10% of deliveries are considered as high risk, which may require cesarean section (CS) [1]. Cesarean section is a surgical intervention which is carried out to ensure safety of mother and child when vaginal delivery is not possible (emergency CS) or when the responsible doctors consider that the danger to the mother and baby of vaginal delivery outweighs the risks of CS (planned CS) [1]. Latest available data (2010–2018) from 154 countries covering 94.5% of world live births shows that 21.1% of women gave birth by caesarean worldwide, averages ranging from 5% in sub-Saharan Africa to 42.8% in Latin America and the Caribbean [3]. CS has risen in all regions since 1990 from around 7% to 21.1% (1 in 5) today. Sub-regions with the greatest increases were Eastern Asia (44.9%), Western Asia (34.7%) and Northern Africa (31.5%) while sub-Saharan Africa (3.6%) and Northern America (9.5%) had the lowest rise. Projections showed that by 2030, 38 million (28.5 %%) of women worldwide will give birth by CS annually of which 33.5 million (88%) will be in Low-to-Middle-Income Countries (LMIC) ranging from 7.1% in sub-Saharan Africa to 63.4% in Eastern Asia [4]. In Uganda, the overall rate of CS for live births at facilities was 9.9%, increasing from 8.5% in 2012 to 11% in 2016 [5]. There are higher rates of CS deliveries in south western Uganda than the national CS rates & WHO recommended rates. Available data from 286 health facilities in Uganda representing 509,206 births and 71% of facilities performing caesarean delivery (CD) revealed that the overall CD rate is 17.9% ranging from 0.08% to 78% [6]. Most CDs are performed in General Hospitals (50.4%) and Regional Referral Hospitals (RRHs) (24.5%) while Heath Centre IVs and Private Not For Profit (PNFP) facilities account for only 18.5%) and 6.7% of the CDs respectively. There is significant variation in CD rates by facility type with RRHs more likely to have CD rates >30% compared to GH and HCIVs [7]. However, the rates of cesarean section at Mbarara Regional Referral Hospital (MRRH) does not support the figures described by Demographic Health Survey. In fact, it is expected that the cesarean section rates have been above the recommended rate by WHO (10 to 15 percent) for several years now [8]. There are several C-sections done at Mbarara Regional Referral hospital of over 250 C-sections averagely every month and it has been noticed that several mothers who undergo the operations have issues on the operation site which include wound infection, bleeding at the site, and burst abdomen [5]. There is increased mortality and morbidity of mothers who have undergone Cesarean section at Mbarara RRH. According to [9]. Puerperal sepsis was the leading cause of maternal death at Mbarara Regional Referral Hospital [5]. Various studies have been conducted on the prevalence and associated risk factors of caesarean section deliveries in different countries like China [10], Pakistan [11], Asia [12], Nepel [13], Ethiopia [14]; [1]. Tanzania [15], Uganda [16-18]. While studies in Uganda exist, studies on Mbarara regional referral hospital are limited yet this serves as the biggest hospital providing CS in western Uganda. The available studies in western Uganda have been conducted from a private hospital in Bushenyi [19], and this may not be generalized to the wider population. It is against the above background that the study sought to examine the Prevalence and Risk Factors for Caesarean Section Delivery following Labor Induction at Mbarara Regional Referral Hospital.


The prevalence of caesarean section after induction of labor in this study was 22.1%. Cervical dilatation (3 cm or less) prior to induction and increasing birth weight could be the major factors leading to caesarean section, hence predicting labor induction success.

Strengths and Limitations

The strengths of this study are; being prospective, investigating nulliparous and multiparous women who are undergoing induction for medical reasons, providing information regarding the confirmation of Bishop score in predicting successful induction, providing information on the outcome of induction as one of the most common obstetric interventions as well as, data collected by trained midwives. Weaknesses of this study could be lack of data on Latent and Active phase during the first stage and second stage of labor, groups were not separated into nulliparous and multiparous women, nulliparous and multiparous groups were not compared, and they were not compared with women in spontaneous labor. Also the complications of this procedure have not been studied and cervical check has been done only by finger examining. Because this study was conducted only at one center, it has a low power and cannot be generalized effectively. Therefore, further studies should be conducted to determine the induction period and decision time for intervention in nulliparous and multiparous women.


  • More funding is necessary by the hospital to further give more light to the all-time prevalence of cesarean section following labor induction within MRRH


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CITEA AS: Atukunda Sandra (2023). Prevalence and Risk Factors for Caesarean Section Delivery Following Labour Induction at Mbarara Regional Referral Hospital. IDOSR JOURNAL OF SCIENTIFIC RESEARCH 8(3) 59-68. JSR /2023/00.5.6000