Department of Midwifery, College of Medicine and Health Science, Woldia University, Woldia, Ethiopia.
Department of Nursing, College of Medicine and Health Science, Woldia University, Woldia, Ethiopia.
PLoS One. 2024 Nov 15;19(11):e0305384. doi: 10.1371/journal.pone.0305384. eCollection 2024.
The occurrence of failed induction led to higher rates of health problems and death among mothers, mainly as a result of complications related to cesarean delivery, such as postpartum bleeding, morbidly adherent placenta and surgical site infection. Even though a systematic review and meta-analysis were done before July 2020 with limited studies, there were varies inconsistent studies after that and no updated summarize evidence about the issue as a nation. Therefore, this systematic review and meta-analysis aimed to assess the current pooled prevalence of failed induction and its associated factors in Ethiopia by including multiple inconsistent studies.
Comprehensive literature was searched in PubMed, Google Scholar, and HINARI from January 1, 2013, to September 23, 2023. A random effect model was used to estimate pooled prevalence and adjusted odds ratio. Stata (version17.0) was used to analyze the data. Cochrane Q-test and I squared statistics were computed to assess heterogeneity among studies. A sub group analysis was done based on study region to minimize underling heterogeneity. Funnel plot and Eggers test were done to assess publication bias and corrected by trim and fill analysis.
Overall, one thousand fifty-two articles were retrieved and finally twenty-eight studies were included in this systematic review, including 9757 participants. The pooled prevalence of failed induction of labor was 22.39% (95% CI: 21.57-23.21). Subgroup analysis showed that failed induction of labor was highest in Addis Ababa and lowest in Tigray region. Rural residence (AOR = 3.31, 95% CI: 2.39-4.57), nullipara women (AOR = 2.63, 95% CI: 2.14-3.24), unfavorable bishop score (AOR = 3.98, 95% CI: 2.19-7.08), hypertensive disorder during pregnancy (AOR = 3.63, 95% CI: 2.69-5.01) and premature rupture of membranes before the onset of labor (AOR = 2.51, 95% CI: 1.5-4.26) were significantly associated with failed induction of labor.
The pooled prevalence of failed induction of labor in Ethiopia was high. Unfavorable bishop score, nulliparous, rural residence, women who had premature rupture of membrane and hypertensive disorder during pregnancy were significantly associated with failed induction of labor. Therefore, Healthcare providers or obstetricians should consider proper cervical assessment for bishop score before the initiation of induction. The Ministry of Health ought to create a distinct set of guidelines specifically addressing the cervical ripening and/or induction protocol for women who experienced premature rupture of membranes (PROM) and had a hypertensive disorder during pregnancy, especially those who were administered magnesium sulfate (MgSO4).
引产失败导致母亲出现更高的健康问题和死亡风险，主要是由于剖宫产相关的并发症，如产后出血、病态粘连胎盘和手术部位感染。尽管在 2020 年 7 月之前进行了一项系统评价和荟萃分析，但此后有许多不一致的研究，而且没有关于该问题的最新综合证据。因此，本系统评价和荟萃分析旨在通过纳入多项不一致的研究，评估埃塞俄比亚目前引产失败的综合流行率及其相关因素。
从 2013 年 1 月 1 日至 2023 年 9 月 23 日，在 PubMed、Google Scholar 和 HINARI 中全面检索文献。使用随机效应模型估计汇总流行率和调整后的优势比。使用 Stata（版本 17.0）分析数据。Cochrane Q 检验和 I 平方统计用于评估研究之间的异质性。根据研究区域进行亚组分析，以最大程度地减少潜在的异质性。漏斗图和 Eggers 检验用于评估发表偏倚，并通过修剪和填充分析进行校正。
总共检索到 1052 篇文章，最终有 28 项研究纳入本系统评价，包括 9757 名参与者。引产失败的综合流行率为 22.39%（95%CI：21.57-23.21）。亚组分析显示，引产失败在亚的斯亚贝巴最高，在提格雷地区最低。农村居住（AOR=3.31，95%CI：2.39-4.57）、初产妇（AOR=2.63，95%CI：2.14-3.24）、不良的bishop 评分（AOR=3.98，95%CI：2.19-7.08）、妊娠期高血压疾病（AOR=3.63，95%CI：2.69-5.01）和胎膜早破（AOR=2.51，95%CI：1.5-4.26）与引产失败显著相关。
埃塞俄比亚引产失败的综合流行率较高。不良的 bishop 评分、初产妇、农村居住、胎膜早破和妊娠期高血压疾病与引产失败显著相关。因此，医疗保健提供者或产科医生应在开始引产前对 bishop 评分进行适当的宫颈评估。卫生部应制定一套明确的指南，专门针对经历胎膜早破和妊娠期高血压疾病的妇女的宫颈成熟和/或引产方案，特别是那些接受硫酸镁（MgSO4）治疗的妇女。
