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The hazards of conducting induction of labour in high-risk pregnancies at district hospitals in low- and middle-income countries: lessons to learn from a case report Ngene, Nnabuike Chibuoke & Moodley, Jagidesa Abstract Background: Induction of labour (IOL) is an obstetric procedure that should be conducted in a healthcare facility with the capacity to provide optimal care based on the patient risk status. Inadequate monitoring, untimely procedure and lack of readily available and experienced medical staff to participate in the care of the patient undergoing induction are hazardous with snowball effects. Methods: A 38-year-old G4P2+1 had IOL because of oligohydramnios at term in a district hospital. The procedure was inadequately monitored and fetal demise occurred. The duration of second stage was prolonged and sequential use of vacuum and forceps deliveries were unsuccessfully performed. Results: At the ensuing caesarean delivery, uterine rupture/tear was diagnosed, and the patient died due to haemorrhage during an emergency hysterectomy. Conclusion: This report highlights important clinical lessons on IOL in a high-risk pregnancy. The timelines for monitoring during IOL, particularly when there is fetal demise in labour, are proposed. Keywords Assisted vaginal delivery; induction of labour; prolonged labour; oligohydramnios; uterine tear.

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