LAUSR

The World Health Organization estimated in 2019 that in high-income countries, as many as one in 10 patients is harmed while receiving hospital treatment [1]. The harm can be caused by a range of adverse events, with nearly 50% of them considered preventable. Furthermore, the same report estimates that 134 million adverse events occur each year due to unsafe care in hospitals in low- and middle-income countries (LMICs). This is a major concern in pregnancy because both the mother and the fetus may be harmed. The adverse event may occur during an obstetric intervention such as induction of labour (IOL). A range of adverse pregnancy outcomes such as stillbirth, low birth weight, admission to neonatal intensive-care units, peripartum hysterectomy and neonatal encephalopathy have been associated with medically indicated IOL in LMICs [2,3]. Therefore, IOL should be undertaken only when the benefits of early delivery outweigh the risks of continuing the pregnancy. However, IOL should be undertaken as soon as it is deemed necessary, regardless of time of day or day of the week, as waiting could lead to fetal demise. Understandably, the fetal and maternal complications of IOL in LMICs are not always elevated [2] but the outcomes may nonetheless be improved. This is of particular importance given that the rates of perinatal asphyxia associated with neonatal encephalopathy are typically higher in LMICs than in high-income countries [4]. Certain challenges, because of their frequency of occurrence and association with complications of IOL in LMICs, are key in determining the outcomes of IOL. These challenges include delays in patients accessing appropriate levels of care (due to issues such as transportation difficulty), inability to afford the fees for obstetric care, unavailability of a variety of medications for the procedure, difficulty in storage of some of the medications, poor patient monitoring (emanating from insufficient equipment, hospital bed spaces and experienced medical staff), poor access to safe caesarean delivery, political unrest, and traditional beliefs (including failure of patients to return for scheduled IOL and ingestion of traditional medicines). This editorial discusses these challenges and measures to improve safety for the mother and baby.