Induction of labour is one of the common obstetric interventions in the world with varied incidence rates between developed and developing countries. It is generally employed by obstetricians and physicians managing pregnant women when the risk of continuing such pregnancy is far greater than delivery at that said point. A detailed evaluation and indications for induction of labour should be done for every single woman. Methods of induction of labour could be pharmacological, mechanical or both; taking care to reduce or eliminate complications associated with this intervention. Decision for induction of labour should involve the most senior member of the team with a woman centered approach to care. Induction of labour carries multiple risks and complications compared with spontaneous onset of uterine contractions with increase tendency of operative vaginal delivery and caesarean section.

Sonographic assessment of amniotic fluid has formed an integral and important component of pregnancy assessment of fetal wellbeing. Changes in amniotic fluid volume are associated with variable outcome of the fetus. Amniotic fluid index which is an objective means of assessing adequacy of amniotic fluid volume does not only vary with gestational age but also differs from population to population. The study determined the reference values of amniotic fluid index and compared the values with the established ranges throughout gestation in uncomplicated singleton pregnancies among women attending our antenatal care facility. This was a longitudinal prospective assessment of amniotic fluid index in eighty six healthy pregnant women with singleton pregnancies recruited at 20 to 22 weeks of gestation and followed up to 41 weeks and 3 days. The patients recruited at 20 weeks had amniotic fluid measurements at recruitment and 4 weeks apart until 40 weeks gestation. Those recruited at 22 weeks had it also at recruitment and 4 weekly with the last estimation at 41 weeks +3 days. These measurements were plotted against their respective gestational ages. The graph was then analyzed using statistical and graphical packages of SPSS version 21. The study populations mean, 5 th and 95 th percentiles was documented and discussed appropriately. A total of 414 readings were obtained from 81 subjects who underwent more than 3 measurements. Analysis of the data obtained shows a rising AFI with a mean 28 weeks and, thereafter gradually fell till term. The mean age obtained in the study group compared with that of Caucasians showed statistically significant difference (P=0.014). Also, comparison with Chama et al. showed obvious statistical difference at the lower limit (5 th percentile; P=0.007, 50 th percentile; P=0.006) but no differences at the upper limit (95 th percentile; P=0.726). Amniotic fluid index values appear to be differing in different population. The reference range of AFI used in clinical practice should therefore be based on data obtained from local population.

The rising rate of caesarean section has implications in the reproductive performance of a woman and increases the likelihood of complications during repeat operations, whether they are planned or performed on an emergency basis. A successful vaginal delivery after caesarean is associated with increased maternal satisfaction, reduced caesarean section rate, and appears to be cost effective. There is a need for careful selection of women that are willing to attempt vaginal birth after caesarean with a clear set of local protocols to increase overall success rate, reduce litigation and improve neonatal outcome. The benefits and risks of planned vaginal birth after caesarean and elective repeat caesarean section should be discussed in detail with the woman during antenatal care and reemphasized at admission to the labour ward. A decision to embark on VBAC should be free from coercion with full informed consent as the bedrock for such a decision. Facilities offering vaginal birth in women with prior caesarean delivery should be equipped with 24-hour standby emergency caesarean section capability. The intrapartum care should be carefully tailored to meet the woman’s need with support from the health care team. Every obstetrics unit should debrief women after delivery irrespective of the outcome and should conduct regular audits to improve the care of women with previous caesarean sections.

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