REPEAT INDUCTION VERSUS EXPECTANT MANAGEMENT AFTER FAILED PRIMARY LABOR INDUCTION AT TERM: A RANDOMISED CLINICAL TRIAL AT KENYATTA NATIONAL HOSPITAL.

INTERVENTION: EXPECTANT MANAGEMENT REPEAT LABOR INDUCTION CONDITION: ; Pregnancy and Childbirth ; FAILED PRIMARY LABOR INDUCTION FAILED PRIMARY LABOR INDUCTION Pregnancy and Childbirth PRIMARY OUTCOME: 1) Time from induction to active phase of labor: entry into active phase of labor within the designated time. This was chosen as a primary outcome in line with literature review that failed IOL should be defined as the inability to achieve active phase of labor. In this instance, final outcome of pregnancy (mode of delivery) which is associated with confounders is not considered. SECONDARY OUTCOME: 1)Time from induction to second stage (induction‐delivery interval) 2)Time from induction to decision to perform CS 3)Final mode of delivery: vaginal vs caesarean delivery 4)Adverse maternal outcome defined as or including maternal nausea, vomiting, diarrhea, postpartum haemorrhage, uterine hyperstimulation with FHR changes, uterine rupture, instrumental vaginal delivery, intensive care unit admission, chorioamnionitis, duration of hospital stay, maternal death 5)Early neonatal morbidity defined as or including meconium‐stained liquor, Apgar score less than seven at five minutes, NICU admission for more than 48 hours, neonatal encephalopathy, perinatal death INCLUSION CRITERIA: The participants to be included will be mothers for induction of labor with: 1.Singleton, live gestation in cephalic presentation 2.Gestation at or beyond 37 weeks 0 days (37 0/7) 3.Post‐term pregnancy 4.Bishop score <6 at failed primary labor induction diagnosis 5.Reactive fetal heart rate pattern 6.Intact membranes 7.Oligohydramnios 8.Hypertensive disorders (preeclampsia without severe features and pregnancy induced hypertension) 9.Diabetes mellitus requiring insulin 10.Maternal cardiac disease: mild cardiac disorders 11.Fetal growth restriction without evidence of fetal compromise on Doppler U/S 12.Elective induction 13.Willing to participate and give a signed informed consent