Feasibility analysis of cervical ripening and labor induction under the whole process management during delivery

doi:10.3877/cma.j.issn.1673-5250.2022.03.015

Objective

To explore the feasibility of cervical ripening and labor induction under the whole management during delivery.

Methods

From January 1, 2018 to December 31, 2020, a total of 848 puerperae who received whole process delivery management in labor-delivery-recovery-postpartum (LDRP) integrated ward in the Department of Obstetrics and Gynecology of Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School were selected as research subjects. According to whether in labor or not, 848 puerperae were divided into natural labor group (n=441) and induced labor group (n=407). The general clinical data, such as age, gravidity, gestational age, pregnancy complications and delivery outcomes were compared between two groups by restrospective study mehod. The procedure followed in the study met the requirements of the Helsinki Declaration of the World Medical Association revised in 2013, and had been reviewed and approved by the Ethics Committee of Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School (Approval No. 201702001).

Results

① There were no significant differences between two group in the age, the proportion of elder pregnant women and gravidity (P>0.05). There were significantly differences in gestational age, the proportion of multiparous, the rate of premature birth, the rate of oxytocin for contraction, and the duration of entry to delivery between two groups (P<0.05). ② In induced labor group, all puerperae received prostaglandins or oxytocin in promoting cervical ripening and labor induction, and the ratios of dinoprostone, misoprostol, oxytocin, dinoprostone + misoprostol were 26.5 % (108/407), 10.3% (42/407), 60.0% (244/407), 3.2% (13/407). ③ The total cesarean section rate (2.9% vs 7.1%), episiotomy rate (20.1% vs 28.6%), neonatal birth weight [3 410 g (3 180-3 650 g) vs 3 340 g (3 040-3 640 g)] and hospital time [4 d (3-4) d vs 4 d (4-5 d)], the differences were statistically significant between two groups (χ²=7.846, χ²=7.894, Z=-0.730, Z=-5.112; P<0.05). ④ There was no significant difference in the cesarean section rate after labor, the rate of postpartum hemorrhage, bleeding volume ≥1 000 mL in 24 hours after delivery, red blood cell infusion, placing intrauterine balloon tamponade and postoperative hospital stay between two groups (P>0.05).

Conclusions

It is feasible to provide puerperae with cervical ripening and labor induction under the whole management during delivery for the appropriate nursing resource and standard labor induction procedure, which can obtain the improving perinatal outcomes.

Key words: Whole process management, Labor, induced, Cesarean section, Natural childbirth, Delivery rooms, Obstetric labor complications, Pregnancy outcome, Pregnant women and puerperant

图1 促宫颈成熟与引产LDRP管理流程图注：LDRP为待产、分娩到产后康复

表1 2组孕产妇一般临床资料和产时药物干预情况比较

组别	例数	年龄[岁，M(P₂₅~P₇₅)]	高龄[例数(%)] ^a	孕次[次，M(P₂₅~P₇₅)]	经产妇[例数(%)]	分娩孕龄[周，M(P₂₅~P₇₅)]	早产[例数(%)]
自然临产组	441	31(29~34)	88(20.0)	1(1~2)	101(22.9)	39.9(39.1~40.6)	2(0.5)
引产组	407	31(29~34)	83(20.4)	1(1~2)	55(13.5)	39.7(38.6~40.4)	24(5.9)
检验值		Z＝-0.483	χ²＝0.025	Z＝-1.915	χ²＝12.429	Z＝-3.220	χ²＝21.101
P值		0.629	0.874	0.056	<0.001	0.001	<0.001
组别	例数	产时药物干预[例数(%)]				进入产房-分娩时长[h，M(P₂₅~P₇₅)]
组别	例数	缩宫素	地西泮	盐酸哌替啶	椎管内分娩镇痛	进入产房-分娩时长[h，M(P₂₅~P₇₅)]
自然临产组	441	165(37.4)	30(6.8)	23(5.2)	96(21.8)	12.5(6.3~23.7)
引产组	407	250(61.4)	37(9.1)	29(7.1)	96(23.6)	19.7(11.3~39.1)
检验值		χ²＝48.829	χ²＝1.523	χ²＝1.341	χ²＝0.400	Z＝-8.037
P值		<0.001	0.217	0.247	0.527	<0.001

表1 2组孕产妇一般临床资料和产时药物干预情况比较

组别	例数	年龄[岁，M(P₂₅~P₇₅)]	高龄[例数(%)] ^a	孕次[次，M(P₂₅~P₇₅)]	经产妇[例数(%)]	分娩孕龄[周，M(P₂₅~P₇₅)]	早产[例数(%)]
自然临产组	441	31(29~34)	88(20.0)	1(1~2)	101(22.9)	39.9(39.1~40.6)	2(0.5)
引产组	407	31(29~34)	83(20.4)	1(1~2)	55(13.5)	39.7(38.6~40.4)	24(5.9)
检验值		Z＝-0.483	χ²＝0.025	Z＝-1.915	χ²＝12.429	Z＝-3.220	χ²＝21.101
P值		0.629	0.874	0.056	<0.001	0.001	<0.001
组别	例数	产时药物干预[例数(%)]				进入产房-分娩时长[h，M(P₂₅~P₇₅)]
组别	例数	缩宫素	地西泮	盐酸哌替啶	椎管内分娩镇痛	进入产房-分娩时长[h，M(P₂₅~P₇₅)]
自然临产组	441	165(37.4)	30(6.8)	23(5.2)	96(21.8)	12.5(6.3~23.7)
引产组	407	250(61.4)	37(9.1)	29(7.1)	96(23.6)	19.7(11.3~39.1)
检验值		χ²＝48.829	χ²＝1.523	χ²＝1.341	χ²＝0.400	Z＝-8.037
P值		<0.001	0.217	0.247	0.527	<0.001

图2 848例孕产妇围生期高危因素分析

表2 2组孕产妇的母儿结局比较

组别	例数	剖宫产术分娩[例数(%)]	产钳助产[例数(%)]	会阴侧切[% (n/n′)] ^a	新生儿出生体重[g, M(P₂₅~P₇₅)]	巨大儿[例数(%)]	产后24 h出血[例数(%)] ^b
自然临产组	441	13(2.9)	10(2.3)	86/428(20.1)	3 410(3 180~3 650)	26(5.9)	98(22.2)
引产组	407	29(7.1)	9(2.2)	108/378(28.6)	3 340(3 040~3 640)	25(6.1)	99(24.3)
检验值		χ²＝7.846	χ²＝0.003	χ²＝7.894	Z＝-2.730	χ²＝0.023	χ²＝0.524
P值		0.005	0.956	0.005	0.006	0.880	0.469
组别	例数	产后24 h出血量≥1 000 mL[例数(%)]	输注异体红细胞悬液[例数(%)]	宫腔水囊压迫[例数(%)]	产后尿潴留[例数(%)]	总住院时间[d，M(P₂₅~P₇₅)]	产后住院时间[d，M(P₂₅~P₇₅)]
自然临产组	441	14(3.2)	1(0.2)	1(0.2)	41(9.3)	4(3~4)	2.8(2.4-3.2)
引产组	407	13(3.2)	4(1.0)	6(1.5)	30(7.4)	4(4~5)	2.8(2.4-3.2)
检验值		χ²<0.001	χ²＝0.976 ^c	χ²＝2.644 ^c	χ²＝1.023	Z＝-5.112	Z＝-0.577
P值		0.987	0.323	0.104	0.312	<0.001	0.564

表2 2组孕产妇的母儿结局比较

组别	例数	剖宫产术分娩[例数(%)]	产钳助产[例数(%)]	会阴侧切[% (n/n′)] ^a	新生儿出生体重[g, M(P₂₅~P₇₅)]	巨大儿[例数(%)]	产后24 h出血[例数(%)] ^b
自然临产组	441	13(2.9)	10(2.3)	86/428(20.1)	3 410(3 180~3 650)	26(5.9)	98(22.2)
引产组	407	29(7.1)	9(2.2)	108/378(28.6)	3 340(3 040~3 640)	25(6.1)	99(24.3)
检验值		χ²＝7.846	χ²＝0.003	χ²＝7.894	Z＝-2.730	χ²＝0.023	χ²＝0.524
P值		0.005	0.956	0.005	0.006	0.880	0.469
组别	例数	产后24 h出血量≥1 000 mL[例数(%)]	输注异体红细胞悬液[例数(%)]	宫腔水囊压迫[例数(%)]	产后尿潴留[例数(%)]	总住院时间[d，M(P₂₅~P₇₅)]	产后住院时间[d，M(P₂₅~P₇₅)]
自然临产组	441	14(3.2)	1(0.2)	1(0.2)	41(9.3)	4(3~4)	2.8(2.4-3.2)
引产组	407	13(3.2)	4(1.0)	6(1.5)	30(7.4)	4(4~5)	2.8(2.4-3.2)
检验值		χ²<0.001	χ²＝0.976 ^c	χ²＝2.644 ^c	χ²＝1.023	Z＝-5.112	Z＝-0.577
P值		0.987	0.323	0.104	0.312	<0.001	0.564

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