Analysis of caesarean section rate and vaginal labor success rate guided by new criteria of labor
10.16781/j.0258-879x.2018.06.0610
- Author:
Li LI
1
Author Information
1. Department of Obstetrics and Gynecology, Changhai Hospital, Navy Medical University (Second Military Medical University)
- Publication Type:Journal Article
- Keywords:
Caesarean section;
Criteria of labor;
Fetal distress;
Gestational diabetes;
Natural childbirth
- From:
Academic Journal of Second Military Medical University
2018;39(6):610-614
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the changes of caesarean section rate, success rate of vaginal labor and intrapartum cesarean indications after applying the new criteria of labor. Methods The clinical data of 5 769 pregnant women who delivered in Changhai Hospital of Navy Medical University (Second Military Medical University) during Jan. 2013 to Dec. 2016 were collected. Among them, 2 829 pregnant women who delivered during Jan. 2015 to Dec. 2016 were enrolled into study group, of which 1 824 women undergoing vaginal trial production were treated with the new criteria of labor by Obstetrics Group of the Society of Obstetrics and Gynecology of the Chinese Medical Association to manage the labor process; 2 940 pregnant women who delivered during Jan. 2013 to Dec. 2014 were enrolled into control group, of which 1 779 women undergoing vaginal trial production were treated according to the original criteria of labor to manage the labor process. The caesarean section rate, the composition ratio of surgical indications, the success rate of vaginal labor and the indications of vaginal trial production for conversion to cesarean section between the two groups were statistically analyzed. Results The caesarean section rate in the study group was 52.7% (1 490/2 829), being significantly lower than that in the control group (57.7%, 1 696/2 940; P<0.05). Among the pregnant women undergoing vaginal trial production, the success rate of vaginal labor in the study group was significantly higher than that in the control group (73.4% [1 339/1 824] vs 69.9% [1 244/1 779], P<0.05). Scarred uterus (23.4%, 348/1 490), fetal distress (19.0%, 283/1 490), and social factors (11.3%, 168/1 490) were the primary cesarean indications in the study group, while fetal distress (21.0%, 356/1 696), social factors (16.2%, 275/1 696), and scarred uterus (14.5%, 246/1 696) were the primary cesarean indications in the control group. The composition ratio of scarred uterus in the study group was significantly higher than that in the control group, and the ratios of social factors and gestational diabetes mellitus (5.8% [86/1 490] vs 7.5% [127/1 696]) were significantly lower than those in the control group (P<0.05). The main indications of vaginal trial production for conversion to cesarean section were fetal distress and social factors. There was no significant difference in fetal distress between the study and control groups (36.3% [176/485] vs 37.2% [199/535]), P>0.05]. However, the ratio of social factors and abnormal fetal position in the study group were significantly higher than those in the control group (26.6% [129/485] vs 20.9% [112/535], 17.3% [84/485] vs 12.5% [67/535]; P<0.05), and the date of abnormal labor progresses at a rate (including labor protraction and labor arrest) was significantly lower (8.9% [43/485] vs 14.8% [79/535], P<0.05). There were no significant differences in the incidences of postpartum hemorrhage, deep perineal laceration, neonatal asphyxia, or puerperal infection between the two groups (P>0.05). Conclusion The new criteria of labor has great clinical value in reducing the cesarean section rate and improving the success rate of vaginal trial production. When implementing the new criteria of labor, we should emphasize the standardized management of birth process and follow the principle of individualization.
