Effect of epidermal growth factor on hormone secretion by term placenta in organ culture

Labor, delivery, and newborn course were studied in 621 pregnancies in which labor was electively induced at or after 39 weeks, and in 3,851 control pregnancies in which the onset of labor was spontaneous. Induced labors were not prolonged, nor was the duration of ruptured membranes. Fetal distress and birth asphyxia were not more frequent after induction, and release of meconium occurred much less frequently (9.3% for induced labor versus 16.7% for spontaneous). There was greater use of epidural analgesia and of forceps delivery in induced labor. Among primiparous patients, cesarean delivery for “failure to progress” was performed in 14% of electively induced labors and 7% of spontaneous control labors, a difference not noted among multiparous patients who had a primary cesarean birth rate of less than 2%, latrogenic prematurity was not a problem; none of the 621 infants who was born after elective induction developed respiratory distress syndrome, and only one weighed less than 2,500 gm.     

Induction of labor with prostaglandin E2 in women with previous cesarean section and unfavorable cervix

OBJECTIVE: To study the pregnancy outcome of induction of labor with prostaglandin E2 (PGE2) in women with one previous lower segment cesarean section. METHODS: A retrospective cohort design was used. The study sample included 1028 consecutive women with one previous cesarean section, of whom 97 underwent induction of labor (study group) and 931 were admitted with spontaneous onset of labor (control group). Vaginal tablets of PGE2 were used for cervical ripening in the study group. Mode of delivery, neonatal outcome, indications for cesarean section, and rate of uterine rupture were compared between the groups. RESULTS: There were no significant differences between the study and control groups in mean (+/-S.D.) maternal age (30.9 +/- 4.7 years versus 31.2 +/- 4.8 years, P = 0.6), gestational age at delivery (39.2 +/- 1.8 weeks versus 39.3 +/- 1.6 weeks, P = 0.36), overall rate of cesarean section (36% versus 37.3%, P = 0.8), rates of low 5-min Apgar score < or =7 (3.1% versus 3.7%, P = 0.67) or cesarean section performed for nonreassuring fetal heart rate (6.1% versus 3.1%, P = 0.1). There were four cases of uterine rupture, all in the control group compared to none in the study group (nonsignificant). CONCLUSION: The findings suggest that induction of labor in women with one previous cesarean section does not increase the risk of cesarean section rate and does not adversely affect immediate neonatal outcome. We cautiously suggest that when there is no absolute indication for repeated cesarean section, induction of labor may be considered.     

不同分娩方式对低危孕产妇分娩结局及卫生经济学指标的影响

目的探讨不同分娩方式对低危孕产妇分娩结局及卫生经济学指标的影响。方法对2002年9月至2007年4月北京协和医院分娩的3751例孕37-41周^＋6的低危孕产妇的资料进行回顾性分析，按分娩的干预方式不同分为3组：择期引产组（包括药物及手术引产）501例、择期剖宫产组1634例和自然临产组1616例，分别对3组孕产妇的一般情况及住院费用以及分娩结局（产后出血、产褥病率、尿潴留、输血情况、切口愈合情况、产时副损伤）、新生儿Apgar评分情况等进行统计比较。结果（1）一般情况分析：自然临产组孕产妇住院天数（4．8d）与择期引产组（6．3d）及择期剖宫产组（6．3d）比较，差异有统计学意义（P〈0．01）；择期剖宫产组孕产妇住院费用（3472元）明显高于择期引产组（3201元）及自然临产组（2293元），分别比较，差异有统计学意义（P〈0．01），尤其是择期引产组中的剖宫产患者住院费用明显高于择期剖宫产组及自然临产组中的剖宫产患者，分别比较，差异均有统计学意义（P〈0．01）。（2）产时及产后并发症总发生率：孕产妇产时及产后并发症总发生率分别是择期引产组为12．4％、择期剖宫产组为0．9％，自然临产组为6．8％。（3）产后出血（≥500ml）发生率：择期引产组、择期剖宫产组和自然临产组分别为3．0％（15／501）、0．6％（9／1634）和1．2％（19／1616），3组分别比较，差异有统计学意义（P〈0．01）。（4）尿潴留发生率：择期引产组、择期剖宫产组和自然临产组分别为4．6％（23／501）、0和3．3％（54／1616），择期剖宫产组尿潴留发生率低于择期引产组与自然临产组（P〈0．01），择期引产组与自然临产组比较，差异无统计学意义（P〉0．01）。（5）有无分娩中或产后输血：择期引产组、择期剖宫产组和自然临产组率孕产妇有输血者分别为2．0％（10／501）、0．1％（1／1634）和0．4％（6／1616），3组分别比较，差异有统计学意义（P〈0．01）。（6）产时副损伤：择期引产组、择期剖宫产组和自然临产组产时副损伤发生率分别为0．6％（3／501）、0和0．4％（7／1616），3组分别比较，择期剖宫产组低于其他两组（P〈0．01），择期引产组与自然临产组比较，差异无统计学意义（P〉0．01）。（7）切口延期愈合：择期引产组、择期剖宫产组和自然临产组分别为0．8％（4／501）、0和0．2％（4／1616），3组分别比较，差异有统计学意义（P〈0．01）。（8）产褥病率：3组间相互比较，差别无统计学意义（P〉0．01）。（9）新生儿窒息发生率：择期引产组、择期剖宫产组和自然临产组分别为1．2％（6／501）、0．1％（1／1634）和1．0％（17／1616），择期剖宫产组与其他两组分别比较，差异均有统计学意义（P〈0．01），择期引产组与自然临产组比较，差异无统计学意义（P〉0．01）。结论择期引产会增加孕产妇产后出血、分娩中或产后输血的机会，且没有降低产妇尿潴留、新生儿窒息的发生率；择期剖宫产是相对安全的分娩方式，对孕产妇分娩并发症的发生没有不良影响，但会明显增加住院费用。     

Physicians who induce labor for fetal macrosomia do not reduce cesarean delivery rates.

OBJECTIVE: To determine whether obstetricians with high rates of induction for the indication of fetal macrosomia had higher or lower cesarean section rates. STUDY DESIGN: Data were analyzed from 1432 deliveries with birthweights > 4000 g. Four physician populations were identified: a faculty service and three groups of private practitioners with induction rates 20% to 40%, 40% to 60% and > 60%. The average cesarean section rate was determined for each group as well as the percentage of each group's deliveries occurring before 39 weeks, at 39, at 40, and after 40 weeks. In addition, the relative risk of cesarean delivery was calculated for the entire study population. RESULTS: No correlation was found between the rate of induction of labor and the rate of cesarean section. Delivery of nulliparous and multiparous patients after 40 weeks carried an increased risk of cesarean section. Delivery of multiparous patients before 39 weeks did also. Obstetricians with induction rates > 40% significantly decreased the incidence of delivery after 40 weeks, which lowered their cesarean section rates, but no net lowering occurred because of increased rate of cesarean section < 39 weeks. CONCLUSION: A fetal weight of 4000 g or more is not an indication for induction of labor. For multiparous patients, induction at 38 weeks or before is associated with an increased rate of cesarean delivery.     

Adherence to guidelines on the management of dystocia and cesarean section rates

The purpose of this study was to investigate to what extent the Society of Obstetricians and Gynecologists of Canada (SOGC) guidelines on dystocia are being followed, and whether adherence to the guidelines is related to cesarean section rates. Data were extracted from a maternity database for nulliparous women with singleton, cephalic pregnancies at 37 or more completed weeks of gestation for a 4-year period. Patients delivered by elective cesarean section were excluded. Data were examined to determine whether those who had a cesarean section for dystocia in the first stage of labor fulfilled SOGC guidelines. In addition, the obstetricians were divided into two groups (high or low) according to their cesarean section rate for dystocia to determine whether a higher section rate was associated with an increased guideline violation rate. There were 239 nulliparous women who had a cesarean section for dystocia in the first stage of labor. The guidelines were followed in 47.7% of spontaneous labors and 77.5% of inductions. The mean section rate for dystocia in the first stage of labor was 10.8% in the high group and 6.6% in the low group, and the incidence of guideline violations in these groups was 48.0% and 39.6%, respectively ( P = 0.07). The study had a power of 0.88 to detect a 40% difference in guideline violation rates between the two groups. We conclude that many women have cesarean section for dystocia performed without fulfilling SOGC guidelines.     

Misoprostol for cervical ripening and labor induction in pregnancies with oligohydramnios

The efficacy and safety of misoprostol for cervical ripening and labor induction in patients with oligohydramnios was investigated. 57 pregnancies with oligohydramnios and 58 cases with a normal amniotic fluid volume (controls) were enrolled in this prospective trial. All patients received 50 microg of intravaginal misoprostol every 5 h. Primary outcomes were: cesarean section rate; induction to delivery time; oxytocin augmentation; uterine hyperstimulation; meconium passage; fetal heart rate (FHR) changes; fetal distress requiring delivery, and Apgar scores. There were no differences in the mean time to delivery, cesarean section rate, oxytocin augmentation or Apgar scores. The mean induction to delivery time in oligohydramnios and control groups were, 11 h 43 min and 11 h 18 min, respectively (p > 0.05). FHR changes were observed in 26.3% of oligohydramnios group and 32.7% of control group (p > 0.05). There was no statistically significant difference in the cesarean section rate and the uterine hyperstimulation between the 2 groups. These data suggest that misoprostol can be used as an effective agent for cervical ripening and labor induction in pregnancies with oligohydramnios without increasing the risk for perinatal outcome, compared to those with normal amniotic fluid volumes.     

Obstetric consequences of postmaturity

The obstetric management of 340 pregnancies delivered 2 or more weeks postterm and 1408 pregnancies delivered at 41 weeks is compared with that of 5915 pregnancies delivered at 39 to 40 weeks. In all patients menstrual dating was confirmed by early ultrasonographic examination. Postterm labor in primiparas resulted in a high cesarean section rate because of failure to progress; this increased rate was observed even after controlling for induction of labor and the size of the infant. We suggest that primiparas who go postterm often have increased uterine dysfunction. Uterine dysfunction accounts for the increase in the cesarean section rate and is a partial explanation for "failed" inductions.     

Impact of abnormal results of outpatient fetal heart rate monitoring on maternal intervention in labor

OBJECTIVE: To conduct a retrospective, cohort study to determine the impact of abnormal outpatient fetal heart rate (FHR) testing on maternal interventions in labor, including labor induction, operative vaginal delivery and unplanned cesarean section. STUDY DESIGN: Our cohort consisted of 1,386 women with singleton gestations who had outpatient fetal nonstress testing within 1 week prior to giving birth etween 1993 and 1998. Antepartum FHR records were interpreted as reassuring or nonreassuring, and pregnancy records were abstracted for background medical information, labor interventions and pregnancy outcomes. Logistic regression models were used to describe the association between abnormal outpatient monitoring results and maternal interventions in labor. RESULTS: After adjusting for potential confounders (maternal age, race, prior history of cesarean section, antepartum indications for monitoring, fetal presentation and abnormal fetal heart rate patterns in labor), women with nonreassuring monitoring were 90% more likely to undergo induction. The 2 groups were similar in operative vaginal delivery rates, but pregnancies with nonreassuring testing were more than twice as likely to end with an unplanned cesarean section. CONCLUSION: Abnormal outpatient antenatal FHR testing may be independently associated with an increased risk of unplanned cesarean section.     

Induction of labor in the high-risk pregnancy with PGF 2 alpha

The induction of labor in the high-risk patient is accompanied by an increased incidence of cesarean section partly due to failed induction. A series of 50 high-risk patients induced with intravenous prostaglandin F 2 alpha is presented. Forty-five were successfully induced, 35 of whom delivered vaginally. Failed inductions occurred in 5 patients. The overall success rate was 90%, and cesarean section rate was 25.5%. There was an increased incidence of late decelerations in the PGF 2 alpha groups as compared to spontaneous and Pitocin-stimulated labors. While the success was high, the use of a drug which itself may caused fetal cardiovascular changes is not desirable, especially in those pregnancies already at risk.     

Clinical trial of induction of labor versus expectant management in twin pregnancy

OBJECTIVE: The appropriate date of delivery in twin pregnancies is supposed to be earlier than that in singleton pregnancy. The aim of this study was to compare two strategies for managing twin pregnancies (i.e., immediate induction and expectant management). METHODS: Seventeen patients underwent immediately induced labor by administration of oral prostaglandin E(2) at 37 weeks, while 19 patients underwent expectant management. RESULTS: The average gestational age at delivery in the induction group was 37.5 +/- 0.4 weeks, significantly earlier than that in the expectant management group (39.0 +/- 1.1 weeks). However, there were no significant differences in the average birth weight between the two groups (2, 700 +/- 330 g in the induction group vs. 2,672 +/- 392 g in the expectant management group). The cesarean delivery rate in the induction group was 18%, not significantly different from that in the expectant management group (32%). The most common indication for cesarean section in the expectant management group was maternal infection, while there was no maternal infection in the induction group (p = 0.08). CONCLUSION: It may be acceptable do intervene in twin pregnancies earlier than in singleton pregnancies during term.     

Biophysical profile scoring in the management of the postterm pregnancy: an analysis of 307 patients

Management and outcome were reviewed in 307 consecutive postterm pregnancies assessed by biophysical profile scoring. Twice-weekly scores accurately differentiated normal fetuses from those at risk for intrauterine hypoxia. When the profile score is normal, waiting for spontaneous labor results in healthy neonates and a much lower cesarean section rate (15% versus 42% for "prophylactic" induction). Confident conservative management of postterm pregnancy is possible.     

Mode of delivery in pregnancies with suspected fetal growth restriction following induction of labor with vaginal prostaglandin E2

BACKGROUND: Many fetuses below the 10th percentile for gestational age are uncompromised. We aimed to evaluate the mode of delivery and immediate neonatal outcome in pregnancies with suspected fetal growth restriction (FGR) and normal antenatal assessment following induction of labor with vaginal application of prostaglandin E2 (PGE2). METHODS: Ninety women with suspected FGR (sonographic estimated fetal weight < 10th percentile) with normal oxytocin contraction test (OCT), biophysical profile (BPP) and reassuring fetal heart rate underwent induction of labor with vaginal application of PGE2 tablets. The findings were compared with 115 women admitted for induction of labor because of decreased fetal movement (group 2) and with 510 women with normal spontaneous onset of labor (group 3). RESULTS: There were no between-group differences in mean maternal age, gravidity, parity, nulliparity rate, number of tablets used or rate of patients receiving more than one PGE2 application. The rate of cesarean section (CS) in the study group (8.9%) was similar to the rate in groups 2 and 3 (14.8% and 9.0%, respectively). The incidence of nonreassuring fetal heart rate pattern leading to cesarean delivery was higher in the study group, but the rate of low 5-min Apgar scores (< 7) was similar in all groups. A logistic regression model and forward likelihood analysis yielded no single significant variable associated with increased risk of cesarean delivery. CONCLUSIONS: In selected cases of suspected FGR with reassuring fetal heart rate and normal OCT and BPP, induction of labor with vaginal PGE2 may yield a similar immediate fetal outcome and CS rate as in uncomplicated, induced or spontaneous deliveries.     

Active induction management of labor for diabetic pregnancies at term; mode of delivery and fetal outcome--a single center experience

OBJECTIVES: To evaluate the mode of delivery in diabetic pregnancies at term following induction of labor with vaginal application of prostaglandin E2 (PGE2), and to identify possible predictors of successful vaginal delivery. PATIENTS AND METHODS: The study group consisted of 105 women with diabetic pregnancies at term admitted for induction of labor; 84 (80%) had gestational diabetes (GDM) and 21 (20%) type 1 diabetes. Findings were compared with women who underwent elective induction of labor (n=115), and women with normal spontaneous onset of labor (n=510). Women with previous cesarean section (CS) were excluded from both study and control groups. RESULTS: Maternal age and gravidity were significantly higher in the study group than the control groups (age: 31.4+/-5, 28+/-5.0 and 28.1+/-4.8 years, respectively; gravidity: 3.0+/-1.9, 2.5+/-1.6, and 2.1+/-1.4, respectively; P<0.001 for both) and gestational age and nulliparity rate were significantly lower (gestational age: 38.6+/-1.1, 40.2+/-1.3 and 39.3+/-2.7 weeks, respectively; nulliparity: 34.6, 45.2, 51.6%, respectively; P<0.002 for both). There were no between-group differences in the incidence of oligohydramnios, number of PGE2 applications used, birth weight, rate of non-reassuring fetal heart rate pattern leading to CS, and rate of low 5 min Apgar score (<7). The rate of CS in the study group (18.2%) was significantly higher than in the spontaneous labor group (9%) but similar to the elective induction group (14.8%). On stepwise analysis, only nulliparity (OR 4.56, 95% CI 1.11-18.67, P=0.035) was independently and significantly associated with increased risk of CS. Within the study group (R2=0.257, P=0.002), type 1 diabetes (OR 2.4, 95% CI 1.04-5.51) was independently and significantly associated with increased risk of CS. CONCLUSION: In diabetic pregnancies, induction of labor at term with vaginal PGE2 is successful in approximately 82% of patients, but yields a significantly higher CS rate compared to uncomplicated pregnancies. Nulliparity and diagnosis of type 1 diabetes are independently and significantly associated with increased risk of CS. CONDENSATION: In diabetic pregnancies, induction of labor at term is successful in 82% of patients, but yields higher CS rates compared to uncomplicated pregnancies.     

Prolonged pregnancy: induction of labor and cesarean births

OBJECTIVE: To determine the effects of labor induction on cesarean delivery in post-date pregnancies. MATERIALS AND METHODS: A total of 1325 women who reached 41 weeks' gestation between December 1, 1997, and April 4, 2000, and who were scheduled for induction of labor at 42 weeks were included in this prospective observational study. Cesarean delivery rates were compared between those women who entered spontaneous labor and those who underwent induction. Women with any medical or obstetric risk factors were excluded. A power analysis was performed to determine how many patients would be required to show no effect of labor induction on cesarean delivery with a beta of.8 and an alpha of.05. Approximately 5200 patients would be required, taking an estimated 28 years to accrue at our institution. RESULTS: Admission to delivery was longer (5.7 compared with 11.1 hours, P =.001) and more likely to extend beyond 10 hours (55 compared with 24%, P =.001) in the induction group. Cesarean deliveries were increased in the induced group (19 compared with 14%, P <.001) due to cesarean for failure to progress (14 compared with 8%, P <.001). Independent risk factors for cesarean delivery included nulliparity, undilated cervix prior to labor, and epidural analgesia. Correction for these risk factors using logistic regression analysis revealed that it was the risk factors, and not induction of labor per se, that increased cesarean delivery. CONCLUSION: Risk factors intrinsic to the patient, rather than labor induction itself, are the cause of excess cesarean deliveries in women with prolonged pregnancies.     

Forty weeks and beyond: pregnancy outcomes by week of gestation

OBJECTIVE: To assess pregnancy outcomes at 40, 41, and 42 weeks' gestation when labor induction is done routinely at 42 but not 41 weeks. METHODS: We reviewed all singleton pregnancies delivered at 40 or more weeks' gestation between 1988 and 1998 at Parkland Memorial Hospital, Dallas, Texas. We excluded women with hypertension, prior cesarean, diabetes, malformations, breech presentation, and placenta previa. Labor characteristics and neonatal outcomes of pregnancies at 41 and 42 weeks' gestation were compared with pregnancies that ended at 40 weeks. Women with certain dating criteria had induction of labor at 42 weeks. Gestational age was calculated from the last menstrual period (LMP), sonography when available, and clinical examination. If the fundal height between 18 and 30 weeks was within 2 cm of gestational age, the reported LMP was accepted as correct. Sonogram was used to calculate gestational age if a discrepancy was identified. Statistical analysis consisted of chi(2) and analysis of variance. RESULTS: We studied 56,317 pregnancies: 29,136 at 40 weeks, 16,386 at 41 weeks, and 10,795 at 42 weeks. Labor complications increased from 40 to 42 weeks, including oxytocin induction (2% versus 35%, P <.001), length of labor (5.5 +/- 4.9 versus 8.8 +/- 6. 5 hours, P <.001), prolonged second stage of labor (2% versus 4%, P <.001), forceps use (6% versus 9%, P <.001), and cesarean delivery (7% versus 14%, P <.001). Neonatal outcomes were similar in the three groups, including 5-minute Apgar score less than 4, admission to the neonatal intensive care unit (NICU), umbilical artery pH less than 7, seizures, and perinatal mortality. Sepsis was more frequent in the 42-week group than the other groups (0.1 versus 0.3%, P =. 001), as was admission to the NICU (0.4 versus 0.6%, P =.008). CONCLUSION: Routine labor induction at 41 weeks likely increases labor complications and operative delivery without significantly improving neonatal outcomes.     

Management of pregnancy after cesarean section.

Management of 226 patients with previous low transverse cesarean section in a special obstetric clinic for high-risk pregnancies significantly and safely reduced the incidence of purely elective cesarean section to less than 10%. A substantial incidence (25%) of other high-risk factors dictating antepartum indicated cesarean section were found in this population. There was 38.5% incidence of vaginal delivery in 145 patients who underwent a trial of labor. Patients delivered vaginally followed a normal labor curve up to full dilatation. Oxytocin was required in three cases of prolonged second stage of labor and resulted in instrumental vaginal delivery in all instances. There were no uterine ruptures on vaginal exploration after delivery or at the time of repeat cesarean section during labor. There was no maternal death or perinatal loss. No justification for the present clinical practice of a 99% inicidence of elective repeat cesarean section could be found. Substantial savings in hospital cost, as well as a decreased number of diagnostic tests for the otherwise normal gravid woman, can be safely achieved.     

Epidural analgesia and cesarean section for dystocia: risk factors in nulliparas.

A retrospective study assessing the effect of epidural analgesia in labor on the incidence of cesarean section was performed. The first 500 consecutive nulliparas meeting the following criteria were included in this study: term (37 weeks or longer) and singleton gestation, cephalic presentation, spontaneous onset of labor, and 5 cm or less of cervical dilation on admission. Patients were grouped according to their rate of cervical dilation in early labor (greater than or equal to 1 cm/hr, and less than 1 cm/hr) and the timing of epidural placement (none, early, or late). There was no effect of epidural analgesia on the incidence of cesarean section for fetal distress. The incidence of cesarean section for dystocia was significantly greater (p greater than 0.000001) in the epidural group (15.6%) than in the nonepidural group (2.4%). The greatest effect of epidural analgesia on the incidence of cesarean section for dystocia was observed in nulliparas who dilated at slower rates (less than 1 cm/hr) in early labor and who had epidural analgesia placed at 5 cm or less of cervical dilation (20.6% versus 3.4%, relative risk of 6, p less than 0.0005). The increase of cesarean section for dystocia associated with epidural analgesia could not be accounted for when other possibly confounding variables were studied. Both the dilation rate prior to epidural placement and the cervical dilation at epidural placement were significantly correlated to frequency of cesarean section for dystocia (p less than 0.01). This study suggests that epidural analgesia in labor may increase the incidence of cesarean section for dystocia in nulliparas.     

孕41周妊娠结局及引产利弊分析

目的通过对孕41周妊娠结局的分析，了解延期妊娠对胎儿及新生儿的影响；孕41周后引产的利弊。方法采用回顾性研究，对2002年7月至2004年12月足月无合并症初产妇资料进行分析，共计2903例，其中461例为延期妊娠（41～41舶周）。结果延期妊娠组剖宫产率为48.81％，胎儿窘迫发生率为43．38％。明显高于其它孕周组（P〈0．01），新生儿窒息发生率为1．08％，高于孕周38周组，低于其它组。但无统计学意义（P〉0．05）。延期妊娠引产组剖官产率为52．28％，自然临产组为28．36％，引产组明显高于自然临产组（P〈0．01），胎儿窘迫和新生儿窒息发生率分别为42．89％和1．02％，34．33％和1．49％，均无统计学意义（P〉0．05）。引产组宫颈Bishop评分低于5分者，剖宫产率为65．6％，高于自然临产组和评分6分及以上组（P〈0．05），与评分5分相比无统计学意义（P〉0．05）。孕41～41^＋3周分娩者与孕41^＋4～41^＋6周分娩者结局无明显差别。结论妊娠满41周后胎儿有官内缺氧的危险，应适时终止。宫颈条件不成熟者引产。难产危险性增加。刚满41周宫颈条件不成熟、又无迫切原因需要立即终止妊娠者，可严密观察下等待2～3d至41^＋4周再引产是可行的。     

Maternal-fetal outcomes in prolonged pregnancy

The intrapartum fetal heart rate changes, type of labor, mode of delivery, and neonatal outcome were evaluated in 379 consecutive continuously monitored prolonged pregnancies (greater than 42 weeks by history and early examination). These represent only a fraction of the total prolonged gestation population. There were 56% multiparous women, 33% less than 20 years of age, and 95% with cephalic presentation. Oxytocin was given to 76% (48% induced, 28% enhanced). Delivery was by cesarean section in 13% of patients (9% of induced cases), and 15% had forceps deliveries. Fetal heart rate alterations were observed in high proportion. Cesarean section for cephalopelvic disproportion was indicated in 60% of operations, and 13% of the fetuses weighed greater than 4000 gm. Depression occurred in 15% of infants at 1 minute and in 4% at 5 minutes. Prolonged hospital stay was seen in 9%, and postmaturity syndrome in 19%. There were four perinatal deaths (two corrected). Active induction does not appear to increase the cesarean section rate. The durations of predelivery observation may be longer because the cervices are frequently unripe. There is a high incidence of fetal heart rate alterations. Induction appears justified as an active intervention to prevent some sudden unexplained deaths.     

应用分娩时机计算表改善分娩结局的探讨

目的探究应用分娩时机计算表与降低剖宫产率、改善分娩结局的相关性。方法将2010年1月至2011年12月在民航总医院妇产科行围生期保健和住院分娩的579例初产妇随机分为两组,研究组（200例）采用主动管理妊娠高危因素指导分娩时机的最佳分娩时限（AMOR-IPAT-UL-OTD）分娩时机计算表,计算最佳分娩时机,给予预防性引产;对照组（379例）给予常规处理。比较两组孕妇的剖宫产率和母儿结局。结果研究组和对照组的引产率分别为47.0%（94/200）和33.8%（128/379）,两组比较,差异有统计学意义（P〈0.01）;研究组和对照组剖宫产率分别为18.5%（37/200）和27.4%（104/379）,两组比较,差异有统计学意义（P〈0.05）。两组的产后出血率（11.5%和18.5%）及巨大儿发生率（4.5%和10.3%）比较,差异均有统计学意义（P〈0.05）。结论主动管理妊娠高危因素,评估最佳分娩时限,给予预防性引产利于降低剖宫产率和改善分娩结局。