Path Evaluation And Health Economics Evaluation Of Term Pregnancy Induced Labor

Objective:To compare the clinical efficacy,safety and economy of vaginal misoprostol and cervical dilatation balloon in the induction of labor in term pregnant women,so as to provide a basis for obstetricians to choose a suitable methods of induced labor.Materials and Methods:The data of 424 eligible pregnant women who were treated to the Affiliated Hospital of Yan’an University from June 2019 to October 2020were collected and analyzed retrospectively.According to the different methods of labor induction,they were divided into the cervical dilatation balloon group,with a total of 211cases of pregnant woman and the misoprostol group,with a total of 213 cases of pregnant woman.According to the stratified analysis based on whether it was a primipara,there were 165 primiparas and 46 multipara in the cervical dilatation balloon group;154primiparas and 59 multiparas in the misoprostol group.Record the women who were induced with misoprostol(20-25ug)and cervical dilatation balloon group’s baseline data(age,BMI,gestational age,parity,cervical Bishop score)and clinical data(indications for labor induction,utilization rate of oxytocin before labor,time from induction to labor,labor time,24-hour vaginal delivery rate,vaginal delivery status,cesarean section rate,cesarean section indications,postpartum hemorrhage,acute labor,cervical laceration,chorioamnionitis and other adverse outcomes)as well as the length and expenses of hospitalization.Perinatal data include:weight,umbilical artery blood p H,amniotic fluid fecal staining rate,Apgar 1min,5min,10min score,fetal distress,neonatal asphyxia,NICU occupancy rate and other adverse outcomes.The t-test andχ~2test were used to compare the labor induction effects and safety of the two groups,and the health economics evaluation was carried out by the least cost method(CMA)and the incremental cost-effectiveness ratio(ICER)to draw relevant results and conclusion.Results:1.The use rate of oxytocin for primiparas to induce labor with balloon was89.1%(147/165),and the use rate of oxytocin for induction of labor with misoprostol was 48.7%(75/154).There was a significant difference between the two groups(P<0.05);The use rate of oxytocin for non-primiparas to induce labor with balloon was84.8%(39/46),and the use rate of oxytocin for induction of labor with misoprostol was32.2%(19/59),the difference was statistically significant(P<0.05).2.For primiparas,the incubation period of the balloon group was shorter than that of the misoprostol group(3.7h vs.4.0h),and the second stage of labor was longer than that of the misoprostol group(40min vs.34min).The difference was statistically significant(P<0.05).There was no significant difference in the time from induction to labor,the first stage,the third stage,and the total stage of labor between the two groups(P>0.05);the24h vaginal delivery rate in the balloon group was 46.06%(76/165),and the 24h vaginal delivery rate in the misoprostol group was 39.61%(61/154),the difference between the two groups was not statistically significant(P>0.05).For multipara,the labor time of the two methods of labor induction and the rate of vaginal delivery at 24 hours were not statistically significant(P>0.05).3.For primiparas and multipara,there was no statistical difference in the vaginal delivery rate,cesarean section rate,and cesarean section indications between the two groups(P>0.05).4.After using the two methods of labor induction,the white blood cell was higher than before,but the comparison between the two groups was not statistically significant(P>0.05).The balloon induction did not increase the risk of infection.The incidence of adverse maternal outcomes in the misoprostol group was higher than that in the balloon group,but the difference was not statistically significant(P>0.05).5.The birth weight of newborns,the p H value of umbilical artery blood,the rate of amniotic fluid contamination,and Apgar scores at 1,5,and 10 minutes after birth were not statistically significant between the two groups(P>0.05).6.For primiparas,there was no statistically significant comparison of fetal distress,neonatal asphyxia and NICU occupancy rates between the two groups of perinatal infants(P>0.05).For multipara,the incidence of fetal distress was 10.2%(6/59)in the misoprostol group and 0%(0)in the balloon group.The difference between the two groups was statistically significant(P<0.05),while neonatal asphyxia,The NICU occupancy rate was not statistically significant(P>0.05).7.For primiparas,the cost of misoprostol group was lower than that balloon group(7142.0 yuan vs.8307.0 yuan),and the difference was statistically significant(P<0.05);for multipara,the cost of hospitalization in the balloon group was 6620.0 yuan,misoprostol group spent 5984.0 yuan,the difference was statistically significant(P<0.05),ICER was 62.35,that is,it costs 62.35 yuan to reduce the incidence of fetal distress by1%.Conclusions:1.For primiparas,misoprostol and cervical dilatation balloon have good clinical efficacy and safety when used to induce labor in full-term pregnancy.From the perspective of health economics,misoprostol can be recommended as the first choice for induction of labor.2.For multipara,using cervical dilatation balloon to induce labor has better perinatal safety,and its cost-effectiveness is better than misoprostol.