Analysis Of Maternal And Infant Outcomes And Influencing Factors Of Successful Induction Of Labor In Two Different Methods Of Late Pregnancy Induction

Objective: To investigate the efficacy and safety of vaginal misoprostol and cervical dilation balloon for induction of labor in late pregnancy and the influencing factors of vaginal delivery within 24 hours after induction,so as provide a theoretical basis for clinicians to choose the best induction method in late pregnancy,reduce the cesarean section rate and improve the good pregnancy outcome of mother and child.Methods: From January 1,2018 to December 31,2020,1277 full-term pregnant women admitted to the Affiliated Hospital of Yan ’an University were retrospectively analyzed.(1)According to different induction methods,they were divided into the the cervical dilatation balloon group(balloon group,346 cases)and the misoprostol group(miso group,931 cases).Statistical software was used to analyze the baseline data,and it was found that the baseline data of the two groups were quite different.The two groups of parturients were matched by the propensity score 1:2 matching method.(2)A total of 1277 women were divided into the successful induction group(535 cases)and the failed induction group(742 cases)according to the outcome of vaginal delivery within 24 hours.The baseline data and outcome indicators were collected.SPSS25.0 software was used to analyze the data.Results:(1)There were no significant differences in age,gestational age,gravidity,parity,number of abortions,height,weight,Body Mass Index(BMI),and Bishop score before induction between the two groups after propensity score matching(P>0.05),but there were significant differences in induction indications(P<0.05).(2)The primary outcome of the two groups after the propensity score: the time from induction to labor in the balloon group was shorter than that in the misoprostol group(P<0.05);The rate of vaginal delivery within 24 hours in balloon group was higher than that in misoprostol group(P<0.05).There was no significant difference in total vaginal delivery rate,acute fetal distress and neonatal intensive care unit(NICU)admission between the two groups.(3)The comparison of secondary outcomes between the two groups after the propensity score: the Bishop score at 12 hours after induction of labor in the balloon group was significantly higher than in the misoprostol group,and the difference was statistically significant(P<0.001).The incidence of adverse outcomes,premature rupture of membranes,postpartum hemorrhage and abnormal labor in the balloon group was significantly lower than that in the misoprostol group,and the difference was statistically significant(P<0.05).There were no significant differences between the two groups in the time from labor to delivery,total labor duration,oxytocin use rate,delivery mode,indication of cesarean section,placental abruption,puerperal infection,chorioamnionitis and umbilical cord prolapse(P>0.05).(4)Comparison of secondary outcomes between two groups of newborns after propensity score:There was no statistically significant difference in newborn birth weight,1-minute and 5-minute Apgar scores,neonatal asphyxia,and neonatal pneumonia(P>0.05);The pathological jaundice of newborns was significantly higher in the balloon group than in the misoprostol group,with a statistically significant difference(P<0.05).(5)Single factor analysis of vaginal delivery within 24 hours showed that:maternal age(Z=-2.992,P=0.003),Bishop score before labor induction(Z=-2.641,P=0.008),BMI at admission(Z=-3.445,P=0.001),gravidity(χ~2=-3.973,P=0.000),parity(χ~2=-6.672,P=0.000)and neonatal birth weight(Z=-4.769,P=0.000),there was statistically significant difference.The maternal gestational age,height,weight,Premature rupture of membranes(PROM),hypertensive disoeders of pregnancy(HDP),and gestational diabetes mellitus(GDM),there was no statistically significant difference(P>0.05).(6)Age,Bishop score before induction,BMI on admission,gravidity,parity,and neonatal birth weight were included in the multivariate logistic regression model.Bishop score before labor induction(OR1.129,95%CI 1.038-1.227),multipara(OR2.385,95%CI 1.850-3.073);neonatal birth weight ≤3500g(OR1.716,95%CI1.333-2.210)was the influencing factor of vaginal delivery within 24 hours.Conclusion:(1)This study found that parity,the rate of vaginal delivery within 24 hours in balloon group was higher than in misoprostol group;Between induced labor and labor,the balloon group was shorter than the misoprostol group,and the incidence of adverse pregnancy outcomes in the balloon group was lower than misoprostol group.It is concluded that the cervical dilatation balloon is more effective and safer than misoprostol,which is worthy of clinical application.(2)This study concluded that multiparas,a relatively high Bishop score before induction of labor,and neonatal birth weight≤3500g are the promoting factors for vaginal delivery within 24 hours,which can provide a theoretical basis for clinicians to evaluate the success rate of induction of labor.