Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2020; 8(16): 3483-3492
Published online Aug 26, 2020. doi: 10.12998/wjcc.v8.i16.3483
Factors affecting failed trial of labor and countermeasures: A retrospective analysis
Jin-Guang Wang, Jing-Li Sun, Jian Shen
Jin-Guang Wang, Jing-Li Sun, Jian Shen, Department of Obstetrics and Gynecology, General Hospital of Northern Theater Command (Heping Campus), Shenyang 110000, Liaoning Province, China
Author contributions: All authors helped to perform the research; Wang JG wrote the manuscript, performed the procedures, and analyzed and interpreted the data; Sun JL designed the research; Shen J collected the materials and clinical data from patients.
Supported by Liaoning Provincial Natural Science Foundation Guidance Program, No. 2019-ZD-1037.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the General Hospital of Northern Theater Command (Heping Campus).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: We have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jing-Li Sun, MAMS, Chief Physician, Department of Obstetrics and Gynecology, General Hospital of Northern Theater Command (Heping Campus), No. 5 Guangrong Street, Heping District, Shenyang 110000, Liaoning Province, China. zg3416@sina.com
Received: April 7, 2020
Peer-review started: April 7, 2020
First decision: April 22, 2020
Revised: May 4, 2020
Accepted: July 14, 2020
Article in press: July 14, 2020
Published online: August 26, 2020
Processing time: 140 Days and 6.7 Hours
Abstract
BACKGROUND

Vaginal delivery is the ideal mode of delivery for the termination of a pregnancy. However, the cesarean section rate in China is much higher than the published by the World Health Organization in the Lancet in 2010.

AIM

To retrospectively analyze the factors related to failed trial of labor and the clinical indications for cesarean section conversion, explore how to promote the trial of labor success rate, and determine the feasibility of reducing the rate of conversion to cesarean section.

METHODS

A retrospective analysis was performed on 9240 maternal women who met vaginal delivery conditions and required a trial of labor from January 2016 to December 2018 at our hospital. Among them, 8164 pregnant women who had a successful trial of labor were used as a control group, and 1076 pregnant women who had a failed trial of labor and converted to an emergency cesarean section were used as an observation group. The patients’ clinical data during hospitalization were collected for comparative analysis, the related factors of the failed trial of labor were discussed, and reasonable prevention and resolution strategies were proposed to increase the success rate of trial of labor.

RESULTS

The analysis revealed that advanced age (≥ 35 years old), macrosomia (≥ 4000 g), delayed pregnancy (≥ 41 wk), use of uterine contraction drugs, primipara, and fever during labor were associated with conversion to an emergency cesarean section in the failed trial of labor. Multivariate regression analysis showed that age, gestational age, primipara, use of uterine contraction drugs, fever during birth, and newborn weight led to a higher probability of conversion to an emergency cesarean section in the failed trial of labor. The analysis indicated that the following clinical indications were associated with the conversion to cesarean section in the failed trial of labor: Fetal distress (44.3%), social factors (12.8%), malpresentation (face presentation, persistent occipitoposterior position, and persistent occipitotransverse position) (9.4%), and cephalopelvic disproportion (8.9%).

CONCLUSION

The conversion to emergency cesarean section in failed trial of labor is affected by many factors. Medical staff should take appropriate preventive measures for the main factors, increase the trial of labor success rate, improve the quality of delivery, ensure the safety of mother and child during the perinatal period, and improve the relationship between doctors and patients.

Keywords: Trial of labor; Vaginal delivery; Cesarean section; Dystocia; Retrospective analysis

Core tip: The cesarean section rate in China is much higher than the threshold of the World Health Organization. The purpose of this study was to explore how to promote the success rate of trial of labor, and determine the feasibility of reducing the rate of conversion to cesarean section.