Indications and pregnancy outcomes of intrapartum cesarean section after the new partogram applied

Abstract

To study the changes of intrapartum cesarean rate, cesarean indications and pregnancy outcomes after the new partogram applied. Totally 3 290 pregnant women trying to vaginal delivery which were managed according to the new partogram in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from August to October in 2014(new partogram group)were involved; 2 987 pregnancy women trying to vaginal delivery from May to July in 2014 which were managed according to the old partogram(old partogram group)were involved as control. The intrapartum cesarean rate, cesarean indications and the pregnancy outcomes between the two groups were analyzed. The rate of intrapartum cesarean delivery was 8.50%(254/2 987)in old partogram group, and was significantly higher than that in new partogram group(6.2%, 204/3 290; P<0.01). Cesarean indications in old partogram group included 18 labor protraction(7.1%, 18/254), 82 labor arrest(32.3%, 82/254), 44 relative cephalopelvic disproportion(17.3%, 44/254), 80 fetal distress(31.5%, 80/254), 23 intrauterine infection(9.1%, 23/254)and 7 cesarean delivery on maternal request(CDMR; 2.8%, 7/254). Cesarean indications in new partogram group included 33 labor arrest(16.2%, 33/204), 71 relative cephalopelvic disproportion(34.8%, 71/204), 73 fetal distress(35.8%, 73/204)and 22 intrauterine infection(10.8%, 22/204), 5 CDMR(2.5%, 5/204). There were no significant differences in incidence of asphyxia neonatorum and puerperal morbidity(P> 0.05), but the incidence of postpartum hemorrhage in new partogram group was higher than the old partogram group[6.9%(14/204)versus 1.6%(4/254), P<0.05]. After the new partogram applied, the rate of intrapartum cesarean delivery is significantly decreased, but the incidence of postpartum hemorrhage is increased.