Cheng Po Jen, Cheng You Hung, Shaw Steven S W, Jang Hung Chi
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital-Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan.
College of Medicine, Chang Gung University, Taoyuan, Taiwan.
NPJ Digit Med. 2023 Jul 11;6(1):126. doi: 10.1038/s41746-023-00867-y.
The rapid changes in clinical maternity situations that occur in a labor and delivery unit can lead to unpredictable maternal and newborn morbidities. Cesarean section (CS) rate is a key indicator of the accessibility and quality of a labor and delivery unit. This retrospective cross-sectional study assesses the nulliparous, term, singleton, vertex (NTSV) cesarean delivery rates before and after the implementation of a smart intrapartum surveillance system. Research data were collected from the electronic medical records of a labor and delivery unit. The primary outcome was the CS rate of the NTSV population. The data of 3648 women admitted for delivery were analyzed. Of the studied deliveries, 1760 and 1888 occurred during the preimplementation and postimplementation periods, respectively. The CS rate for the NTSV population was 31.0% and 23.3% during the preimplementation and postimplementation periods, respectively, indicating a significant 24.7% (p = 0.014) reduction in CS rate after the implementation of the smart intrapartum surveillance system (relative risk, 0.75; 95% confidence interval, 0.71-0.80). In the NTSV population, the vaginal and CS birth groups, no significant difference in terms of newborn weight, neonatal Apgar scores, composite neonatal adverse outcome indicator, and the occurrence of the following: neonatal intensive care unit admission, neonatal meconium aspiration, chorioamnionitis, shoulder dystocia, perineal laceration, placental abruption, postpartum hemorrhage, maternal blood transfusion, and hysterectomy before and after the implementation of the smart intrapartum surveillance system. This study reveals that the use of the smart intrapartum surveillance system can effectively reduce the primary CS rate for low-risk NTSV pregnancies without significantly affecting perinatal outcomes.
分娩单元中临床产科情况的快速变化可能导致不可预测的孕产妇和新生儿发病情况。剖宫产（CS）率是分娩单元可及性和质量的关键指标。这项回顾性横断面研究评估了智能产时监测系统实施前后初产妇、足月、单胎、头位（NTSV）剖宫产率。研究数据从一个分娩单元的电子病历中收集。主要结局是NTSV人群的CS率。对3648名入院分娩的女性数据进行了分析。在所研究的分娩中，分别有1760例和1888例发生在实施前和实施后阶段。NTSV人群的CS率在实施前和实施后阶段分别为31.0%和23.3%，表明智能产时监测系统实施后CS率显著降低了24.7%（p = 0.014）（相对风险，0.75；95%置信区间，0.71 - 0.80）。在NTSV人群的阴道分娩和剖宫产分娩组中，智能产时监测系统实施前后在新生儿体重、新生儿阿氏评分、综合新生儿不良结局指标以及以下情况的发生率方面无显著差异：新生儿重症监护病房入院、新生儿胎粪吸入、绒毛膜羊膜炎、肩难产、会阴裂伤、胎盘早剥、产后出血、产妇输血和子宫切除术。本研究表明，使用智能产时监测系统可有效降低低风险NTSV妊娠的首次剖宫产率，而不会显著影响围产期结局。
