ObjectiveTo probe into the clinical effects of intra-amniotic injection of ethacridine with Cook cervical ripening balloon in terminating mid-pregnancy. MethodsA total of 150 mid-pregnant women who required induction of labor from January 2011 to December 2012 were randomly divided into two groups: observation group (intra-amniotic injection of ethacridine with Cook cervical ripening balloon) and control group (intra-amniotic injection of ethacridine). ResultsThe time of labor induction was obviously shorter in the observation group than the control group [the time from using ethacridine to contraction: （29.68±4.17） vs (33.60±5.38) hours, P<0.05; total process: (7.63±2.30) vs (9.86±3.20) hours, P<0.05], and the residual rate of placental membranes [28.6% (10/35) vs 56.4%(22/39), P<0.05] was significantly lower. But there was no significant difference in postpartum hemorrhage [(81.60±17.64) vs (83.82±15.08 ) mL, P>0.05] and rate of success [100.0% (35/35) vs 94.9% (37/39), P>0.05]. ConclusionTerminating mid-pregnancy by intra-amniotic injection of ethacridine with Cook cervical ripening balloon has the advantages of shorter time and less pain, which deserves clinical application widely.
ObjectiveTo evaluate the efficacy and safety of moistened versus dry misoprostol for mid-trimester pregnancy termination. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 11, 2015), Web of Science, WanFang Data, CBM and CNKI were searched to collect randomized controlled trials (RCTs) about misoprostol for mid-trimester pregnancy termination from inception to Nov. 2015. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsFive RCTs involving 742 patients were included. The results of meta-analysis showed that, compared with dry tablet, moistened tablet could reduce induction-abortion interval (MD=-0.41, 95% CI-0.75 to-0.08, P=0.02), while there were no significant differences between two groups in completely abortion within 24 hours or 48 hours, nausea, vomiting, chill, fever, diarrhea, retained placenta, blood loss and total dose of misoprostol. ConclusionCurrent evidence shows that, compared with the dry misoprostol, the moistened misoprostol for treating mid-trimester pregnancy termination could reduce the induction-abortion interval without increasing adverse reactions. Due to the limited quality of quantity of included studies, more high-quality and large-scale RCTs are needed to prove the above conclusion.
Objective To explore the safety and efficiency of cervical expansion balloon in promoting cervical ripening of cicatrical uter women with full-term pregnancy attempting vaginal delivery. Methods Fifty cases of pregnant women at the third trimester with cicatrical uter admitted to Nanshan District Maternal and Child Health Care Hospital of Shenzhen from July 2015 to March 2016 were retrospectively and randomly collected as the observation group. Another 50 pregnant women at the third trimester with normal uter admitted to the same hospital in the same period were retrospectively and randomly collected as the control group. All the cases had indications for labor induction, and had intention and conditions of vaginal delivery. Cervical expansion balloons were used in the two groups to promote cervical ripening. The effective rate of promoting cervical ripening, the outcomes of delivery and the incidences of adverse outcomes were compared between the two groups. Results The differences in effective rate of promoting cervical ripening and success rate of induced labor of cervical ripening of pregnant women between the observation group (66%, 76%) and the control group (76%, 84%) were not statistically significant (P>0.05). There were no significant differences in the time of birth process, amout of postpartum bleeding, birth immediate Apgar score, neonatal birth weight, and vaginal delivery rate, and the incidences of acute chorioamnionitis and cervical laceration of pregnant women between the two groups (P>0.05). Incomplete uterine rupture occurred in one case in the observation group, while none in the control group; neonatal mild asphyxia occurred in one case in the control group, while none in the observation group; the differences were not statistically significant (P>0.05). No postpartum hemorrhage occurred in the two groups. Conclusions Under the premise of strictly following the indications, cervical expansion balloon can be used in promoting cervical ripening at the third trimester of pregnant women with cicatrical uter attempting vaginal delivery, improve the success of attempting vaginal delivery, reduce the occurrence of reduplicated cesarean section, and not increase the incidence of maternal and fetal adverse outcomes.
Because of the diversity and complexity of clinical indicators, it is difficult to establish a comprehensive and reliable prediction model for induction of labor (IOL) outcomes with existing methods. This study aims to analyze the clinical indicators related to IOL and to develop and evaluate a prediction model based on a small-sample of data. The study population consisted of a total of 90 pregnant women who underwent IOL between February 2023 and January 2024 at the Shanghai First Maternity and Infant Healthcare Hospital, and a total of 52 clinical indicators were recorded. Maximal information coefficient (MIC) was used to select features for clinical indicators to reduce the risk of overfitting caused by high-dimensional features. Then, based on the features selected by MIC, the support vector machine (SVM) model based on small samples was compared and analyzed with the fully connected neural network (FCNN) model based on large samples in deep learning, and the receiver operating characteristic (ROC) curve was given. By calculating the MIC score, the final feature dimension was reduced from 55 to 15, and the area under curve (AUC) of the SVM model was improved from 0.872 before feature selection to 0.923. Model comparison results showed that SVM had better prediction performance than FCNN. This study demonstrates that SVM successfully predicted IOL outcomes, and the MIC feature selection effectively improves the model’s generalization ability, making the prediction results more stable. This study provides a reliable method for predicting the outcome of induced labor with potential clinical applications.