[Clinical analysis of maternal and neonatal outcomes in uncomplicated term nulliparous after different routes of delivery].

Objective: To compare maternal and neonatal outcomes after induction, elective cesarean section and spontaneous onset of labor in uncomplicated term nulliparous women.

Methods: A total of 3751 uncomplicated term nullipara who delivered in Peking Union Medical College Hospital from Sept 2002 to April 2007 were retrospectively analyzed. They were divided into three groups: the induction group, the elective cesarean section group, and the spontaneous onset of labor group. Their general conditions (such as age, weeks of pregnancy, hospital days and cost), postpartum complications (such as postpartum hemorrhage, puerperal morbidity, urinary retention, blood transfusion, delayed healing, and trauma), and Apgar score were compared by statistic methods.

Results: (1) Among 3751 women, 501 (13.3%) of them underwent induction( the induction group), 1634 (43.6%) delivered by cesarean section (cesarean section group), the other 1616 (43.1%) women underwent spontaneous onset of labor (the spontaneous onset of labor group). (2) Results of general conditions: the spontaneous onset of labor group had the shortest hospital days, which was longer in the induction group, and the longest in the selective cesarean section group (P < 0.01). The selective cesarean section group had the most cost during hospitalization, which was less in the induction group, and least in the spontaneous onset of labor group (P < 0.01). Women who undergwent emergent cesarean section after induction spent more money on hospitalization than those who were in the selective cesarean section group and the spontaneous onset of labor group (P < 0.01). (3) Puerperal complications: (1) postpartum hemorrhage: the incidence of postpartum hemorrhage was 3.0% (15/501) in the induction group, 0.6% (9/1634) in the selective cesarean section group and was 1.2% (19/1616) in the spontaneous onset of labor group (P < 0.01). (2 Urinary retention: the incidence of urinary retention was 4. 6% (23/501) in the induction group, 0 in the selective cesarean section group, and 3.3% (54/1616) in the spontaneous onset of labor group. So the rate of urinary retention was lower in the cesarean section group than in the other two groups (P < 0.01). (3) Blood transfusion: the incidence of blood transfusion in delivery was 2.0% (10/501) in the induction group, 0.1% (1/1634) in the selective cesarean section group, and 0.4% (6/1616) in the spontaneous onset of labor group (P < 0.01). (4) Trauma: the incidence of trauma in delivery was 0. 6% (3/501) in the induction group, 0 in the selective cesarean section group, and 0.4% (7/1616) in the spontaneous onset of labor group. So the rate of trauma was lower in the cesarean section group than in the other two groups (P < 0.01). (5) Delayed healing: the incidence of delayed healing of incision was 0.8% (4/501) in the induction group, 0 in the selective cesarean section group, and 0.2% (4/1616) in the spontaneous onset of labor group (P < 0.01). (6) Puerperal morbidity: there was no difference in puerperal morbidity among the three groups (P < 0.01). (7) Neonatal asphyxia: the incidence of neonatal asphyxia was 1.2% (6/501) in the induction group, 0.1% (1/1634) in the selective cesarean section group, and 1.0% (17/1616) in the spontaneous onset of labor group. The rate of neonatal asphyxia was lower in the cesarean section group than in the other two groups (P < 0.01).

Conclusions: Induction may increase incidences of postpartum hemorrhage and blood transfusion, yet, it does not decrease the incidence of urinary retention and neonatal asphyxia. Generally, selective cesarean section is safer than induction and spontaneous onset of labor, but it costs most.