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Active Management of Labor Process under Smart Medical Model Improves Vaginal Delivery Outcomes of Pregnant Women with Preeclampsia

Active Management of Labor Process under Smart Medical Model Improves Vaginal Delivery Outcomes... Hindawi Journal of Healthcare Engineering Volume 2022, Article ID 8926335, 7 pages https://doi.org/10.1155/2022/8926335 Research Article Active Management of Labor Process under Smart Medical Model Improves Vaginal Delivery Outcomes of Pregnant Women with Preeclampsia 1 2 1 1 1 Siming Xin , Xianxian Liu , Jiusheng Zheng , Hua Lai , Jiao Zhou , 1 1 1 3 1 Feng Zhang , Xiaoying Wu , Ting Shen , Lin Xu , and Xiaoming Zeng Department of Obstetrics, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China Key Laboratory of Women’s Reproductive Health of Jiangxi Province, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China Department of Science and Education, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China Correspondence should be addressed to Ting Shen; sintyst508@126.com, Lin Xu; xulinlin5270@163.com, and Xiaoming Zeng; 18070038675@163.com Received 12 February 2022; Revised 9 March 2022; Accepted 26 March 2022; Published 7 April 2022 Academic Editor: Han Wang Copyright © 2022 Siming Xin et al. 1is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. In a global environment of increasing cesarean delivery rate, promoting vaginal delivery, reducing the rate of first cesarean section, and the incidence of vaginal delivery complications are the objectives of obstetric medical quality and safety in China. As a common obstetric complication, preeclampsia affects the safety of many pregnant women. It is the obstetrician’s great responsibility to promote vaginal delivery and improve delivery outcomes in preeclampsia. To this end, we explored the roles of active labor management under the smart medical model in improving the outcomes of vaginal delivery for pregnant women with preeclampsia. Methods. 1e clinical data of 219 cases of preeclampsia pregnant women who delivered vaginally in our hospital from January 2017 to December 2020 were retrospectively analyzed. According to different labor process management, they were divided into study group (active labor process management group) and control group (normal labor process management group). Active labor process management methods included intrapartum ultrasound, central fetal heart rate monitoring, Doula delivery, labor analgesia, and quality of life care. 1e differences in delivery process, delivery outcome, bleeding causes, and hemostatic measures were compared between the two groups. Results. (1) 1e incidence of preeclampsia in our hospital showed an increasing trend in recent four years; (2) in smart hospitals, the active management of labor process reduced the probability of transferring to the cesarean section in preeclampsia pregnant women with vaginal trial failure; and (3) active labor process management reduced the rate of lateral episiotomy, decreased the postpartum hemorrhage volume within two hours, and improved the vaginal delivery outcome of preeclampsia pregnant women. Conclusions. In the era of the rapid development of the Internet, vigorously promoting the construction of smart hospitals and actively managing the delivery process can reduce the failure rate of vaginal trial delivery and improve the outcomes of vaginal delivery in preeclampsia women. integrates with traditional medical services through infor- 1. Introduction mation means, effectively connects patients, medical staff, In recent years, with the rapid development of Internet medical equipment, and medical institutions, and realizes technology, emerging technologies such as artificial intel- efficient coordination among various departments and ligence, informatization, big data, and cloud computing have personnel. 1is not only promotes the sharing and exchange emerged, driving technological changes in the medical field. of medical information and resources and improves the Smart medicine is an innovative application of the Internet utilization rate of medical resources but also meets the needs in the medical field. Based on Internet technology, it deeply of disease diagnosis and treatment of patients and improves 2 Journal of Healthcare Engineering their medical satisfaction. At present, smart medical re- 2. Materials and Methods search mainly covers electronic medical records, medical 2.1. Materials. 1is is a single-center retrospective case-control and health big data analysis and mining, intelligent study. All medical records came from Jiangxi Provincial Ma- medical image analysis, intelligent assisted diagnosis, ternal and Child Health Hospital and were retrieved through the intelligent diagnosis and treatment, etc. In obstetrics, the electronic medical record system of the hospital. 1e retrieval smart medical treatment has penetrated the prediction of strategies were as follows: preeclampsia as the discharge diag- preeclampsia [1, 2], placenta implantation [3], type of nosis, vaginal delivery as the delivery mode, and January 1, 2017, labor [4], fetal growth [5], and other aspects. At the same to December 31, 2020, as the delivery time. Inclusion criteria time, it also made some beneficial explorations in forceps were as follows: singleton live birth, full-term pregnancy, and delivery [6] and treatment of obstetric complications spontaneous delivery. Exclusion criteria were as follows: scarred [7, 8]. uterus, poorly controlled blood pressure, severe impairment of Preeclampsia is a common obstetric complication with organ function, chronic hypertension complicated with pre- a global prevalence of 2%–8% [9, 10]. In China, with the eclampsia, and renal hypertension complicated with anti- liberalization of fertility policy and the development of phospholipid antibody syndrome. A total of 219 pregnant assisted reproductive technology, the number of pregnant women were enrolled in this study. women of advanced age, assisted reproduction, multiple pregnancies, and overweight have increased significantly, and the incidence of preeclampsia is about 2.7% [11], 2.2. Diagnostic Criteria of Preeclampsia. 1e diagnosis of which is one of the major causes of maternal and perinatal preeclampsia refers to the Guidelines for the Diagnosis and death [12]. At present, the common treatment regimen for Treatment of Hypertensive Disorders in Pregnancy (2015) preeclampsia is symptomatic treatment with sedation, formulated by the Hypertensive Diseases Group in Pregnancy antispasmodic, antihypertensive, and correction of of the Chinese Society of Obstetrics and Gynecology. Systolic hypoproteinemia, and the only effective intervention plan blood pressure≥ 140 mmHg or diastolic blood pressur- is the termination of pregnancy. 1e 2020 edition of the e≥ 90 mmHg at or after 20 weeks of pregnancy, together with Chinese Medical Association’s guidelines for the man- one or more of the following new-onset conditions; urinary agement of hypertensive disorders in pregnancy states protein≥ 3.0 g per 24 hours, urinary protein/creatinine that, in principle, vaginal delivery should be considered ratio≥ 0.3, random urinary protein≥ (+) if quantitative urine for pregnant women with preeclampsia who are not se- protein detection is not available; no proteinuria but with verely ill and who do not have an indication for cesarean damage to vital organs such as the heart, lung, liver, kidney, or delivery. However, in actual clinical practice, many involvement of the hematological system, nervous system, pregnant women with preeclampsia who are eligible for digestive system, and fetus, etc. vaginal trial of labor directly opt for cesarean section, or because of the imperfection of medical information sys- 2.3. Definition of Each Stage of Labor. (1) 1e first stage of tems and inadequate maternal-fetal monitoring, patients with preeclampsia undergo unnecessary conversion to labor was known as the cervical dilation period, which re- cesarean section during the vaginal trial of labor. 1is has ferred to the process from regular uterine contractions to the full dilation of the cervix; (2) the second stage of labor was undoubtedly increased the cesarean section rate and the incidence of surgery-related complications in our coun- also known as the fetal delivery period, referred to the process from the full dilation of the cervix to the delivery of try, aggravating the economic burden on maternal fam- ilies and the country. the fetus; and (3) the third stage of labor also known as the placental delivery period referred to the process from the To effectively promote vaginal delivery and reduce the rate of first cesarean section and complications of vaginal delivery of the fetus to the delivery of the placenta. delivery, our hospital launched the construction of smart hospital in 2018 and successively introduced the integrated 2.4. Key Points of Labor Management in the Control Group. platform, hospital information system, laboratory infor- 1e treatment of labor process was performed according to mation management system, hospital resource planning, the “Expert Consensus on New Labor Process Standards and remote fetal heart rate monitor, and central fetal heart rate Treatment (2014)” issued by the Obstetrics and Gynecology monitor. At the same time, we established a sound medical Group of the Chinese Medical Association’s Obstetrics and information system and fetal monitoring system. Since Gynecology Branch. 1e main details were as follows: 2019, relying on the above intelligent systems and equip- ment, our hospital started to explore the active labor (1) Key Points of the First Stage of Labor Management. process management methods under the new labor Vaginal palpation was used to assess the progress of guidelines for preeclampsia pregnant women. In this study, labor, which included fetal position, fetal head po- we retrospectively analyzed the clinical data of pregnant sition, and fetal lie. 1e criteria for abnormal labor women with preeclampsia who delivered vaginally in our were as follows: cessation of uterine orifice dilation, hospital from January 1, 2017, to December 31, 2020, to cessation of fetal head descent, and non-parallelism explore the effectiveness of active labor management in between fetal head height and uterine orifice dilation. improving the delivery outcomes of pregnant women with 1e standard of parallelism between the height of preeclampsia. fetal head and the dilation of the uterus is as follows, Journal of Healthcare Engineering 3 ultrasound, the symphysis pubis and fetal head when uterine orifice dilation size was<3 cm, 3–4 cm, 5–6 cm, 7–8 cm, and 9–10 cm, and the corresponding position of pregnant women were often used as markers. 1e content of the intrapartum ultrasound fetal head position was S—3∼S—2, S—2∼S—1, S 0∼S + 1, S + 1 ∼ S + 2, and S + 2∼S + 3. 1e fetal heart measurement included fetal head progression angle, rate monitoring was performed every 2 hours for midline angle, distance between fetal head and pubic duration of 20–40 minutes. 1e observation of labor symphysis, fetal head direction, and distance be- progress and fetal heart rate was carried out by the tween fetal head and perineum. 1e fetal heart rate resident physician in the delivery room. If there was monitoring was performed by central fetal heart rate any abnormality during labor, the attending physi- monitor, and the related parameters of fetal heart cian with more than 5 years of delivery room work rate monitoring were the same as those of the control experience must check it again. When the final group. If there was any abnormality during labor, the resident physician would immediately contact the judgment was abnormal labor, interventions such as sedation, manual rupture of membranes, oxytocin attending obstetrician who has been trained in systematic ultrasound to check again. If an abnormal drip, and transfer to cesarean section were taken according to the situation. labor did occur, interventions such as sedation, ar- tificial rupture of membranes, oxytocin drip, and (2) Key Points of the Second Stage of Labor Manage- transfer to cesarean section were taken according to ment. A bedside fetal monitor was used for con- the situation. tinuous fetal heart rate monitoring. Doctors and midwives in the delivery room checked the fetal (2) Key Points of the Second Stage of Labor Manage- heart rate pattern timely to detect abnormalities as ment. 1e central fetal heart rate monitor was used to monitor the fetal heart rate continuously throughout soon as possible and then actively adopt forceps or cesarean section to terminate pregnancy according the whole process. Once abnormal fetal heart rate monitor pattern occurred, the central monitor would to the situation. open an alarm to remind the medical staff to take (3) Key Points of the 1ird Stage of Labor Management. active measures. When the fetal shoulder was delivered, 10–20 U oxytocin was used immediately. If necessary, 100 μg (3) Key Points of the 1ird Stage of Labor Management. carbetocin was injected intravenously after fetal 1e treatments were basically the same as the control delivery. If there was still active bleeding, 250 μg group, except that delayed umbilical cord amputa- carboprost trometamol was added. Excluding lac- tion and controlled cord pulling were encouraged eration of birth canal and residual placenta, if uterine when the mother and newborn were in stable bleeding persisted after the use of a variety of uterine condition. contraction drugs and uterine massage to promote uterine contraction, uterine tamponade hemostatic 2.6. Blood Pressure Management during Labor. For patients treatments would be used as soon as possible. without organ dysfunction, the target blood pressure control value was 130–155/80–105 mmHg, and for those with organ dysfunction, the blood pressure control target value was 2.5. Key Points of Labor Management in the Study Group. 130–139/80–89 mmHg. During the first stage of labor, blood During the whole labor process, all patients were provided pressure was monitored every 2 hours to ensure the patient’s with professional, comprehensive, and humanized Doula rest and proper activities. During the second stage of labor, delivery services by systematically trained Doula personnel blood pressure was continuously monitored, and blood to give patients physical, psychological, and emotional pressure was monitored every half hour during the third support. 1e main details of labor management according to stage of labor. Of course, if blood pressure exceeded the the active labor management methods under the new labor target value during the monitoring period, the monitoring standard were as follows: interval needed to be shortened accordingly. (1) Key Points of the First Stage of Labor Management. Under the premise of informed consent of patients, 2.7. Observed Indicators. Duration of 3 stages of labor, rate all pregnant women with preeclampsia were pro- vided with intraspinal labor analgesia by an anes- of forceps assisted delivery, rate of perineal laceration, rate of cervical laceration and placental abruption, postpartum thesiologist in the delivery room. At the same time, life care would be strengthened, and feeding, fluid hemorrhage volume within two hours, birth weight of the newborn, and Apgar score at 1 minute after birth were rehydration, and rest were encouraged during labor. 1e progress of labor was assessed by intravaginal observed. palpation and ultrasound during labor. 1e model of the ultrasonic diagnostic apparatus was S8Exp, and 3. Statistical Analysis the probe frequency was set as 2–4 mega-hertz. Transabdominal ultrasound was used to determine IBM SPSS 24.0 software was used for data processing. 1e fetal position, and transperineal ultrasound was used normally distributed data were expressed as mean- to evaluate fetal head position. In transperineal ± standard deviation, the nonnormally distributed data were 4 Journal of Healthcare Engineering drugs, followed by a single pro-uterine contraction drug, and expressed as median and interquartile spacing, and quali- tative data were expressed as composition ratio. We used the in a few cases, three contraction drugs or even uterine tamponade were used. Statistical analysis showed no dif- independent-samples t test, Mann–Whitney U test, and chi- square test to analyze the statistical differences. P< 0.05 was ference in the methods of hemostasis between the two considered a statistically significant difference. groups. 1e detailed results are shown in Table 5. 4. Results 5. Discussion 4.1. Deliveries of Pregnant Women with Preeclampsia in Our In the context of rising cesarean section rate globally, according Hospital during Four Years. From 2017 to 2020, a total of to the statistics of National Maternal and Child Health Care, 87010 deliveries were made in our hospital, including 44601 the cesarean section rate in China increased from 28.80% to deliveries from 2017 to 2018 and 42409 deliveries from 2019 36.70% from 2008 to 2018 [13], which seriously exceeded the to 2020. 1e delivery mode and delivery volume of pregnant alarm level of the cesarean delivery rate set by the World Health women with preeclampsia are shown in Table 1. Statistical Organization [14]. At the same time, a series of serious analysis results showed that the number of deliveries of complications caused by cesarean section, such as placenta preeclampsia from 2019 to 2020 increased significantly previa, uterine incision pregnancy, placenta implantation, and compared with the previous two years, and the rate of uterine rupture, have seriously affected maternal safety and also delivery of cesarean section due to vaginal trial delivery impose heavy economic burden to the society. In recent years, failure decreased compared with the previous two years. vaginal delivery has been advocated worldwide to reduce the primary cesarean section rate [15], and in 2021, China’s Health and Welfare Commission listed “reducing the incidence of 4.2. Clinical Characteristics of Mothers and Newborns. vaginal delivery complications” as an improvement goal of 1e age distribution of patients with preeclampsia was medical quality and safety. As a common obstetric compli- 17∼45 years, the gestational week of delivery was 259∼291 cation, preeclampsia affects a large number of women in China. days, and the number of pregnancies ranged from 1 to 6, and It was not difficult to find that the incidence of simple pre- these in the control group were 18∼43 years, 259∼ 293 days, eclampsia in our hospital increased significantly in the past two and 1∼8 times. In addition, there were 50 (39.37%) women years, and the number of pregnant women who directly chose in the study group and 32 (34.78%) women in the control cesarean section for various reasons also increased under the group who had histories of childbirth. 1ere were no dif- background of the continuous improvement of medical ferences in the demographic parameters of mothers and technology, which was contrary to the goal of improving newborns between the two groups, as shown in Table 2 for medical quality and safety in China. 1erefore, based on the details. safety of mother and baby, it is one of the key works of ob- stetricians to promote vaginal delivery of pregnant women with 4.3. Vaginal Delivery Outcomes of the Two Groups. 1e preeclampsia. vaginal delivery outcomes are compared between the two 1e introduction of the smart medical information groups of preeclampsia women. We found that the duration system is one of the major initiatives to promote vaginal of the first and second stages of labor was slightly shorter in delivery in our hospital. In 2019, the hospital completed the the study group than in the control group, and the rates of interconnection of the outpatient electronic case system, episiotomy and postpartum hemorrhage volume within two remote fetal heart rate monitoring system, inpatient elec- hours were lower than those in the control group, but the tronic case system, nursing system, testing system, and duration of the third stage of labor, rate of forceps delivery, imaging system so that obstetricians could get a compre- rate of cervical laceration, and placental abruption were not hensive and detailed understanding of patients’ blood significantly different from those in the control group. See pressure fluctuations during pregnancy when receiving Table 3. pregnant women with preeclampsia. Changes in blood test indicators, drug use, and fetal growth indicators are con- ducive to the development of detailed prenatal examination 4.4. Comparison of the Causes of Postpartum Hemorrhage plans and reasonable delivery plans for patients and reduce between the two Groups. A total of 39 patients in the two misdiagnosis and missed diagnosis caused by incomplete groups suffered from postpartum hemorrhage. 1e main and accurate patient history review. When the patients were causes of postpartum hemorrhage were uterine weakness, sent to the delivery room to wait for delivery, the delivery followed by placental factors and birth canal lacerations. No room medical staff could also achieve good communication postpartum hemorrhage caused by coagulation dysfunction with outpatient doctors, ward doctors, and nurses through occurred. Statistical analysis showed that there was no the medical information system, better observe the progress difference in the causes of postpartum hemorrhage between of labor, and give timely and accurate intervention measures the two groups. See Table 4. according to the timely feedback of the central fetal heart rate monitor. 4.5. Comparison of Hemostatic Methods between the Two Intrapartum ultrasound is a technique of labor moni- toring that has become popular in clinic in recent years. 1e Groups. 1e hemostatic measures of the two groups were mainly the combination of two pro-uterine contraction monitoring includes fetal position, fetal head position, and Journal of Healthcare Engineering 5 Table 1: Preeclampsia deliveries in our hospital during four years. 01/01/2017–31/12/2018 01/01/2019–31/12/2020 P value Method Total number of deliveries (cases) 44601 42409 Preeclampsia deliveries (cases/rate) 261 (0.59%) 440 (1.04%) ＜0.001 Pearson’s chi-square Vaginal deliveries (cases/rate) 92 (35.25%) 127 (28.86%) 0.078 Pearson’s chi-square Cesarean delivery (cases/rate) 169 (64.75%) 313 (71.14%) 0.078 Pearson’s chi-square Births converted to cesarean section (cases/rate) 29 (17.16%) 33 (10.86%) 0.038 Pearson’s chi-square Table 2: Clinical characteristics of mothers and newborns of study population. Study group (n � 127) Control group (n � 92) P value Method Age (years) 28.65± 5.32 29.36± 5.62 0.340 Independent-samples t Gestational age (days) 273.85± 7.68 275.47± 8.26 0.138 Independent-samples t Gravidity (times) 2 (1, 3) 2 (1, 3) 0.598 Mann–Whitney Parity (times) 1 (1, 2) 1 (1, 2) 0.520 Mann–Whitney Neonatal weight (kg) 3.29± 0.42 3.29± 0.39 0.941 Independent-samples t Apgar score at 1 minute after birth 10 (10, 10) 10 (10, 10) 0.091 Mann–Whitney Data are presented as median (interquartile spacing) or mean± standard deviation. Table 3: Vaginal delivery outcomes of these study groups. Study group (n � 127) Control group (n � 92) P value Method Duration of the first stage of labor (minutes) 440 (245, 600) 480 (280, 750) 0.496 Mann–Whitney Duration of the second stage of labor (minutes) 29 (16, 48) 31 (15, 60) 0.787 Mann–Whitney Duration of the third stage of labor (minutes) 8 (5, 10) 8 (5, 10) 0.759 Mann–Whitney Episiotomy (cases/rate) 39 (30.71%) 41 (44.57%) 0.042 Pearson’s chi-square Forceps delivery (cases/rate) 4 (3.15%) 4 (4.35%) 0.919 Continuity correction Perineal laceration (cases/rate) 32 (25.20%) 24 (26.09%) 0.882 Pearson’s chi-square Cervical laceration (cases/rate) 7 (5.51%) 1 (1.09%) 0.174 Continuity correction Postpartum hemorrhage volume within two hours (mL) 280 (200, 355) 325 (240, 433.75) 0.037 Mann–Whitney Data are presented as median (interquartile spacing) or mean± standard deviation. Table 4: Comparison of causes of postpartum hemorrhage between the two study groups. Weak contractions (cases/rate) Placental factors (cases/rate) Birth canal laceration (cases/rate) Study group (n � 15) 10 (66.67%) 3 (20.00%) 2 (13.33%) Control group (n � 24) 18 (75.00%) 4 (16.67%) 2 (8.33%) P value 1.000 Method Monte Carlo Table 5: Comparison of hemostatic methods between the two groups. One uterine contraction drug Two uterine contraction drugs 1ree uterine contraction drugs Uterine tamponade (cases/rate) (cases/rate) (cases/rate) (cases/rate) Study group 59 (46.46%) 62 (48.82%) 5 (3.94%) 1 (0.79%) Control group 39 (42.39%) 48 (52.17%) 4 (4.35%) 1 (1.09%) P value 0.932 Method Monte Carlo fetal lie. Commonly used parameters include fetal head labor to comprehensively evaluate the labor process. On the progression angle, midline angle, distance between fetal one hand, it avoided the misjudgment of labor process head and pubic symphysis, fetal head direction, and distance caused by inadequate clinical experience in obstetrics and between fetal head and perineum. With the guidance of inaccurate palpation of vagina, and on the other hand, it ultrasound imaging, we can quantify each parameter index avoided the measurement error of parameters caused by to evaluate the progress of labor more accurately and to seize incomplete ultrasound knowledge. Compared with the the right time to intervene in labor to avoid unnecessary outcomes of the two groups, the duration of the first and vaginal-assisted labor and intermediate cesarean delivery. In second stages of labor in the study group was slightly shorter the past two years, we have adopted the method of vaginal than that in the control group, and the rates of forceps palpation combined with intrapartum ultrasound during delivery and perineal laceration were also lower than in the 6 Journal of Healthcare Engineering control group, while the rate of cesarean section and perineal Conflicts of Interest lateral resection was significantly lower than that in the 1e authors declared that no potential conflicts of interest control group. 1e results of this study gave positive im- exist. plications for the observation of labor progress of pregnant women with preeclampsia by vaginal palpation combined with intrapartum ultrasound. Authors’ Contributions While efforts are being made to promote vaginal delivery in preeclampsia, we need to be more proactive in preventing and Siming Xin and Xianxian Liu contributed equally to this reducing the delivery complications of preeclampsia. Pregnant work. women with preeclampsia are often accompanied by decreased proteinuria and plasma albumin levels and are prone to edema Acknowledgments of the limbs and skin, as well as edema of the myometrium, which can lead to weak uterine contractions. Combined with the 1is work was supported by the Science and Technology use of sedatives and antispasmodics during labor, the probability Project of Jiangxi Province (grant nos. 20192BBGL70003, of postpartum hemorrhage due to weak uterine contractions will 20203BBGL73130, and 20212BAB216065). be higher. In this study, the main cause of bleeding in both groups was uterine contraction weakness. 1e median post- References partum hemorrhage volume within two hours in the study group was 280 mL and the maximum bleeding volume was [1] F. Xie, T. Im, and D. Getahun, “A computerized algorithm to 1650 mL, while in the control group, they were respective capture patient’s past preeclampsia and eclampsia history 325 mL and 1500 mL. 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Active Management of Labor Process under Smart Medical Model Improves Vaginal Delivery Outcomes of Pregnant Women with Preeclampsia

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Copyright © 2022 Siming Xin et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Hindawi Journal of Healthcare Engineering Volume 2022, Article ID 8926335, 7 pages https://doi.org/10.1155/2022/8926335 Research Article Active Management of Labor Process under Smart Medical Model Improves Vaginal Delivery Outcomes of Pregnant Women with Preeclampsia 1 2 1 1 1 Siming Xin , Xianxian Liu , Jiusheng Zheng , Hua Lai , Jiao Zhou , 1 1 1 3 1 Feng Zhang , Xiaoying Wu , Ting Shen , Lin Xu , and Xiaoming Zeng Department of Obstetrics, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China Key Laboratory of Women’s Reproductive Health of Jiangxi Province, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China Department of Science and Education, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China Correspondence should be addressed to Ting Shen; sintyst508@126.com, Lin Xu; xulinlin5270@163.com, and Xiaoming Zeng; 18070038675@163.com Received 12 February 2022; Revised 9 March 2022; Accepted 26 March 2022; Published 7 April 2022 Academic Editor: Han Wang Copyright © 2022 Siming Xin et al. 1is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. In a global environment of increasing cesarean delivery rate, promoting vaginal delivery, reducing the rate of first cesarean section, and the incidence of vaginal delivery complications are the objectives of obstetric medical quality and safety in China. As a common obstetric complication, preeclampsia affects the safety of many pregnant women. It is the obstetrician’s great responsibility to promote vaginal delivery and improve delivery outcomes in preeclampsia. To this end, we explored the roles of active labor management under the smart medical model in improving the outcomes of vaginal delivery for pregnant women with preeclampsia. Methods. 1e clinical data of 219 cases of preeclampsia pregnant women who delivered vaginally in our hospital from January 2017 to December 2020 were retrospectively analyzed. According to different labor process management, they were divided into study group (active labor process management group) and control group (normal labor process management group). Active labor process management methods included intrapartum ultrasound, central fetal heart rate monitoring, Doula delivery, labor analgesia, and quality of life care. 1e differences in delivery process, delivery outcome, bleeding causes, and hemostatic measures were compared between the two groups. Results. (1) 1e incidence of preeclampsia in our hospital showed an increasing trend in recent four years; (2) in smart hospitals, the active management of labor process reduced the probability of transferring to the cesarean section in preeclampsia pregnant women with vaginal trial failure; and (3) active labor process management reduced the rate of lateral episiotomy, decreased the postpartum hemorrhage volume within two hours, and improved the vaginal delivery outcome of preeclampsia pregnant women. Conclusions. In the era of the rapid development of the Internet, vigorously promoting the construction of smart hospitals and actively managing the delivery process can reduce the failure rate of vaginal trial delivery and improve the outcomes of vaginal delivery in preeclampsia women. integrates with traditional medical services through infor- 1. Introduction mation means, effectively connects patients, medical staff, In recent years, with the rapid development of Internet medical equipment, and medical institutions, and realizes technology, emerging technologies such as artificial intel- efficient coordination among various departments and ligence, informatization, big data, and cloud computing have personnel. 1is not only promotes the sharing and exchange emerged, driving technological changes in the medical field. of medical information and resources and improves the Smart medicine is an innovative application of the Internet utilization rate of medical resources but also meets the needs in the medical field. Based on Internet technology, it deeply of disease diagnosis and treatment of patients and improves 2 Journal of Healthcare Engineering their medical satisfaction. At present, smart medical re- 2. Materials and Methods search mainly covers electronic medical records, medical 2.1. Materials. 1is is a single-center retrospective case-control and health big data analysis and mining, intelligent study. All medical records came from Jiangxi Provincial Ma- medical image analysis, intelligent assisted diagnosis, ternal and Child Health Hospital and were retrieved through the intelligent diagnosis and treatment, etc. In obstetrics, the electronic medical record system of the hospital. 1e retrieval smart medical treatment has penetrated the prediction of strategies were as follows: preeclampsia as the discharge diag- preeclampsia [1, 2], placenta implantation [3], type of nosis, vaginal delivery as the delivery mode, and January 1, 2017, labor [4], fetal growth [5], and other aspects. At the same to December 31, 2020, as the delivery time. Inclusion criteria time, it also made some beneficial explorations in forceps were as follows: singleton live birth, full-term pregnancy, and delivery [6] and treatment of obstetric complications spontaneous delivery. Exclusion criteria were as follows: scarred [7, 8]. uterus, poorly controlled blood pressure, severe impairment of Preeclampsia is a common obstetric complication with organ function, chronic hypertension complicated with pre- a global prevalence of 2%–8% [9, 10]. In China, with the eclampsia, and renal hypertension complicated with anti- liberalization of fertility policy and the development of phospholipid antibody syndrome. A total of 219 pregnant assisted reproductive technology, the number of pregnant women were enrolled in this study. women of advanced age, assisted reproduction, multiple pregnancies, and overweight have increased significantly, and the incidence of preeclampsia is about 2.7% [11], 2.2. Diagnostic Criteria of Preeclampsia. 1e diagnosis of which is one of the major causes of maternal and perinatal preeclampsia refers to the Guidelines for the Diagnosis and death [12]. At present, the common treatment regimen for Treatment of Hypertensive Disorders in Pregnancy (2015) preeclampsia is symptomatic treatment with sedation, formulated by the Hypertensive Diseases Group in Pregnancy antispasmodic, antihypertensive, and correction of of the Chinese Society of Obstetrics and Gynecology. Systolic hypoproteinemia, and the only effective intervention plan blood pressure≥ 140 mmHg or diastolic blood pressur- is the termination of pregnancy. 1e 2020 edition of the e≥ 90 mmHg at or after 20 weeks of pregnancy, together with Chinese Medical Association’s guidelines for the man- one or more of the following new-onset conditions; urinary agement of hypertensive disorders in pregnancy states protein≥ 3.0 g per 24 hours, urinary protein/creatinine that, in principle, vaginal delivery should be considered ratio≥ 0.3, random urinary protein≥ (+) if quantitative urine for pregnant women with preeclampsia who are not se- protein detection is not available; no proteinuria but with verely ill and who do not have an indication for cesarean damage to vital organs such as the heart, lung, liver, kidney, or delivery. However, in actual clinical practice, many involvement of the hematological system, nervous system, pregnant women with preeclampsia who are eligible for digestive system, and fetus, etc. vaginal trial of labor directly opt for cesarean section, or because of the imperfection of medical information sys- 2.3. Definition of Each Stage of Labor. (1) 1e first stage of tems and inadequate maternal-fetal monitoring, patients with preeclampsia undergo unnecessary conversion to labor was known as the cervical dilation period, which re- cesarean section during the vaginal trial of labor. 1is has ferred to the process from regular uterine contractions to the full dilation of the cervix; (2) the second stage of labor was undoubtedly increased the cesarean section rate and the incidence of surgery-related complications in our coun- also known as the fetal delivery period, referred to the process from the full dilation of the cervix to the delivery of try, aggravating the economic burden on maternal fam- ilies and the country. the fetus; and (3) the third stage of labor also known as the placental delivery period referred to the process from the To effectively promote vaginal delivery and reduce the rate of first cesarean section and complications of vaginal delivery of the fetus to the delivery of the placenta. delivery, our hospital launched the construction of smart hospital in 2018 and successively introduced the integrated 2.4. Key Points of Labor Management in the Control Group. platform, hospital information system, laboratory infor- 1e treatment of labor process was performed according to mation management system, hospital resource planning, the “Expert Consensus on New Labor Process Standards and remote fetal heart rate monitor, and central fetal heart rate Treatment (2014)” issued by the Obstetrics and Gynecology monitor. At the same time, we established a sound medical Group of the Chinese Medical Association’s Obstetrics and information system and fetal monitoring system. Since Gynecology Branch. 1e main details were as follows: 2019, relying on the above intelligent systems and equip- ment, our hospital started to explore the active labor (1) Key Points of the First Stage of Labor Management. process management methods under the new labor Vaginal palpation was used to assess the progress of guidelines for preeclampsia pregnant women. In this study, labor, which included fetal position, fetal head po- we retrospectively analyzed the clinical data of pregnant sition, and fetal lie. 1e criteria for abnormal labor women with preeclampsia who delivered vaginally in our were as follows: cessation of uterine orifice dilation, hospital from January 1, 2017, to December 31, 2020, to cessation of fetal head descent, and non-parallelism explore the effectiveness of active labor management in between fetal head height and uterine orifice dilation. improving the delivery outcomes of pregnant women with 1e standard of parallelism between the height of preeclampsia. fetal head and the dilation of the uterus is as follows, Journal of Healthcare Engineering 3 ultrasound, the symphysis pubis and fetal head when uterine orifice dilation size was<3 cm, 3–4 cm, 5–6 cm, 7–8 cm, and 9–10 cm, and the corresponding position of pregnant women were often used as markers. 1e content of the intrapartum ultrasound fetal head position was S—3∼S—2, S—2∼S—1, S 0∼S + 1, S + 1 ∼ S + 2, and S + 2∼S + 3. 1e fetal heart measurement included fetal head progression angle, rate monitoring was performed every 2 hours for midline angle, distance between fetal head and pubic duration of 20–40 minutes. 1e observation of labor symphysis, fetal head direction, and distance be- progress and fetal heart rate was carried out by the tween fetal head and perineum. 1e fetal heart rate resident physician in the delivery room. If there was monitoring was performed by central fetal heart rate any abnormality during labor, the attending physi- monitor, and the related parameters of fetal heart cian with more than 5 years of delivery room work rate monitoring were the same as those of the control experience must check it again. When the final group. If there was any abnormality during labor, the resident physician would immediately contact the judgment was abnormal labor, interventions such as sedation, manual rupture of membranes, oxytocin attending obstetrician who has been trained in systematic ultrasound to check again. If an abnormal drip, and transfer to cesarean section were taken according to the situation. labor did occur, interventions such as sedation, ar- tificial rupture of membranes, oxytocin drip, and (2) Key Points of the Second Stage of Labor Manage- transfer to cesarean section were taken according to ment. A bedside fetal monitor was used for con- the situation. tinuous fetal heart rate monitoring. Doctors and midwives in the delivery room checked the fetal (2) Key Points of the Second Stage of Labor Manage- heart rate pattern timely to detect abnormalities as ment. 1e central fetal heart rate monitor was used to monitor the fetal heart rate continuously throughout soon as possible and then actively adopt forceps or cesarean section to terminate pregnancy according the whole process. Once abnormal fetal heart rate monitor pattern occurred, the central monitor would to the situation. open an alarm to remind the medical staff to take (3) Key Points of the 1ird Stage of Labor Management. active measures. When the fetal shoulder was delivered, 10–20 U oxytocin was used immediately. If necessary, 100 μg (3) Key Points of the 1ird Stage of Labor Management. carbetocin was injected intravenously after fetal 1e treatments were basically the same as the control delivery. If there was still active bleeding, 250 μg group, except that delayed umbilical cord amputa- carboprost trometamol was added. Excluding lac- tion and controlled cord pulling were encouraged eration of birth canal and residual placenta, if uterine when the mother and newborn were in stable bleeding persisted after the use of a variety of uterine condition. contraction drugs and uterine massage to promote uterine contraction, uterine tamponade hemostatic 2.6. Blood Pressure Management during Labor. For patients treatments would be used as soon as possible. without organ dysfunction, the target blood pressure control value was 130–155/80–105 mmHg, and for those with organ dysfunction, the blood pressure control target value was 2.5. Key Points of Labor Management in the Study Group. 130–139/80–89 mmHg. During the first stage of labor, blood During the whole labor process, all patients were provided pressure was monitored every 2 hours to ensure the patient’s with professional, comprehensive, and humanized Doula rest and proper activities. During the second stage of labor, delivery services by systematically trained Doula personnel blood pressure was continuously monitored, and blood to give patients physical, psychological, and emotional pressure was monitored every half hour during the third support. 1e main details of labor management according to stage of labor. Of course, if blood pressure exceeded the the active labor management methods under the new labor target value during the monitoring period, the monitoring standard were as follows: interval needed to be shortened accordingly. (1) Key Points of the First Stage of Labor Management. Under the premise of informed consent of patients, 2.7. Observed Indicators. Duration of 3 stages of labor, rate all pregnant women with preeclampsia were pro- vided with intraspinal labor analgesia by an anes- of forceps assisted delivery, rate of perineal laceration, rate of cervical laceration and placental abruption, postpartum thesiologist in the delivery room. At the same time, life care would be strengthened, and feeding, fluid hemorrhage volume within two hours, birth weight of the newborn, and Apgar score at 1 minute after birth were rehydration, and rest were encouraged during labor. 1e progress of labor was assessed by intravaginal observed. palpation and ultrasound during labor. 1e model of the ultrasonic diagnostic apparatus was S8Exp, and 3. Statistical Analysis the probe frequency was set as 2–4 mega-hertz. Transabdominal ultrasound was used to determine IBM SPSS 24.0 software was used for data processing. 1e fetal position, and transperineal ultrasound was used normally distributed data were expressed as mean- to evaluate fetal head position. In transperineal ± standard deviation, the nonnormally distributed data were 4 Journal of Healthcare Engineering drugs, followed by a single pro-uterine contraction drug, and expressed as median and interquartile spacing, and quali- tative data were expressed as composition ratio. We used the in a few cases, three contraction drugs or even uterine tamponade were used. Statistical analysis showed no dif- independent-samples t test, Mann–Whitney U test, and chi- square test to analyze the statistical differences. P< 0.05 was ference in the methods of hemostasis between the two considered a statistically significant difference. groups. 1e detailed results are shown in Table 5. 4. Results 5. Discussion 4.1. Deliveries of Pregnant Women with Preeclampsia in Our In the context of rising cesarean section rate globally, according Hospital during Four Years. From 2017 to 2020, a total of to the statistics of National Maternal and Child Health Care, 87010 deliveries were made in our hospital, including 44601 the cesarean section rate in China increased from 28.80% to deliveries from 2017 to 2018 and 42409 deliveries from 2019 36.70% from 2008 to 2018 [13], which seriously exceeded the to 2020. 1e delivery mode and delivery volume of pregnant alarm level of the cesarean delivery rate set by the World Health women with preeclampsia are shown in Table 1. Statistical Organization [14]. At the same time, a series of serious analysis results showed that the number of deliveries of complications caused by cesarean section, such as placenta preeclampsia from 2019 to 2020 increased significantly previa, uterine incision pregnancy, placenta implantation, and compared with the previous two years, and the rate of uterine rupture, have seriously affected maternal safety and also delivery of cesarean section due to vaginal trial delivery impose heavy economic burden to the society. In recent years, failure decreased compared with the previous two years. vaginal delivery has been advocated worldwide to reduce the primary cesarean section rate [15], and in 2021, China’s Health and Welfare Commission listed “reducing the incidence of 4.2. Clinical Characteristics of Mothers and Newborns. vaginal delivery complications” as an improvement goal of 1e age distribution of patients with preeclampsia was medical quality and safety. As a common obstetric compli- 17∼45 years, the gestational week of delivery was 259∼291 cation, preeclampsia affects a large number of women in China. days, and the number of pregnancies ranged from 1 to 6, and It was not difficult to find that the incidence of simple pre- these in the control group were 18∼43 years, 259∼ 293 days, eclampsia in our hospital increased significantly in the past two and 1∼8 times. In addition, there were 50 (39.37%) women years, and the number of pregnant women who directly chose in the study group and 32 (34.78%) women in the control cesarean section for various reasons also increased under the group who had histories of childbirth. 1ere were no dif- background of the continuous improvement of medical ferences in the demographic parameters of mothers and technology, which was contrary to the goal of improving newborns between the two groups, as shown in Table 2 for medical quality and safety in China. 1erefore, based on the details. safety of mother and baby, it is one of the key works of ob- stetricians to promote vaginal delivery of pregnant women with 4.3. Vaginal Delivery Outcomes of the Two Groups. 1e preeclampsia. vaginal delivery outcomes are compared between the two 1e introduction of the smart medical information groups of preeclampsia women. We found that the duration system is one of the major initiatives to promote vaginal of the first and second stages of labor was slightly shorter in delivery in our hospital. In 2019, the hospital completed the the study group than in the control group, and the rates of interconnection of the outpatient electronic case system, episiotomy and postpartum hemorrhage volume within two remote fetal heart rate monitoring system, inpatient elec- hours were lower than those in the control group, but the tronic case system, nursing system, testing system, and duration of the third stage of labor, rate of forceps delivery, imaging system so that obstetricians could get a compre- rate of cervical laceration, and placental abruption were not hensive and detailed understanding of patients’ blood significantly different from those in the control group. See pressure fluctuations during pregnancy when receiving Table 3. pregnant women with preeclampsia. Changes in blood test indicators, drug use, and fetal growth indicators are con- ducive to the development of detailed prenatal examination 4.4. Comparison of the Causes of Postpartum Hemorrhage plans and reasonable delivery plans for patients and reduce between the two Groups. A total of 39 patients in the two misdiagnosis and missed diagnosis caused by incomplete groups suffered from postpartum hemorrhage. 1e main and accurate patient history review. When the patients were causes of postpartum hemorrhage were uterine weakness, sent to the delivery room to wait for delivery, the delivery followed by placental factors and birth canal lacerations. No room medical staff could also achieve good communication postpartum hemorrhage caused by coagulation dysfunction with outpatient doctors, ward doctors, and nurses through occurred. Statistical analysis showed that there was no the medical information system, better observe the progress difference in the causes of postpartum hemorrhage between of labor, and give timely and accurate intervention measures the two groups. See Table 4. according to the timely feedback of the central fetal heart rate monitor. 4.5. Comparison of Hemostatic Methods between the Two Intrapartum ultrasound is a technique of labor moni- toring that has become popular in clinic in recent years. 1e Groups. 1e hemostatic measures of the two groups were mainly the combination of two pro-uterine contraction monitoring includes fetal position, fetal head position, and Journal of Healthcare Engineering 5 Table 1: Preeclampsia deliveries in our hospital during four years. 01/01/2017–31/12/2018 01/01/2019–31/12/2020 P value Method Total number of deliveries (cases) 44601 42409 Preeclampsia deliveries (cases/rate) 261 (0.59%) 440 (1.04%) ＜0.001 Pearson’s chi-square Vaginal deliveries (cases/rate) 92 (35.25%) 127 (28.86%) 0.078 Pearson’s chi-square Cesarean delivery (cases/rate) 169 (64.75%) 313 (71.14%) 0.078 Pearson’s chi-square Births converted to cesarean section (cases/rate) 29 (17.16%) 33 (10.86%) 0.038 Pearson’s chi-square Table 2: Clinical characteristics of mothers and newborns of study population. Study group (n � 127) Control group (n � 92) P value Method Age (years) 28.65± 5.32 29.36± 5.62 0.340 Independent-samples t Gestational age (days) 273.85± 7.68 275.47± 8.26 0.138 Independent-samples t Gravidity (times) 2 (1, 3) 2 (1, 3) 0.598 Mann–Whitney Parity (times) 1 (1, 2) 1 (1, 2) 0.520 Mann–Whitney Neonatal weight (kg) 3.29± 0.42 3.29± 0.39 0.941 Independent-samples t Apgar score at 1 minute after birth 10 (10, 10) 10 (10, 10) 0.091 Mann–Whitney Data are presented as median (interquartile spacing) or mean± standard deviation. Table 3: Vaginal delivery outcomes of these study groups. Study group (n � 127) Control group (n � 92) P value Method Duration of the first stage of labor (minutes) 440 (245, 600) 480 (280, 750) 0.496 Mann–Whitney Duration of the second stage of labor (minutes) 29 (16, 48) 31 (15, 60) 0.787 Mann–Whitney Duration of the third stage of labor (minutes) 8 (5, 10) 8 (5, 10) 0.759 Mann–Whitney Episiotomy (cases/rate) 39 (30.71%) 41 (44.57%) 0.042 Pearson’s chi-square Forceps delivery (cases/rate) 4 (3.15%) 4 (4.35%) 0.919 Continuity correction Perineal laceration (cases/rate) 32 (25.20%) 24 (26.09%) 0.882 Pearson’s chi-square Cervical laceration (cases/rate) 7 (5.51%) 1 (1.09%) 0.174 Continuity correction Postpartum hemorrhage volume within two hours (mL) 280 (200, 355) 325 (240, 433.75) 0.037 Mann–Whitney Data are presented as median (interquartile spacing) or mean± standard deviation. Table 4: Comparison of causes of postpartum hemorrhage between the two study groups. Weak contractions (cases/rate) Placental factors (cases/rate) Birth canal laceration (cases/rate) Study group (n � 15) 10 (66.67%) 3 (20.00%) 2 (13.33%) Control group (n � 24) 18 (75.00%) 4 (16.67%) 2 (8.33%) P value 1.000 Method Monte Carlo Table 5: Comparison of hemostatic methods between the two groups. One uterine contraction drug Two uterine contraction drugs 1ree uterine contraction drugs Uterine tamponade (cases/rate) (cases/rate) (cases/rate) (cases/rate) Study group 59 (46.46%) 62 (48.82%) 5 (3.94%) 1 (0.79%) Control group 39 (42.39%) 48 (52.17%) 4 (4.35%) 1 (1.09%) P value 0.932 Method Monte Carlo fetal lie. Commonly used parameters include fetal head labor to comprehensively evaluate the labor process. On the progression angle, midline angle, distance between fetal one hand, it avoided the misjudgment of labor process head and pubic symphysis, fetal head direction, and distance caused by inadequate clinical experience in obstetrics and between fetal head and perineum. With the guidance of inaccurate palpation of vagina, and on the other hand, it ultrasound imaging, we can quantify each parameter index avoided the measurement error of parameters caused by to evaluate the progress of labor more accurately and to seize incomplete ultrasound knowledge. Compared with the the right time to intervene in labor to avoid unnecessary outcomes of the two groups, the duration of the first and vaginal-assisted labor and intermediate cesarean delivery. In second stages of labor in the study group was slightly shorter the past two years, we have adopted the method of vaginal than that in the control group, and the rates of forceps palpation combined with intrapartum ultrasound during delivery and perineal laceration were also lower than in the 6 Journal of Healthcare Engineering control group, while the rate of cesarean section and perineal Conflicts of Interest lateral resection was significantly lower than that in the 1e authors declared that no potential conflicts of interest control group. 1e results of this study gave positive im- exist. plications for the observation of labor progress of pregnant women with preeclampsia by vaginal palpation combined with intrapartum ultrasound. Authors’ Contributions While efforts are being made to promote vaginal delivery in preeclampsia, we need to be more proactive in preventing and Siming Xin and Xianxian Liu contributed equally to this reducing the delivery complications of preeclampsia. Pregnant work. women with preeclampsia are often accompanied by decreased proteinuria and plasma albumin levels and are prone to edema Acknowledgments of the limbs and skin, as well as edema of the myometrium, which can lead to weak uterine contractions. Combined with the 1is work was supported by the Science and Technology use of sedatives and antispasmodics during labor, the probability Project of Jiangxi Province (grant nos. 20192BBGL70003, of postpartum hemorrhage due to weak uterine contractions will 20203BBGL73130, and 20212BAB216065). be higher. In this study, the main cause of bleeding in both groups was uterine contraction weakness. 1e median post- References partum hemorrhage volume within two hours in the study group was 280 mL and the maximum bleeding volume was [1] F. Xie, T. Im, and D. Getahun, “A computerized algorithm to 1650 mL, while in the control group, they were respective capture patient’s past preeclampsia and eclampsia history 325 mL and 1500 mL. 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Published: Apr 7, 2022

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