Supervisor: National Health Commission of the PRC
Sponsored by: Chinese Medical Doctor Association
China Medical University
Sponsored by: Chinese Medical Doctor Association
China Medical University
Oxytocin plays a crucial role in the process of labor induction and augmentation by promoting uterine contractions. However，its administration requires refined management to ensure maternal and fetal safety and to avoid uterine tachysystole and related complications. This article systematically reviews the physiological and pharmacological mechanisms of oxytocin， clinical outcomes of different administration protocols， monitoring techniques， risk factors and corresponding control strategies. Incorporating the latest randomized controlled trials and observational studies，it focuses on the clinical value of oxytocin dose adjustment，timing of use，individualized management，and multidisciplinary collaboration in reducing cesarean section rates and preventing uterine rupture and postpartum hemorrhage. Through a comprehensive analysis of existing evidence，this paper aims to provide evidence-based guidance for clinical obstetric practice，promote the safe and effective use of oxytocin，optimize delivery room management protocols，and improve maternal and neonatal health outcomes.
Effective and safe uterine contractions are the core driving force of childbirth，and the limitations of traditional assessment methods of uterine contractions have restricted the precise management of labor progress and uterine contractility. Non-invasive uterine electromyography （uEMG） technology can non-invasively reflect the onset，propagation direction，and intensity distribution of uterine contractions by capturing the electrical activity characteristics of uterine smooth muscle in real time. It can automatically extract parameters such as uterine contraction frequency，duration，and synchrony，thereby realizing the quantification of uterine contraction monitoring. The development of non-invasive uEMG technology is further elaborated based on the basic physiology of uterine bioelectrical activity. It has demonstrated the clinical application value of refined assessment in aspects such as the objective monitoring and abnormal diagnosis of uterine contractility during labor，the accurate prediction of preterm birth，and the individualized decision-making of delivery timing in high-risk pregnancies，providing a new perspective for the clinical intervention of uterine contractility. In the future，it is necessary to further promote the standardization and AI intelligence of the technology，and facilitate its integration with multi-modal information such as fetal heart rate monitoring，so as to construct an intelligent safe labor management system and achieve safe childbirth.
Electronic fetal monitoring （EFM） reflects real-time changes in fetal heart rate and serves as an important tool for assessing the intrauterine condition of the fetus. Intrapartum EFM performed against a background of frequent uterine contractions differs from antepartum EFM in terms of interpretive priorities and has significant implications for intrapartum decision-making. Emerging evidence suggests that baseline stability and variability of fetal heart rate correlate with pregnancy outcomes ，warranting increased attention in the interpretation of intrapartum EFM. In recent years，with the continuous updates on international guidelines for intrapartum EFM，the interpretation of intrapartum EFM is shifting from pattern recognition toward pathophysiological mechanism analysis. Individualized interpretation of EFM and assessment of intrauterine fetal condition should be achieved based on EFM characteristics，maternal risk factors，comorbidities，and labor progress，identifying the type of fetal hypoxia and fetal compensatory and decompensatory status and implementing targeted management. This approach of interpretation contributes to improving perinatal outcomes and ensuring maternal and fetal safety.
Intrauterine fetal resuscitation is an important intervention in the management of fetal distress. However，evidence on resuscitative measures remains inconsistent regarding the indications，implementation timing，and effects on perinatal outcomes， and some therapeutic effects are controversial. Based on current national and international guidelines and evidence-based evidence，the mechanisms and suitable settings of application of commonly used intrauterine resuscitation measures are systematically summarized，and a stepwise management approach focusing on the correction of reversible causes is proposed.
Intrapartum fever is a common emergency in obstetrics. Intrauterine infection （with chorioamnionitis as the core） is the main pathogenic factor，which can significantly increase the risk of adverse outcomes for both the mother and the fetus. Accurate etiological traceability diagnosis and standardized whole-process management are the key to improving prognosis. Based on clinical guidelines and evidence-based medical evidence，this article systematically elaborates on the key points of diagnosis and treatment of intrauterine infection in intrapartum fever，emphasizing the clinical application value of pathogen detection techniques and the importance of multidisciplinary collaboration in order to provide a reference for obstetric clinical practice.
With the proportion of high-risk pregnant women rising，the pressure on delivery units to provide emergency care is increasing. Consequently，many institutions in China have adopted the ‘5-minute emergency caesarean section’ or ‘DDI ≤ 30 minutes’ as core indicators for quality assessment. By examining the time-based rules for emergency caesarean sections，this article explores their scientific limitations and potential risks. The original ‘5-minute rule’ is applicable only to caesarean sections performed during the terminal phase of labour and should not be blindly generalised. Currently，there is no high-quality evidence demonstrating a direct link between a DDI exceeding 30 minutes and adverse outcomes of fetal neurological development; moreover，an excessive focus on short time limits may lead to increased perioperative risks for the mother. Therefore，delivery room management should abandon the‘one-size-fits-all’ approach and establish dynamic，tiered，and individualised DDI targets instead，whilst introducing outcome-oriented composite quality indicators to achieve a scientific balance between time efficiency and maternal and neonatal safety.
Globally，the cesarean section rate continues to rise，which is expected to reach 28.5% by 2030. Meanwhile，the rate of assisted vaginal delivery is on the decline， and there are significant regional differences. This results from the combined effects of various factors including medical technology，social concepts，and medical environments. Under appropriate indications，skilled and safe assisted vaginal delivery remains an effective measure for saving lives，as it can accelerate the delivery process and avoid or reduce the short and long-term complications associated with second-stage cesarean sections. How to enhance the skills of obstetricians in assisted vaginal birth while ensuring safety has become an important issue that needs urgent attention and resolution in the field of obstetrics.This article reviews the current best evidence on assisted vaginal delivery and proposes the following good recommendations on practice，including： the prerequisites for assisted vaginal delivery，high-risk factors，the feasibility of difficult delivery procedures，technological innovations，standard operating procedures，training of operators' qualifications，and the use of a safety checklist for assisted vaginal delivery to reduce the risk of complications，etc.It is suggested that all obstetric healthcare providers，including obstetricians and midwives at all levels，should receive training and possess the team collaboration ability to perform assisted vaginal deliveries （including forceps delivery and vacuum extraction），which will help slow down the rising trend of cesarean section rate， and thus decrease the adverse outcomes caused by inappropriate delivery modes.
Obstetric lacerations are common complications of vaginal delivery，and inadequate repair is prone to inducing long-term complications such as pelvic floor dysfunction. Therefore，standardized repair of obstetric lacerations is of great significance for improving the quality of obstetric clinical practice. The rectovaginal septum，perineal body，anal sphincter complex and other structures are key components in maintaining the structural integrity and normal physiological function of the pelvic floor，and they are vulnerable to injuries during vaginal delivery. Hence，the repair of such obstetric lacerations should emphasize structural and functional reconstruction based on anatomy，and the repair strategy must abide by the core principle of "prioritizing anatomical reduction and functional orientation". Prior to suture，the degree of lacerations should be fully evaluated. Clinical interventions should include adequate hemostasis，layered apposition of injured tissues，and reconstruction of the anatomical continuity of muscles and fasciae. In addition，the implementation of comprehensive perioperative management centering on functional recovery is also essential，so as to promote the overall rehabilitation of the pelvic floor structure and function of patients.
As a high-risk and fast-paced clinical setting，the delivery room serves as the core stage for obstetric medical quality and safety. Establishing a delivery room safety system is crucial for reducing maternal and neonatal morbidity and mortality，and the key to constructing the safety system is the training of the staff in the delivery room. This article elaborates on the challenges facing delivery room safety and the limitations of current training models. Subsequently，through the introduction of the competency-based skill training，the teamwork training that enhances team capability，and the training of multidisciplinary in-situ simulation that replicates real clinical scenarios，this article discusses the establishment and implementation of a training curriculum system for constructing a delivery room safety system. By establishing a closed-loop system of "design-training-assessment-improvement，" this article aims to provide a theoretical basis and practical strategies for the scientific construction and sustained enhancement of a delivery room safety system.
Objective To explore the application effects of different surgical techniques in cesarean section for placenta previa，with consideration of varying fertility policies. Methods To explore the application effects of different surgical methods in cesarean section for placenta previa，with consideration of changes in fertility policies. MethodsA retrospective analysis was conducted on 237 pregnant women with placenta previa who underwent cesarean section in the Obstetric Department of our hospital from January 1，2003 to December 31，2022. Based on the time of changes in fertility policies，they were divided into three groups： Group A （before the two-child policy， from January 1，2003 to December 31，2015），Group B （after the two-child policy， from January 1，2016 to December 31，2019），and Group C （after the three-child policy， from January 1，2020 to December 31，2022）. During this period，the main surgical approaches for managing placenta previa in our department included hysterectomy，ligation of the ascending uterine artery branches intraoperatively and placement of an intrauterine hemostatic balloon，and cervical suture ligation. We analyzed and compared the hysterectomy rates，length of hospital stay，surgical duration，intraoperative blood loss，perioperative transfusion rates，perioperative infection rates，and perioperative ICU transfer rates among the three time periods. Results Comparison among the three groups showed that the hysterectomy rates were 31.6%，16.7%，and 11.3%，respectively； the lengths of hospital stay were 12.72 days，8.80 days，and 10.11 days，respectively； there were statistically significant differences （all P<0.05）. There were no statistically significant differences in surgical duration，intraoperative blood loss，perioperative transfusion rates，perioperative infection rates，or perioperative ICU transfer rates among the three groups. Conclusion With changes in fertility policies，comprehensive treatment for placenta previa，especially improvements in surgical methods，has contributed to reducing hysterectomy rates and shortening the length of maternal hospital stay.
Objective To compare the clinical effect of single-port robot-assisted vNOTES （RSP-vNOTES） with that of traditional vNOTES （T-vNOTES） in total hysterectomy. Methods The data of 90 patients who underwent vNOTES total hysterectomy in the Second Affiliated Hospital of Nanjing Medical University from January 2024 to July 2025 were retrospectively analyzed. Propensity score matching was used to match patients in the RSP-vNOTES group and the T-vNOTES group，resulting in 30 pairs （60 patients） included in the study.Compare and analyze the differences in surgical effects，total hospitalization cost and the operator’s subjective intensity of workload between the two groups of patients. Results There were no significant differences in the total operation time，postoperative 24 h pain score，first postoperative flatus time，CD gradeⅠ~Ⅱcomplication rate，or hospital stay between the two groups（P>0.05）. Compared with the T-vNOTES group，the RSP-vNOTES group had less intraoperative blood loss， less intraoperative fluid infusion （P<0.05），and less operating time of critical surgical steps（P<0.05），but higher total cost of hospitalization （P<0.05）. Compared with the T-vNOTES group，the RSP-vNOTES group had lower mental need，lower physical need，lower score in performance level and lower score in effort level （P<0.05）. Conclusions For experienced surgeons，both RSP-vNOTES total hysterectomy and T-vNOTES total hysterectomy are safe and feasible. Compared with T-vNOTES，RSP-vNOTES total hysterectomy does not increase the length of operation，and may be more efficient in the critical surgical steps of hysterectomy； it has less intraoperative blood loss and fluid infusion，less workload of the operator ，and can improve the comfort of the operation.
Objective To investigate the association between high-normal blood pressure in the first trimester and adverse pregnancy outcomes （APO）. Methods This cohort study recruited singleton and live birth pregnancies in the first trimester （6-13+6 weeks of gestation） from Shenzhen Maternity and Child Healthcare Hospital Affiliated from January 1，2020 to December 31，2022.The general data，mean blood pressure in the first trimester and APO were collected. According to the 2024 Chinese Guidelines for the Management of Hypertension，participants were categorized based on mean blood pressure in the first trimester into three groups： normotensive pressure group[<120/80 mmHg（1 mmHg=0.133 kPa）]，high-normal blood pressure group （120-139/80-89 mmHg），and hypertension group （≥140/90 mmHg）. Statistical analyses were performed using the χ² test，multivariate logistic regression，and sensitivity analysis. Results Compared with the normotensive group，the high-normal blood pressure group had a significantly higher overall incidence of APO （P<0.05）. Multivariate logistic regression analysis showed that high-normal blood pressure was an independent risk factor for gestational hypertension （aOR=6.22，95%CI 4.99-7.76） and preeclampsia （aOR=3.43，95%CI 2.85-4.13）. After excluding the women who developed gestational hypertension or preeclampsia in the second or third trimester，high-normal blood pressure remained significantly associated with increased risks of gestational diabetes mellitus （aOR=1.95，95%CI 1.42-2.67），preterm birth （aOR=1.17，95%CI 1.03-1.33），and small for gestational age （aOR=1.23，95%CI 1.11-1.44） （P<0.05）. Conclusions There is a significant dose-response relationship between first-trimester blood pressure level and the risk of APO. High-normal blood pressure，as defined by the Chinese guidelines，is an independent risk factor for APO.
Objective To explore the natural recovery of pelvic floor function and its influencing factors in primiparas. Methods From May 2018 to May 2024，189 primiparas received follow-ups at 6 weeks，12 weeks，and 1 year postpartum in Shijiazhuang No.4 Hospital. Their general conditions，obstetric conditions， and manual muscle strength，electrophysiological indicators of pelvic floor and pelvic organ prolapse classification at three time points of follow-up were collected. Chi-square test and generalized estimating equations （GEE） were used to analyze influencing factors of pelvic floor muscle strength. Results No significant difference was found in the detection rate of abnormal pelvic floor muscle strength （Grade 0-2） at 6 and 12 weeks postpartum，but the abnormal rate at 1 year was significantly higher. GEE showed that 1 year postpartum，voluntary pelvic floor muscle exercise，physical labor intensity，and fetal weight significantly affected pelvic floor function （P<0.05）； the 1 year postpartum，physical labor intensity and fetal weight were risk factors，while voluntary pelvic floor muscle exercise was a protective factor. Conclusions In natural recovery state， the incidence of abnormal pelvic floor muscle strength in primiparas increases with postpartum time. Voluntary pelvic floor muscle exercise improves pelvic floor function，while 1 year postpartum，physical labor intensity，and fetal weight are risk factors for pelvic floor muscle strength.
