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Koenigbauer JT, Kummer J, Malan M, Simon LM, Hellmeyer L, Kyvernitakis I, Maul H, Wohlmuth P, Rath W. Preinduction cervical ripening in an outpatient setting: a prospective pilot study of a synthetic osmotic dilator compared with a double-balloon catheter. J Perinat Med 2024; 0:jpm-2024-0307. [PMID: 39175160 DOI: 10.1515/jpm-2024-0307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 08/07/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVES To compare the effectiveness, safety and patient satisfaction of a double balloon catheter (DB) with a synthetic osmotic cervical dilator (OD) for pre-induction cervical ripening in an outpatient setting. METHODS This is a prospective, dual-center pilot study including 94 patients with an unripe cervix (Bishop Score <6) near term; 50 patients received the DB and 44 patients the OD. The primary outcomes were the difference in Bishop Score (BS) and cervical shortening. Pain perception at insertion and during the cervical ripening period was evaluated by a visual analogue scale and patient satisfaction by a predefined questionnaire. RESULTS The use of DB was associated with a significantly higher increase in BS (median 3) compared to OD (median 2; p=0.002) and resulted in significantly greater cervical shortening (median -14 mm vs. -9 mm; p=0.003). There were no serious adverse events at placement of devices or during the cervical ripening. There were no significant differences in perinatal outcomes. Pain perception during cervical ripening was significantly higher (p<0.001), and patient satisfaction regarding sleep, relaxing time and performing desired daily activities were significantly lower in patients with DB compared to patients with OD (p<0.001). CONCLUSIONS DB was superior to OD regarding cervical ripening based on BS and on sonographic measurement of the cervical length. Patients with OD experienced less pain during cervical ripening and were more satisfied with the method compared to patients with DB.
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Affiliation(s)
| | - Julia Kummer
- Department of Gynecology and Obstetrics, Vivantes Klinikum Im Friedrichshain, Berlin, Germany
| | - Marcel Malan
- Faculty of Medicine, Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Gynecology and Obstetrics, Asklepios Kliniken Barmbek, Wandsbek und Nord-Heidberg, Hamburg, Germany
| | - Luisa Maria Simon
- Department of Gynecology and Obstetrics, Vivantes Klinikum Im Friedrichshain, Berlin, Germany
| | - Lars Hellmeyer
- Department of Gynecology and Obstetrics, Vivantes Klinikum Im Friedrichshain, Berlin, Germany
| | - Ioannis Kyvernitakis
- Department of Gynecology and Obstetrics, Asklepios Kliniken Barmbek, Wandsbek und Nord-Heidberg, Hamburg, Germany
| | - Hoger Maul
- Department of Gynecology and Obstetrics, Asklepios Kliniken Barmbek, Wandsbek und Nord-Heidberg, Hamburg, Germany
| | | | - Werner Rath
- Faculty of Medicine, Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Kiel, Germany
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Rodríguez-Zurita A, Álvarez SC, García CC, Paniagua MG, González AR, Bello MÁG, González ED, Montesino JLT. Effectiveness and Safety of the Double Intracervical Balloon vs Dinoprostone in Patients with Previous Cesarean Section. Reprod Sci 2024:10.1007/s43032-024-01617-5. [PMID: 38862859 DOI: 10.1007/s43032-024-01617-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 06/03/2024] [Indexed: 06/13/2024]
Abstract
To compare effectiveness and safety of the Cook's balloon with vaginal dinoprostone to induce labor in patients with previous cesarean section. Observational, and retrospective study that included pregnant women at ≥ 37 weeks' gestation, with unfavorable cervix, singleton pregnancy, intact membranes, and a previous cesarean section, who had undergone labor induction in the period 2014-2019. 170 patients (86 balloon-84 dinoprostone) were analyzed. The proportion of women achieving vaginal delivery within 24 h was higher in the dinoprostone than in double-balloon group (RR, 3.24; 95% CI, 1.36-7.72). No significant differences were detected in the first 48 h in vaginal deliveries (P = .749) or in cesarean section rates (P = .634). Nor were there differences in maternal or fetal safety profiles. A body mass index > 35 increased the risk of cesarean section by 1.53 times (P = .017) and a Bishop's test score < 3 by 1.91 times (P = .009). A vaginal delivery following a cesarean section decreased the probability of another cesarean section by 0.46 times (P = .039). Labor induction with vaginal dinoprostone achieves better vaginal delivery rates in the first 24 h vs Cook's balloon. While the difference in uterine rupture rate did not reach significance, this was higher in women receiving prostaglandin.
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Affiliation(s)
- Alicia Rodríguez-Zurita
- Department of Obstetrics and Gynecology, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain.
- La Laguna University, Santa Cruz de Tenerife, Spain.
| | - Sara Caamiña Álvarez
- Department of Obstetrics and Gynecology, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | - María Gallego Paniagua
- Department of Obstetrics and Gynecology, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Alba Rodríguez González
- Department of Obstetrics and Gynecology, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Miguel Ángel García Bello
- Department of Clinical Psychology-Psychobiology and Methodology, University of La Laguna, Santa Cruz de Tenerife, Spain
| | - Elena Díez González
- Department of Obstetrics and Gynecology, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - José Luis Trabado Montesino
- Department of Obstetrics and Gynecology, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
- La Laguna University, Santa Cruz de Tenerife, Spain
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3
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Ghesquière L, Bengler C, Drumez E, Subtil D, Houfflin-Debarge V, Insubri S, Garabedian C. Factors associated with successful balloon catheter labor induction in women with a previous caesarean section: A retrospective single-center evaluation. J Gynecol Obstet Hum Reprod 2024; 53:102743. [PMID: 38341084 DOI: 10.1016/j.jogoh.2024.102743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Labor induction of women with a history of uterine scarring is an increasingly frequent situation and one for which there are currently no clear professional recommendations favoring one method over another. The objectives of this study were to determine the success rate of balloon catheter induction in women with a history of caesarean section and to evaluate the main factors associated with vaginal delivery. MATERIALS AND METHODS This single-center retrospective study was conducted between January 1, 2014, and December 31, 2018, in Lille, France, and included all women with one previous caesarean section who were induced by first-line balloon catheter induction. Multivariate analysis was performed to identify the factors associated with the primary outcome (vaginal delivery). RESULTS Of the 310 women in the sample, 192 delivered vaginally (62 %). After adjustment, factors associated with successful induction (vaginal delivery) were the number of previous vaginal deliveries (odds ratio [OR] 1.37; 95 % confidence interval [CI] 1.04-1.81), evolution of the Bishop score after balloon removal (OR 1.24; 95 % CI 1.10-1.41), and the initial Bishop score (OR 1.17; 95 % CI 1.00-1.37). Uterine rupture was observed in three women (1 %). CONCLUSION The vaginal delivery rate after balloon catheter induction in women with a previous caesarean section was 62 %. Prognostic factors for vaginal delivery include previous vaginal delivery, the initial Bishop score, and evolution of the Bishop score after balloon catheter induction.
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Affiliation(s)
- Louise Ghesquière
- Department of Obstetrics, CHU Lille, Lille F-59000, France; ULR 2694 - METRICS - Health Technology and Medical Practice Assessment, Univ. Lille, CHU Lille, Lille F-59000, France.
| | - Cyril Bengler
- Department of Obstetrics, CHU Lille, Lille F-59000, France
| | - Elodie Drumez
- ULR 2694 - METRICS - Health Technology and Medical Practice Assessment, Univ. Lille, CHU Lille, Lille F-59000, France; Department of Biostatistics, CHRU Lille, France
| | - Damien Subtil
- Department of Obstetrics, CHU Lille, Lille F-59000, France; ULR 2694 - METRICS - Health Technology and Medical Practice Assessment, Univ. Lille, CHU Lille, Lille F-59000, France
| | - Véronique Houfflin-Debarge
- Department of Obstetrics, CHU Lille, Lille F-59000, France; ULR 2694 - METRICS - Health Technology and Medical Practice Assessment, Univ. Lille, CHU Lille, Lille F-59000, France
| | | | - Charles Garabedian
- Department of Obstetrics, CHU Lille, Lille F-59000, France; ULR 2694 - METRICS - Health Technology and Medical Practice Assessment, Univ. Lille, CHU Lille, Lille F-59000, France
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4
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Ma K, Yang M, Feng X, Liu L, Li L, Li Y. Predictors of vaginal delivery following balloon catheter for labor induction in women with one previous cesarean. BMC Pregnancy Childbirth 2023; 23:417. [PMID: 37277699 DOI: 10.1186/s12884-023-05734-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/24/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND The aim of this study was to estimate predictors for vaginal birth following balloon catheter induction of labor (IOL) in women with one previous cesarean section (CS) and an unfavorable cervix. METHODS This 4-year retrospective cohort study was conducted in Longhua District Central Hospital in Shenzhen China, between January 2015 and December 2018. Patients with one previous CS and a current singleton-term pregnancy who underwent balloon catheter cervical ripening and IOL were enrolled. Univariate analysis was used to identify predictive factors associated with vaginal birth after cesarean section (VBAC). Binary logistic regression was further used to identify which factors were independently associated with the outcome measure. The primary outcome was VBAC, which was a successful trial of labor after cesarean delivery (TOLAC) following IOL. RESULTS A total of 69.57% (208/299) of the women who planned for IOL had VBAC. In the final binary logistic regression equation, lower fetal weight (< 4000 g) (odds ratio [OR]5.26; 95% confidence interval [CI] 2.09,13.27), lower body mass index (BMI,<30 kg/m2) (OR 2.27; CI 1.21, 4.26), Bishop score after cervical ripening > 6 (OR 1.94; CI 1.37, 2.76) remained independently associated with an increased chance of VBAC. CONCLUSIONS The influencing factors of VBAC following IOL were fetal weight, BMI, and Bishop score after cervical ripening. Adequate individualized management and assessment of the IOL may help improve the VBAC rate.
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Affiliation(s)
- Kaidong Ma
- Obstetrics department, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Ming Yang
- Obstetrics department, The First Dongguan Affiliated Hospital of Guangdong Medical University, Dongguan, China
| | - Xiaoling Feng
- Obstetrics department, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Liyuan Liu
- Obstetrics department, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Liangliang Li
- Obstetrics department, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Yunxiu Li
- Obstetrics department, Shenzhen Longhua District Central Hospital, Shenzhen, China.
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Rath W, Hellmeyer L, Tsikouras P, Stelzl P. Mechanical Methods for the Induction of Labour After Previous Caesarean Section – An Updated, Evidence-based Review. Geburtshilfe Frauenheilkd 2022; 82:727-735. [PMID: 35815098 PMCID: PMC9262630 DOI: 10.1055/a-1731-7441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/29/2021] [Indexed: 11/04/2022] Open
Abstract
There are currently no up-to-date evidence-based recommendations on the preferred method to induce labour after previous Caesarean section, especially for patients with unripe cervix, as
randomised controlled studies are lacking. Intravenous oxytocin and misoprostol are contraindicated in these women because of the high risk of uterine rupture. In women with ripe cervix
(Bishop Score > 6), intravenous administration of oxytocin is an effective procedure with comparable rates of uterine rupture to those with spontaneous onset of labour. Vaginal
prostaglandin E
2
(PGE
2
) and mechanical methods (balloon catheters, hygroscopic cervical dilators) are effective methods to induce labour in pregnant women with unripe
cervix and previous Caesarean section. According to current guidelines, the administration of PGE
2
is associated with a higher rate of uterine rupture compared to balloon
catheters. Balloon catheters are therefore a suitable alternative to PGE
2
to induce labour after previous Caesarean section, even though this is an off-label use. In addition to
two meta-analyses published in 2016, 12 mostly retrospective cohort/observational studies with low to moderate levels of evidence have been published on mechanical methods of cervical
ripening after previous Caesarean section. But because of the significant heterogeneity of the studies, substantial differences in study design, and insufficient numbers of pregnant women
included in the studies, it is not possible to make any evidence-based recommendations based on these studies. According to a recent meta-analysis, the average rate using balloon catheters
is approximately 53% and the average rate after spontaneous onset of labour is 72%. The uterine rupture rate was 0.2–0.9% for vaginal PGE
2
and 0.56–0.94% for balloon catheters and
is therefore comparable to the uterine rupture rate associated with spontaneous onset of labour. According to the product informations, hygroscopic cervical dilators (Dilapan-S) are
currently the only method which is not contraindicated for cervical ripening/induction of labour in women with previous Caesarean section, although data are insufficient. Well-designed,
randomised, controlled studies with sufficient case numbers comparing balloon catheters and hygroscopic cervical dilators with mechanical methods and vaginal prostaglandin E
2
/oral
misoprostol are therefore necessary to allow proper decision-making.
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Affiliation(s)
- Werner Rath
- Medizinische Fakultät, Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Lars Hellmeyer
- Klinik für Gynäkologie und Geburtsmedizin, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Panagiotis Tsikouras
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Patrick Stelzl
- Universitätsklinik für Gynäkologie, Geburtshilfe und Gynäkologische Endokrinologie, Kepler Universitätsklinikum, Johannes Kepler Universität Linz, Linz, Austria
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Ducarme G, Martin S, Chesnoy V, Planche L, Berte MP, Netier-Herault E. Prospective observational study investigating the effectiveness, safety, women’s experiences and quality of life at 3 months regarding cervical ripening methods for induction of labor at term—The MATUCOL study protocol. PLoS One 2022; 17:e0262292. [PMID: 35061804 PMCID: PMC8782477 DOI: 10.1371/journal.pone.0262292] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/20/2021] [Indexed: 11/19/2022] Open
Abstract
Background The purposes of successful induction of labor (IOL) are to shorten the time for IOL to delivery, increase the vaginal delivery rate, and reduce the rate of maternal and neonatal morbidity. In cases of unfavorable cervix (Bishop score <6), cervical ripening is advised to improve vaginal delivery rate. It may be initiated by mechanical (double balloon catheter (DBC), synthetic osmotic dilator) or pharmacologic (prostaglandins) methods, and the problem is complex due to the multitude of cervical ripening methods. We are constantly looking for the optimal protocol of cervical ripening for each woman. The present study aims to elucidate whether cervical ripening method is associated with increase rate of vaginal delivery, good women’s experience and unaltered long-term quality of life after cervical ripening at term regarding maternal and obstetric characteristics. Methods and design The MATUCOL study is a monocentric, prospective, observational study of all consecutive women who required cervical ripening (Bishop score <6) using different methods (DBC, vaginal dinoprostone, oral misoprostol) with a live fetus at term (≥37 weeks) between January 2020 and August 2021. The outcomes will be mode of delivery, maternal and neonatal morbidity, discomfort/pain assessments during cervical ripening, women’s experience and satisfaction, and the impact of cervical ripening on the health-related quality of life at 3 months. If it reports a significant efficacy/safety/perinatal morbidity/women’s satisfaction/quality of life at 3 months post-delivery associated with a method of cervical ripening in a specific situation (gestational and/or fetal disease) using a multivariate analysis, its use should be reconsidered in clinical practice. Discussion This study will reveal that some cervical ripening methods will be more effectiveness, safe, with good women’s experiences and QOL at 3 months compared to others regarding maternal and obstetric characteristics. Trial registration This study is being performed at La Roche sur Yon Hospital following registration as GNEDS on January 8, 2020.
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Affiliation(s)
- Guillaume Ducarme
- Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, 85000, La Roche sur Yon, France
- * E-mail:
| | - Stephanie Martin
- Clinical Research Center, Centre Hospitalier Departemental, 85000, La Roche sur Yon, France
| | - Veronique Chesnoy
- Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, 85000, La Roche sur Yon, France
| | - Lucie Planche
- Clinical Research Center, Centre Hospitalier Departemental, 85000, La Roche sur Yon, France
| | - Marie-Pierre Berte
- Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, 85000, La Roche sur Yon, France
| | - Elodie Netier-Herault
- Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, 85000, La Roche sur Yon, France
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Chiossi G, D’Amico R, Tramontano AL, Sampogna V, Laghi V, Facchinetti F. Prevalence of uterine rupture among women with one prior low transverse cesarean and women with unscarred uterus undergoing labor induction with PGE2: A systematic review and meta-analysis. PLoS One 2021; 16:e0253957. [PMID: 34228760 PMCID: PMC8259955 DOI: 10.1371/journal.pone.0253957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/16/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND As uterine rupture may affect as many as 11/1000 women with 1 prior cesarean birth and 5/10.000 women with unscarred uterus undergoing labor induction, we intended to estimate the prevalence of such rare outcome when PGE2 is used for cervical ripening and labor induction. METHODS We searched MEDLINE, ClinicalTrials.gov and the Cochrane library up to September 1st 2020. Retrospective and prospective cohort studies, as well as randomized controlled trials (RCTs) on singleton viable pregnancies receiving PGE2 for cervical ripening and labor induction were reviewed. Prevalence of uterine rupture was meta-analyzed with Freeman-Tukey double arcsine transformation among women with 1 prior low transverse cesarean section and women with unscarred uterus. RESULTS We reviewed 956 full text articles to include 69 studies. The pooled prevalence rate of uterine rupture is estimated to range between 2 and 9 out of 1000 women with 1 prior low transverse cesarean (5/1000; 95%CI 2-9/1000, 122/9000). The prevalence of uterine rupture among women with unscarred uterus is extremely low, reaching at most 0.7/100.000 (<1/100.000.000; 95%CI <1/100.000.000-0.7/100.000, 8/17.684). CONCLUSIONS Uterine rupture is a rare event during cervical ripening and labor induction with PGE2.
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Affiliation(s)
- Giuseppe Chiossi
- Division of Obstetrics, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto D’Amico
- Statistics Unit, Department of Diagnostic and Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Anna L. Tramontano
- Division of Obstetrics, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Veronica Sampogna
- Division of Obstetrics, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Viola Laghi
- Division of Obstetrics, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Facchinetti
- Division of Obstetrics, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
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Peng J, Li R, Du S, Yin H, Li M, Zheng X, Wu S, Zhao Y. Induction of labour in mid-trimester pregnancy using double-balloon catheter placement within 12 h versus within 12-24 h. BMC Pregnancy Childbirth 2021; 21:17. [PMID: 33407258 PMCID: PMC7788842 DOI: 10.1186/s12884-020-03513-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/21/2020] [Indexed: 12/02/2022] Open
Abstract
Background This study aims to evaluate the efficacy and safety of the induction of labour in mid-trimester pregnancy using a double-balloon catheter (DBC) within 12 h versus within 12–24 h. Methods In this retrospective study, a total of 58 pregnant women at 14 + 0 weeks to 27 + 6 weeks of gestation were enrolled as research subjects, and they underwent the intended termination of pregnancy at our birth centre from January 1, 2017, to June 31, 2019. Based on the duration of DBC, the patients were divided into two groups, namely, the DBC group within 12 h and the DBC group within 12–24 h. Results All 58 cases were successful vaginal deliveries, and no one chose to undergo caesarean section. The success rate of induction (successful abortion of the foetus and placenta without the implementation of dilation and evacuation) was higher in the DBC group within 12–24 h (96.3%, 29/31) than in the DBC group within 12 h (71.0%, 18/27) (p < 0.05). Additionally, the time from DBC removal to delivery in the DBC group within 12–24 h was significantly shorter than that in the DBC group within 12 h (3.0 h versus 17.8 h) (p < 0.05), and the degree of cervical dilation after DBC removal in the DBC group within 12–24 h was larger than that in the DBC group within 12 h (p < 0.05). Conclusion In the clinic, the placement time of DBC generally lasts for approximately 12 h. However, considering that the cervical condition is immature in the mid-trimester, properly extending the placement time of DBC to 24 h will benefit cervical ripening and reduce the chance of dilation and evacuation.
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Affiliation(s)
- Jing Peng
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No. 745, Wuluo Road, Hongshan District, Wuhan, 430070, China
| | - Ruobing Li
- Department of Gynaecology and Obstetrics, Wuhan University of Science and Technology, No.2, Huangjiahu West Road, Hongshan District, Wuhan, 430065, China
| | - Shuguo Du
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No. 745, Wuluo Road, Hongshan District, Wuhan, 430070, China
| | - Heng Yin
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No. 745, Wuluo Road, Hongshan District, Wuhan, 430070, China
| | - Min Li
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No. 745, Wuluo Road, Hongshan District, Wuhan, 430070, China
| | - Xuan Zheng
- Department of Gynaecology and Obstetrics, Wuhan University of Science and Technology, No.2, Huangjiahu West Road, Hongshan District, Wuhan, 430065, China
| | - Shiyao Wu
- Department of Gynaecology and Obstetrics, Wuhan University of Science and Technology, No.2, Huangjiahu West Road, Hongshan District, Wuhan, 430065, China
| | - Yun Zhao
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No. 745, Wuluo Road, Hongshan District, Wuhan, 430070, China.
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