Clinical Analysis of 17 Cases of the Second Trimester Induction of Labor in Pregnant Women with Chronic Kidney Disease Stages 3-5

doi:10.12280/gjfckx.20250044

Abstract

Abstract:

Objective: To evaluate the safety and efficacy of different induction methods in pregnant women in the second trimester with chronic kidney disease (CKD) Stages 3-5. Methods: A retrospective study was conducted on 17 pregnant women with CKD Stages 3-5 who underwent midtrimester induction of labor at the First Affiliated Hospital of Zhengzhou University between October 1, 2019 and September 30, 2023. Patients were divided into two groups based on induction method: the ethacridine group (intra-amniotic injection of ethacridine lactate, n=9) and the balloon catheter group (mechanical dilation with a Foley catheter, n=8). General characteristics, induction outcomes (success rate, induction-to-delivery interval, total labor duration), complications, and renal function before and after induction were compared. Results: No significant differences were observed in induction success rate (88.9% vs. 100.0%, P =1.000), induction-to-delivery time, total labor duration, intra-partum blood loss, fetal weight, or incidence of retained products of conception (all P>0.05). Neither group experienced complications such as postpartum hemorrhage, perineal laceration, placental abruption, disseminated intravascular coagulation, intrauterine infection, uterine rupture, conversion to cesarean section, or puerperal infection. Renal function markers (serum creatinine, blood urea nitrogen, uric acid and estimated glomerular filtration rate) remained stable before and after induction in both groups(all P>0.05). For patients with a scarred uterus, success rate did not differ significantly (P =1.000). Conclusions: Both ethacridine lactate and balloon catheter methods are safe and effective for induction of labor in the second trimester in CKD Stages 3-5 patients, without increasing complication risks. However, each method has specific advantages and limitations. Multidisciplinary collaboration is recommended to select individualized induction strategies.

Key words: Pregnancy trimester, second, Renal insufficiency, chronic, Labor, induction, Ethacridine, Pregnancy with chronic kidney disease, Balloon catheter

LI Ling-yan, ZHAO Xian-lan. Clinical Analysis of 17 Cases of the Second Trimester Induction of Labor in Pregnant Women with Chronic Kidney Disease Stages 3-5[J]. Journal of International Obstetrics and Gynecology, 2025, 52(4): 389-393.

Figures/Tables 5

References 16

[1]	Piccoli GB, Zakharova E, Attini R, et al. Pregnancy in Chronic Kidney Disease: Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Different CKD Stages and Phases[J]. J Clin Med, 2018, 7(11):415. doi: 10.3390/jcm7110415.
[2]	Webster P, Webster LM, Cook HT, et al. A Multicenter Cohort Study of Histologic Findings and Long-Term Outcomes of Kidney Disease in Women Who Have Been Pregnant[J]. Clin J Am Soc Nephrol, 2017, 12(3):408-416. doi: 10.2215/CJN.05610516.
[3]	南京总医院,国家肾脏疾病临床医学研究中心. 慢性肾脏病患者妊娠管理指南[J]. 中华医学杂志, 2017, 97(46):3604-3611. doi: 10.3760/cma.j.issn.0376-2491.2017.46.002.
[4]	Wiles K, Webster P, Seed PT, et al. The impact of chronic kidney disease Stages 3-5 on pregnancy outcomes[J]. Nephrol Dial Transplant, 2021, 36(11):2008-2017. doi: 10.1093/ndt/gfaa247.
[5]	华茜. 妊娠与慢性肾脏病的研究进展[J]. 国际泌尿系统杂志, 2019, 39(2):381-384. doi: 10.3760/cma.j.issn.1673-4416.2019.02.058.
[6]	Mittal S, Aggarwal P, Dadhwal V. Medical abortion in women with impaired renal function[J]. Int J Gynaecol Obstet, 2011, 114(1):76-77. doi: 10.1016/j.ijgo.2011.01.016. pmid: 21524746
[7]	Bagga R, Sharma B, Choudhary N, et al. Second trimester medical abortion in a primigravida with lupus nephritis and rapidly progressive renal failure: challenges and outcome[J]. Eur J Contracept Reprod Health Care, 2021, 26(2):171-173. doi: 10.1080/13625187.2021.1879782. pmid: 33615941
[8]	Stengel B, Muenz D, Tu C, et al. Adherence to the Kidney Disease: Improving Global Outcomes CKD Guideline in Nephrology Practice Across Countries[J]. Kidney Int Rep, 2021, 6(2):437-448. doi: 10.1016/j.ekir.2020.11.039. pmid: 33615069
[9]	黄紫蓉. 常用中期妊娠引产方法的选择[J]. 中国计划生育学杂志, 2017, 25(8):508-510. doi: 10.3969/j.issn.1004-8189.2017.08.001.
[10]	吴丹, 唐晓彤, 吴刘鑫, 等. 妊娠中期前置胎盘引产方式探讨[J]. 现代妇产科进展, 2022, 31(8):614-618. doi: 10.13283/j.cnki.xdfckjz.2022.08.010.
[11]	武文娟, 牛蕾蕾, 王瑜. 妊娠中期胎盘前置状态的引产方式探讨[J]. 国际妇产科学杂志, 2019, 46(5):519-522. doi: 10.3969/j.issn.1674-1870.2019.05.009.
[12]	刘喆, 牛建华, 杨慧霞. 依沙吖啶羊膜腔注射引产术用于妊娠28周后胎死宫内引产的有效性及安全性[J]. 中华围产医学杂志, 2023, 26(3):194-200. doi: 10.3760/cma.j.cn113903-20221215-01033.
[13]	Grobman WA, Bailit J, Lai Y, et al. Defining failed induction of labor[J]. Am J Obstet Gynecol, 2018, 218(1):122.e1-122.e8. doi: 10.1016/j.ajog.2017.11.556.
[14]	中华医学会妇产科学分会产科学组. 剖宫产术后再次妊娠阴道分娩管理的专家共识(2016)[J]. 中华妇产科杂志, 2016, 51(8):561-564. doi: 10.3760/cma.j.issn.0529-567x.2016.08.001.
[15]	韩慧娟, 薛云琴, 郑柳, 等. 三种引产方法联合对瘢痕子宫妊娠中期终止妊娠安全性的影响[J]. 中国妇产科临床杂志, 2024, 25(3):203-205. doi: 10.13390/j.issn.1672-1861.2024.03.004.
[16]	Andrikopoulou M, Lavery JA, Ananth CV, et al. Cervical ripening agents in the second trimester of pregnancy in women with a scarred uterus: a systematic review and metaanalysis of observational studies[J]. Am J Obstet Gynecol, 2016, 215(2):177-194. doi: 10.1016/j.ajog.2016.03.037. pmid: 27018469

组别	n	年龄（岁）	孕周（周）	孕次（次）	产次（次）	瘢痕子宫占比
依沙吖啶组	9	33.1±4.5	20.7±3.7	3.00（2.00， 5.00）	1.00（0.50， 1.50）	6（66.7）
水囊组	8	29.0±4.7	19.7±5.2	3.00（1.00， 3.75）	1.50（0.00， 2.75）	3（37.5）
t		1.847	0.451	-	-	-
P		0.085	0.658	1.000^a	0.335^a	0.347^b

组别	n	年龄（岁）	孕周（周）	孕次（次）	产次（次）	瘢痕子宫占比
依沙吖啶组	9	33.1±4.5	20.7±3.7	3.00（2.00， 5.00）	1.00（0.50， 1.50）	6（66.7）
水囊组	8	29.0±4.7	19.7±5.2	3.00（1.00， 3.75）	1.50（0.00， 2.75）	3（37.5）
t		1.847	0.451	-	-	-
P		0.085	0.658	1.000^a	0.335^a	0.347^b

组别	n	肌酐（μmol/L）	尿素氮（mmol/L）	尿酸（μmol/L）	肾小球滤过率 [ mL/（min·1.73 m²）]
依沙吖啶组	9	264.2±103.2	15.8±6.9	475.1±102.3	23.1±7.9
水囊组	8	338.9±185.5	17.5±7.9	448.1±119.8	22.6±15.5
t		1.008	0.464	0.501	0.083
P		0.336	0.650	0.624	0.936

组别	n	肌酐（μmol/L）	尿素氮（mmol/L）	尿酸（μmol/L）	肾小球滤过率 [ mL/（min·1.73 m²）]
依沙吖啶组	9	264.2±103.2	15.8±6.9	475.1±102.3	23.1±7.9
水囊组	8	338.9±185.5	17.5±7.9	448.1±119.8	22.6±15.5
t		1.008	0.464	0.501	0.083
P		0.336	0.650	0.624	0.936

组别	n	引产-临产时间（h）	总产程时间（h）	产时出血量（mL）	死胎质量（g）	宫内残留
依沙吖啶组	8^#	19.4±6.6	4.4±1.2	100（100，150）	340.0±195.1	4（50.0）
水囊组	8	30.0±23.9	4.0±1.2	100（100，150）	326.3±254.7	4（50.0）
t		1.204	0.652	-	0.121	-
P		0.263	0.525	1.000^a	0.905	1.000^b