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///2018 Abstract Details
2018 Abstract Details2019-08-02T15:57:01-05:00

Improving Obstetric and Anesthesia Outcomes in China through the No Pain Labor and Delivery Program

Abstract Number: F1A-1
Abstract Type: Original Research

Dan M Drzymalski MD1 ; Fengling Hu --2; Jun-Cai Guo MD3; Xue-Qin Qi MD4; Jean-Pierre Ouanes MD5; Ling-Qun Hu MD6

This project was sponsored by the SOAP/Kybele International Outreach Grant.


Every year, the No Pain Labor & Delivery (NPLD) program provides education to medical staff working on labor and delivery units in China (1). The educational effort functions like a quality improvement initiative: outcomes are measured prior to intervention, after which external observers (the US-based teams) offer suggestions for improvement in clinical practice, and local teams implement changes based on those suggestions. The aim of this study was to determine the effect of the NPLD program on outcomes in a single hospital in China. Our hypothesis was that the NPLD program would safely increase the rate of labor epidural analgesia in a rural Chinese area hospital.


We performed an IRB-approved retrospective review of all deliveries at Weixian Renmin Hospital in Weixian, China, from June 1, 2013 to May 31, 2015. We compared outcomes after and before the NPLD program, which lasted from June 15, 2014-June 20, 2014. Our primary outcome was labor epidural analgesia rate. Our secondary outcomes included obstetric outcomes (rates of cesarean delivery (CD), postpartum blood transfusion, antibiotic administration and Foley catheter use). Student’s T test and Chi-squared test were used to analyze continuous and categorical variables, respectively, using R software.


The records of 18,701 parturients were reviewed, of which 9,940 delivered prior to the NPLD program and 8,761 delivered afterwards. Baseline demographic data were similar between the two groups. The proportion of parturients who received labor epidural analgesia was higher after NPLD vs. before (42% vs. 39%, OR 1.1, [95% CI 1.03 to 1.2], P=0.01). The proportion of parturients who underwent CD for any indication was lower after NPLD vs. before (44% vs. 49%, OR 0.8, [95% CI 0.8 to 0.9], P<0.00001). Comparing deliveries after NPLD vs. before, the proportion of parturients who had postpartum hemorrhage requiring blood transfusion was similar after vs. before (1.58% vs. 1.63%, OR 0.97, [95% CI 0.7 to 1.2], P=0.77), but the proportion of parturients who received antibiotics during the peripartum period was less (88% vs. 90%, OR 0.9, [95% CI 0.78 to 0.96], P=0.003). The proportion of parturients who had a Foley catheter placement during the peripartum period was lower after NPLD vs. before (50% vs. 53%, OR 0.89, [95% CI 0.83 to 0.95], P=0.00008).


The NPLD intervention resulted in an increased rate of labor epidural analgesia, and decreased rates of CD, antibiotic administration, and Foley catheter placement. The NPLD program resulted in higher quality of obstetric and anesthetic care in China. Education is an important intervention that can improve maternal and neonatal outcomes (2).


1. Hu et al. A&A, 2016

2. Kopic et al. IJOA, 2009

SOAP 2018