妊娠晚期用于促宫颈成熟的两种方法比较研究
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摘要
目的探讨地诺前列酮栓(欣普贝生)和宫颈扩张球囊用于妊娠晚期促宫颈成熟的安全性及有效性。方法回顾性分析2014年10月至2017年10月昌吉州人民医院产科收治的妊娠足月宫颈成熟度<6分的270例初产妇的临床资料,其中地诺前列酮栓组144例,宫颈扩张球囊组126例,分析2组患者的促宫颈成熟效果、分娩方式、子宫过度刺激、产后出血等。结果①地诺前列酮栓组与球囊组引产前、后宫颈评分比较差异有统计学意义(t值分别为-20.64,-17.17,P值均<0.01)。②宫颈评分<4分的患者中,地诺前列酮栓组引产后宫颈评分明显高于球囊组(t=2.37,P=0.02),且经阴道分娩率(65%)也明显高于球囊组(44%)。③2组患者在安全性指标方面差异有统计学意义(P<0.05)。结论 2种引产方法均能有效促宫颈成熟,宫颈扩张球囊用于引产作用缓和,但地诺前列酮栓对于宫颈成熟度<4分的患者引产成功率更高。
Objective To investigate the safety and efficiency of dinoprostonevs and cervical balloon dilatation for cervical ripening in late pregnancy. Methods The clinical data of 270 primiparas with full-term pregnancy and cervical maturity <6 points in the Obstetrics Department of Changji People′s Hospital between October 2014 and October 2017 were retrospectively analyzed, with 144 women in the dinoprostone group and 126 in the cervical balloon dilatation group. The outcome of cervical ripening, mode of delivery, uterine hyperstimulation, and postpartum hemor-rhage were analyzed in the two groups. Results ① There was a statistically significant difference in the cervical scores between the dinoprostone group and the cervical balloon dilatation group before and after labor induction( t=-20.64,-17.17, both P<0.01). ②Among patients with cervical score <4 points, the cervical score after labor induction in the dinoprostone group was significantly higher than thosein the balloon dilation group( t=2.37, P=0.02), so was the vaginal delivery rate(65% vs 44%). ③There were significant differences in safety indicators between the two groups(P<0.05). Conclusion Both methods of labor induction may effectively promote cervical ripening. Cervical balloon dilatation offers milder effects for labor induction; on the other hand, dinoprostonemay lead to a higher success rate of labor induction for patients with cervical score <4 points.
Objective To investigate the safety and efficiency of dinoprostonevs and cervical balloon dilatation for cervical ripening in late pregnancy. Methods The clinical data of 270 primiparas with full-term pregnancy and cervical maturity <6 points in the Obstetrics Department of Changji People′s Hospital between October 2014 and October 2017 were retrospectively analyzed, with 144 women in the dinoprostone group and 126 in the cervical balloon dilatation group. The outcome of cervical ripening, mode of delivery, uterine hyperstimulation, and postpartum hemor-rhage were analyzed in the two groups. Results ① There was a statistically significant difference in the cervical scores between the dinoprostone group and the cervical balloon dilatation group before and after labor induction( t=-20.64,-17.17, both P<0.01). ②Among patients with cervical score <4 points, the cervical score after labor induction in the dinoprostone group was significantly higher than thosein the balloon dilation group( t=2.37, P=0.02), so was the vaginal delivery rate(65% vs 44%). ③There were significant differences in safety indicators between the two groups(P<0.05). Conclusion Both methods of labor induction may effectively promote cervical ripening. Cervical balloon dilatation offers milder effects for labor induction; on the other hand, dinoprostonemay lead to a higher success rate of labor induction for patients with cervical score <4 points.
引文
[1]阮焱,张为远.剖宫产的现状及剖宫产率高居不下的原因[J].实用妇产科杂志,2015,31(4):241-243.
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[3]刘铭,段涛.控制剖宫产率的有效措施[J].实用妇产科杂志,2015,31(4):243-245.
[4]Mayer RB,Oppelt P,Shebl O,et al.Initial clinical experience with a misoprostol vaginal insert in comparison with a dinoprostone insert for inducing labor[J].Eur J Obstet Gynecol Reprod Biol,2016,200:89-93.
[5]Tu YA,Chen CL,Lai YL,et al.Transcervical double-balloon catheter as an alternative and salvage method for medical termination of pregnancy in midtrimester[J].Taiwan J Obstet Gynecol,2017,56(1):77-80.
[6]Gommers JSM,Diederen M,Wilkinson C,et al.Risk of maternal,fetal and neonatal complications associated with the use of the transcervical balloon catheter in induction of labour:a systematic review[J].Eur J Obstet Gynecol Reprod Biol,2017,218:73-84.
[7]Coste-Mazeau P,Catalan C,Eyraud JL,et al.Cervical ripening after previous cesarean section with dinoprostone vaginal insert[J].Gynecol Obstet Fertil Senol,2017,45(2):77-82.
[8]Pennell CE,Henderson JJ,O′Neill MJ,et al.Induction of labour in nulliparous women with an unfavourable cervix:a randomised controlled trial comparing double and single balloon catheters and PGE2 gel[J].BJOG,2009,116(11):1443-1452.
[2]Lumbiganon P,Laopaiboon M,Gülmezoglu AM,et al.Method of delivery and pregnancy outcomes in Asia:the WHO global survey on maternal and perinatal health 2007-2008[J].Lancet,2010,376(9756):1902.
[3]刘铭,段涛.控制剖宫产率的有效措施[J].实用妇产科杂志,2015,31(4):243-245.
[4]Mayer RB,Oppelt P,Shebl O,et al.Initial clinical experience with a misoprostol vaginal insert in comparison with a dinoprostone insert for inducing labor[J].Eur J Obstet Gynecol Reprod Biol,2016,200:89-93.
[5]Tu YA,Chen CL,Lai YL,et al.Transcervical double-balloon catheter as an alternative and salvage method for medical termination of pregnancy in midtrimester[J].Taiwan J Obstet Gynecol,2017,56(1):77-80.
[6]Gommers JSM,Diederen M,Wilkinson C,et al.Risk of maternal,fetal and neonatal complications associated with the use of the transcervical balloon catheter in induction of labour:a systematic review[J].Eur J Obstet Gynecol Reprod Biol,2017,218:73-84.
[7]Coste-Mazeau P,Catalan C,Eyraud JL,et al.Cervical ripening after previous cesarean section with dinoprostone vaginal insert[J].Gynecol Obstet Fertil Senol,2017,45(2):77-82.
[8]Pennell CE,Henderson JJ,O′Neill MJ,et al.Induction of labour in nulliparous women with an unfavourable cervix:a randomised controlled trial comparing double and single balloon catheters and PGE2 gel[J].BJOG,2009,116(11):1443-1452.