米索前列醇不同用法促进妊娠晚期孕妇宫颈成熟的效果分析  

Comparative analysis of misoprostol regimens for cervical ripening in late pregnancy

作　　者：杨丽娟 宋英[1] 孙宇[1] 王爱华[1] 沈翠花[1] Yang Lijuan;Song Ying;Sun Yu;Wang Aihua;Shen Cuihua(Departmentof Obstetrics,Kunming City Maternal and Child Health Hospital,Kunming 650031,China)

机构地区：[1]云南省昆明市妇幼保健院产科,昆明650031

出　　处：《保健医学研究与实践》2024年第3期69-74,共6页Health Medicine Research and Practice

基　　金：云南省科技厅科技计划项目(2018FD167);云南省昆明市卫生科技人才培养项目暨“十百千”工程培养计划[2021-SW(后备)-61]。

摘　　要：目的探讨米索前列醇单用及与缩宫素、宫颈球囊分别联用在促进妊娠晚期孕妇宫颈成熟中的效果,以期为临床治疗提供参考。方法选取昆明市妇幼保健院产科2022年5月—2023年5月收治的需引产孕妇90例为研究对象,采用随机数字表法将其分为A、B、C组,每组30例。A组孕妇单用米索前列醇治疗;B组孕妇采用米索前列醇+缩宫素治疗;C组孕妇采用米索前列醇+宫颈球囊治疗。采用宫颈成熟度(Bishop)评分对3组孕妇用药前、用药后6 h及用药后12 h宫颈成熟情况进行分析;比较3组孕妇引产一般情况,包括治疗开始至临产时间、临产至分娩时间以及产后出血量;比较3组阴道成功分娩率、手术助产率、阴道分娩转剖宫产率、新生儿重症监护中心(NICU)入住率与不良结局发生率;采用新生儿5分钟Apgar评分评价3组新生儿质量。结果3组孕妇用药前、用药后6 h宫颈Bishop评分比较,差异无统计学意义(P>0.05),3组孕妇用药后12 h宫颈Bishop评分均高于用药前,C组孕妇宫颈Bishop评分高于A、B组,差异均具有统计学意义(P<0.05)。C组孕妇治疗开始至临产时间、临产至分娩时间短于A组与B组,差异均有统计学意义(P<0.05)。3组孕妇产后出血量比较,差异无统计学意义(P>0.05)。C组孕妇阴道分娩率高于A组,孕妇不良结局发生率低于A组,差异均有统计学意义(P<0.05)。B组与C组新生儿5分钟Apgar评分均高于A组,差异均有统计学意义(P<0.05),但B组与C组新生儿5分钟Apgar评分差异无统计学意义(P>0.05)。结论米索前列醇+宫颈球囊在妊娠晚期促进宫颈成熟及引产中综合应用价值更高,能提高宫颈Bishop评分、阴道分娩率及新生儿5分钟Apgar评分,可减少母婴不良结局与缩短各产程时间,建议临床推广使用。Objective To analyze the effectiveness of misoprostol alone and in combination with oxytocin or a cervical balloon for cervical ripening in late pregnancy,to provide clinical treatment guidance.Methods Ninety patients requiring labor in-duction,admitted to the Department of Obstetrics of our hospital between May 2022 and May 2023,were randomly assigned to three groups of 30 each:Group A received misoprostol alone,Group B received misoprostol plus oxytocin,and Group C received misoprostol plus a cervical balloon.Cervical maturity was assessed using the Bishop score before medication,6 hours after medication,and 12 hours after medication.General induction outcomes were compared,including time from treatment start to labor onset,labor onset to delivery,and postpartum hemorrhage volume.Vaginal delivery rates,instru-mental delivery rates,cesarean section conversion rates,NICU admission rates,and adverse outcome rates were also com-pared.Newborn quality was evaluated using the 5-minute Apgar score.Results No significant differences were observed in Bishop scores before medication and 6 hours after medication among the three groups(P>0.05).Twelve hours after medi-cation,all three groups showed higher Bishop scores compared to pre-medication,with Group C having significantly higher scores than Groups A and B(P<0.05).Group C also had significantly shorter times from treatment start to labor onset and from labor onset to delivery compared to Groups A and B(P<0.05).Postpartum hemorrhage volumes were not signif-icantly different among the three groups(P>0.05).Group C had significantly higher vaginal delivery rates and lower ad-verse outcome rates compared to Group A(P<0.05).Both Groups B and C had significantly higher 5-minute Apgar scores than Group A(P<0.05),but no significant difference was found between Groups B and C(P>0.05).Conclusion The combination of misoprostol and a cervical balloon has higher comprehensive value for promoting cervical ripening and labor induction in late pregnancy,which can improve Bishop scores,

关 键 词：米索前列醇 缩宫素 宫颈球囊 妊娠晚期 促宫颈成熟 引产 

分 类 号：R719.31[医药卫生—妇产科学]