阴道放置米索前列醇引产在足月胎膜早破初产妇中的应用  

Application of Vaginal Misoprostol Induction in Primiparas with Term PrelaborRupture of Membranes(PROM)

作　　者：张诚燕[1] 周莉[1] ZHANG Chengyan;ZHOU Li(Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing Maternal and Child Health Care Hospital,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院、北京妇幼保健院围产医学科,100026

出　　处：《医学研究杂志》2024年第11期64-68,共5页Journal of Medical Research

基　　金：首都卫生发展科研专项(2020-2-2113)。

摘　　要：目的 在足月胎膜早破、宫颈不成熟的初产妇中,比较阴道放置米索前列醇和静脉滴注缩宫素引产的有效性及安全性。方法 回顾性选取2018年1月~2019年12月在首都医科大学附属北京妇产医院分娩的506例足月胎膜早破初产妇。入组孕妇均满足下述条件:单胎头位、胎心监护反应型、胎膜早破至引产时间为2~24h、宫颈Bishop评分<6分、无子宫手术史。根据引产方式不同,将入组初产妇分为米索前列醇组和缩宫素组,米索前列醇组初产妇阴道放置米索前列醇引产,缩宫素组初产妇静脉滴注缩宫素引产,比较两组初产妇的引产效率、分娩方式和母儿结局。结果 与缩宫素组比较,米索前列醇组进入活跃期的产妇明显增多(96.8%vs 89.1%,P=0.001),引产后24h阴道分娩率显著提高(60.6%vs 46.3%,P=0.001)。在分娩方式方面,与缩宫素组比较,米索前列醇组阴道分娩率和自然分娩率均显著升高(87.1%vs 72.8%,P<0.001;76.3%vs 64.2%,P=0.003)。在剖宫产指征方面,与米索前列醇组比较,缩宫素组因胎儿窘迫和引产失败手术的比率增高(3.6%vs 8.6%,P=0.020;1.6%vs 8.2%,P=0.001),子宫过度刺激[过频和(或)过强]发生率较低(16.5%vs 9.7%,P=0.024)。两组宫内感染、产褥病、产后出血、新生儿窒息、新生儿入院发生率比较,差异均无统计学意义(P>0.05)。结论 在足月胎膜早破、宫颈不成熟的初产妇引产方式中,与静脉滴注缩宫素比较,阴道放置米索前列醇24h引产效率更高,阴道分娩率增高。两种引产方法母儿安全性差异无统计学意义。Objective To compare the efficacy and safety of vaginal misoprostol induction and oxytocin infusion induction in primiparas with term premature rupture of membranes(PROM)and unfavorable cervixes.Methods A total of 506 primiparas with PROM who delivered in Beijing Obstetrics and Gynecology Hospital,Capital Medical University from January 2018 to December 2019 were retrospectively selected.All of the primiparas were with singleton cephalic presentation,reactive nonstress tests,2h≤PROM≤24h,cervical Bishop score<6,and no previous uterine surgery.According to different methods of labor induction,the enrolled primiparas were divided into misoprostol group and oxytocin group.In the misoprostol group,misoprostol was placed vaginally to induce labor,and in the oxytocin group,oxytocin was intravenously injected to induce labor.The efficacy of induction,mode of delivery and m maternal and neonatal outcomes were compared between the two groups.Results The misoprostol group had more primiparas achieved the active phase than the oxytocin group(96.8%vs 89.1%,P=0.001).After 24h of induction,the misoprostol group showed a higher proportion of vaginal delivery than the oxytocin group(60.6%vs 46.3%,P=0.001).The misoprostol group exhibited a significantly higher vaginal delivery rate and spontaneous vaginal delivery rate than the oxytocin group(87.1%vs 72.8%,P<0.001;76.3%vs 64.2%,P=0.003).The oxytocin group had more primiparas who underwent cesarean section due to fetal distress(8.6%vs 3.6%,P=0.020)and failed labor induction(8.2%vs 1.6%,P=0.001)than the misoprostol group.The misoprostol group had a higher rate of uterine hyperstimulation than the oxytocin group(16.5%vs 9.7%,P=0.024).There were no significant differences in intrapartum chorioamnionitis,endometritis,postpartum hemorrhage,the incidence of neonatal asphyxia and admission to the neonatal intensive care unit between the two groups(P>0.05).Conclusion Compared with oxytocin infusion,vaginal misoprostol induction in term PROM primiparas with unfavorable cervixes was asso

关 键 词：足月胎膜早破 引产 宫颈BISHOP评分 米索前列醇 缩宫素 初产妇 

分 类 号：R719[医药卫生—妇产科学]