Foley尿管宫颈促熟失败后不同序贯干预方式对分娩结局的影响  

Effects of different sequential interventions on delivery outcomes following failed Foley catheter ripening

作　　者：方婧[1] 李新安[1] 呼慧莲 周航[1] 王雯雯[1] 周燕 顾宁[1] 戴毅敏[1] Fang Jing;Li Xinan;Hu Huilian;Zhou Hang;Wang Wenwen;Zhou Yan;Gu Ning;Dai Yimin(Department of Obstetrics and Gynecology,Nanjing Drum Tower Hospital,Affiliated Hospital of Nanjing University Medical School,Nanjing Jiangsu 210008,P.R.China)

机构地区：[1]南京大学医学院附属鼓楼医院妇产科,江苏南京210008

出　　处：《中国计划生育和妇产科》2025年第1期72-77,共6页Chinese Journal of Family Planning & Gynecotokology

基　　金：2023年南京鼓楼医院临床研究专项资金项目(项目编号:2023-LCPJ-PY-31)。

摘　　要：目的探讨足月单胎妊娠初产妇经Foley尿管(下文简称球囊)促宫颈成熟后Bishop评分仍<6分但宫颈容受性不同的产妇在分别采用米索前列醇、人工破膜两种不同序贯干预方式下引产的有效性及安全性。方法建立前瞻性队列,选择2023年3月至9月在南京大学医学院附属鼓楼医院行球囊促宫颈成熟的单胎足月初产妇,根据球囊脱落或移除后1 h内胎膜完整、宫缩频率10 min<3次且宫颈Bishop评分<6分为标准最终纳入223例患者作为研究对象。根据宫颈可容受程度不同,将其分为米索组(容受不到1指,157例)和破膜组(容受达1指及以上,66例)。比较两组孕产妇一般资料、宫颈促熟至分娩时间、分娩方式、宫缩过频发生率、绒毛膜羊膜炎发生率、新生儿结局等。结果两组年龄、身高、孕前BMI、孕期增重、宫颈促熟前Bishop评分、引产孕周、球囊放置时长、阴道分娩率、宫缩过频发生率、绒毛膜羊膜炎发生率、产后出血率、新生儿结局指标比较,差异均无统计学意义(P>0.05)。破膜组球囊促熟至分娩、序贯干预至临产、序贯干预至分娩时间均短于米索组,宫缩抑制剂使用率低于米索组(P<0.05)。结论球囊促宫颈成熟后,宫颈成熟度不佳但宫颈内口可容受1指的孕妇积极行人工破膜的引产时限短于使用米索前列醇产妇,且不增加绒毛膜羊膜炎发生风险,宫缩抑制剂使用率低,具有较好的有效性和安全性。Objective To investigate the efficacy and safety of two sequential interventions,misoprostol or amniotomy in women with cervical Bishop score<6 but the cervical receptivity is dfferent after the Foley catheter ripening in full-term singleton pregnancies.Methods This was a prospective cohort conducted from March to September 2023 in Nanjing Drum Tower Hospital,recruit the full-term singleton pregnancies who undergoing induction using cervical ripening by Foley catheter,according to the intact membranes,contraction frequency<3 times in 10 minutes or removal and Bishop score<6 within 1 hour after balloon detachment 223 patients were ultimately included as the study subjects.According to the different tolerance levels of the cervix,they were divided into the Miso group(less than 1 finger tolerance,157 cases)and the amniotomy group(tolerance of 1 finger or more,66 cases).The general information of pregnant women,the time from cervical ripening to delivery,the mode of delivery,the incidence of uterine hyperstimulation,the incidence of chorioamnionitis,and neonatal outcomes were compared between the two groups.Results There were no statistically significant diferences in age,height,pre-pregnancy BMI,weight gain during pregnancy,Bishop score before ripening,gestational age of labor induction,Foley catheter placement duration,the rate of vaginal delivery,the incidence of uterine hyperstimulation,the incidence ofchorioamnionitis,postpartum hemorrhage and neonatal outcomes(P>0.05).The time from cervical ripening to delivery,sequentialintervention to labor and sequential intervention to delivery in the amniotomy group were shorter than that in the Miso group,the rate ofuse tocolytics was significantly lower than that in the Miso group(P<0.05).Conclusions Amniotomy after failed Foley catheterripening with the internal orifice of the cervix could recept one finger resulted shorter time to delivery than using misoprostol,and the riskof chorioamnionitis is not increased,the rate of using tocolytics is lower,which has good effica

关 键 词：Foley尿管促熟 人工破膜 米索前列醇 催引产 

分 类 号：R719.3[医药卫生—妇产科学]