中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2014年
10期
741-745
,共5页
赫英东%胡君%章小维%黄禾%陈倩
赫英東%鬍君%章小維%黃禾%陳倩
혁영동%호군%장소유%황화%진천
引产%宫颈成熟%地诺前列酮%促子宫颈成熟球囊
引產%宮頸成熟%地諾前列酮%促子宮頸成熟毬囊
인산%궁경성숙%지낙전렬동%촉자궁경성숙구낭
Labor,induced%Cervical ripening%Dinoprostone%Cervical ripening balloon
目的 探讨促子宫颈成熟球囊在足月妊娠产妇引产过程中改善子宫颈条件的有效性及安全性.方法 本研究应用前瞻性对照研究方法,选取2011年8月至2013年4月北京大学第一医院因妊娠期并发症或合并症而需要引产的足月单胎妊娠产妇128例为观察对象,并随机分为两组:使用促子宫颈成熟球囊66例为球囊组,前列腺素E2阴道用药62例为对照组.比较两组产妇子宫颈条件改善的有效性及不良反应的发生情况.结果 球囊组与对照组产妇子宫颈条件改善的有效性(Bishop评分改善＞2分)无明显差异,改善率分别为82％(54/66)、81％(50/62),两组比较,差异无统计学意义(P＞0.05).球囊组产妇从放置至临产的时间长于对照组[分别为(24.2±8.5)、(14.5±8.0) h,P＜0.05];球囊组放置12h内临产率低于对照组,分别为9％(6/66) 、21％(13/62),两组比较,差异有统计学意义(P＜0.05);两组产妇的剖宫产率比较无明显差异[分别为41％(27/66)、43％(27/62),P＞0.05].球囊组产妇临床诊断为宫内感染的发生率较对照组增高[分别为11％(7/66)、6％(4/62),P＜0.05].球囊组产妇宫缩过频[分别为0(0/66)、42％(26/62)]、体温升高[分别为3％(2/66)、19％(12/62)]、取出前胎心率异常[分别为5％ (3/66)、19％(12/62)]、急产[分别为2％(1/66)、16％(10/62)]的发生率均明显低于对照组(P均＜0.05).结论 经子宫颈放置促子宫颈成熟球囊与阴道用前列腺素类制剂改善子宫颈条件的效果近似,但前者可能增加宫内感染的风险.经子宫颈放置球囊对母体及胎儿的安全性优于阴道用前列腺素类制剂,可考虑使用促子宫颈成熟球囊改善子宫颈条件以增加引产的成功率.
目的 探討促子宮頸成熟毬囊在足月妊娠產婦引產過程中改善子宮頸條件的有效性及安全性.方法 本研究應用前瞻性對照研究方法,選取2011年8月至2013年4月北京大學第一醫院因妊娠期併髮癥或閤併癥而需要引產的足月單胎妊娠產婦128例為觀察對象,併隨機分為兩組:使用促子宮頸成熟毬囊66例為毬囊組,前列腺素E2陰道用藥62例為對照組.比較兩組產婦子宮頸條件改善的有效性及不良反應的髮生情況.結果 毬囊組與對照組產婦子宮頸條件改善的有效性(Bishop評分改善＞2分)無明顯差異,改善率分彆為82％(54/66)、81％(50/62),兩組比較,差異無統計學意義(P＞0.05).毬囊組產婦從放置至臨產的時間長于對照組[分彆為(24.2±8.5)、(14.5±8.0) h,P＜0.05];毬囊組放置12h內臨產率低于對照組,分彆為9％(6/66) 、21％(13/62),兩組比較,差異有統計學意義(P＜0.05);兩組產婦的剖宮產率比較無明顯差異[分彆為41％(27/66)、43％(27/62),P＞0.05].毬囊組產婦臨床診斷為宮內感染的髮生率較對照組增高[分彆為11％(7/66)、6％(4/62),P＜0.05].毬囊組產婦宮縮過頻[分彆為0(0/66)、42％(26/62)]、體溫升高[分彆為3％(2/66)、19％(12/62)]、取齣前胎心率異常[分彆為5％ (3/66)、19％(12/62)]、急產[分彆為2％(1/66)、16％(10/62)]的髮生率均明顯低于對照組(P均＜0.05).結論 經子宮頸放置促子宮頸成熟毬囊與陰道用前列腺素類製劑改善子宮頸條件的效果近似,但前者可能增加宮內感染的風險.經子宮頸放置毬囊對母體及胎兒的安全性優于陰道用前列腺素類製劑,可攷慮使用促子宮頸成熟毬囊改善子宮頸條件以增加引產的成功率.
목적 탐토촉자궁경성숙구낭재족월임신산부인산과정중개선자궁경조건적유효성급안전성.방법 본연구응용전첨성대조연구방법,선취2011년8월지2013년4월북경대학제일의원인임신기병발증혹합병증이수요인산적족월단태임신산부128례위관찰대상,병수궤분위량조:사용촉자궁경성숙구낭66례위구낭조,전렬선소E2음도용약62례위대조조.비교량조산부자궁경조건개선적유효성급불량반응적발생정황.결과 구낭조여대조조산부자궁경조건개선적유효성(Bishop평분개선＞2분)무명현차이,개선솔분별위82％(54/66)、81％(50/62),량조비교,차이무통계학의의(P＞0.05).구낭조산부종방치지임산적시간장우대조조[분별위(24.2±8.5)、(14.5±8.0) h,P＜0.05];구낭조방치12h내임산솔저우대조조,분별위9％(6/66) 、21％(13/62),량조비교,차이유통계학의의(P＜0.05);량조산부적부궁산솔비교무명현차이[분별위41％(27/66)、43％(27/62),P＞0.05].구낭조산부림상진단위궁내감염적발생솔교대조조증고[분별위11％(7/66)、6％(4/62),P＜0.05].구낭조산부궁축과빈[분별위0(0/66)、42％(26/62)]、체온승고[분별위3％(2/66)、19％(12/62)]、취출전태심솔이상[분별위5％ (3/66)、19％(12/62)]、급산[분별위2％(1/66)、16％(10/62)]적발생솔균명현저우대조조(P균＜0.05).결론 경자궁경방치촉자궁경성숙구낭여음도용전렬선소류제제개선자궁경조건적효과근사,단전자가능증가궁내감염적풍험.경자궁경방치구낭대모체급태인적안전성우우음도용전렬선소류제제,가고필사용촉자궁경성숙구낭개선자궁경조건이증가인산적성공솔.
Objective To evaluate the efficacy and safety for cervical ripening by double-balloon catheter among full-term pregnancy women underwent labor induction.Methods It was a prospective nonrandomly controlled research.Totally 128 singleton-pregnancy women in full-term who had to undergo labor induction because of pregnancy complications or comorbidities from August 2011 to April 2013 in Peking University First Hospital were selected as study subjects.Participants were allocated to preinduction cervical ripening with either a double-balloon catheter (66 participants,study group) or prostaglandin vaginal insert (62 participants,control group).Compare the efficacy for cervical ripening and adverse reactions between the two groups.Results The efficacy for cervical ripening (Bishop scores improved by ≥ 2) had no significant differences between study and control groups [82％ (54/66) compared with 81％ (50/ 62),P＞0.05].The time interval between intervention and parturiency was significantly higher in the doubleballoon catheter group than in the prostaglandin vaginal insert group [(24.2±8.5) compared with (14.5±8.0) hours,P＜0.05].The proportion of women who achieved parturiency within 12 hours was significantly lower in the double-balloon catheter group than that in the control group [9％ (6/66) compared with 21％ (13/62),P＜0.05].The cesarean section rate showed no significant differences [41％ (27/66) compared with 43％(27/62),P＞0.05].The prevalence of intrauterine infection demonstrated by clinical diagnosis was significantly higher in the double-balloon catheter group [11％ (7/66) compared with 6％ (4/62),P＜O.05].The double-balloon catheter group had significantly lower rates of contraction overfrequency [0(0/66) compared with 42％ (26/62),P＜0.05],hyperthermia [3％ (2/66) compared with 19％ (12/62),P＜0.05],fetal heart rate abnormalities before removing the device or drug [5％ (3/66) compared with 19％ (12/62),P＜0.05],as well as precipitate labour [2％ (1/66) compared with 16％ (10/62),P＜0.05].Conclusions The efficacy of a double-balloon transcervieal catheter is similar to that of a prostaglandin vaginal insert.However,the double-balloon catheter cannot significantly reduce the cesarean section rate while it increases the risk of intrauterine infection.The materual and fetal safety of transcervical catheter is superior to the prostaglandin vaginal insert.In cases of oligohydramnios,fetal growth restriction,pregnancy complicated with asthma,hypertension and scar uterine are in favor of a balloon catheter using for cervical ripening on account of high risk of using prostaglandin.
