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    足月妊娠初产妇应用不同方法对促宫颈成熟及引产的临床效果观察

    Clinical effectiveness of different methods on cervical maturation and induction of labor in full-term pregnant women

    • 摘要: 目的 比较足月妊娠初产妇使用欣普贝生(地诺前列酮栓)、Foley导管、米索前列醇、缩宫素催引产的安全性和有效性。方法 选取2018年5月—2019年5月于徐州医科大学附属医院住院分娩的足月妊娠且有引产指征的孕妇,共268例,收集临床资料进行回顾性分析。根据催引产方法的不同,将纳入对象分为4组:欣普贝生组、Foley导管组、米索前列醇组、小剂量缩宫素组。比较各组促宫颈成熟效果、分娩时间和剖宫产情况,记录新生儿情况及产时并发症。结果 欣普贝生组、Foley导管组和米索前列醇组的促子宫颈成熟效果优于缩宫素组(P<0.05)。对于宫颈Bishop评分0~3分者,米索前列醇的促宫颈成熟效果优于Foley导管(P<0.05);对于宫颈Bishop评分4~5分者,米索前列醇和Foley导管促宫颈成熟的效果无统计学差异(P>0.05)。欣普贝生组第一产程和总产程用时较短,缩宫素组第一产程及总产程用时最长,2组比较差异有统计学意义(P<0.05),此外,欣普贝生组剖宫产率最低,缩宫素组剖宫产率最高,2组比较差异有统计学意义(P<0.05)。各组新生儿体重,5 min Apgar评分,以及新生儿窒息、羊水粪染、新生儿转新生儿重症监护室(NICU)情况比较,差异无统计学意义(P>0.05)。欣普贝生组发生宫缩过强3例,米索前列醇组宫缩过强1例,Foley导管组及缩宫素组未发生宫缩过强。结论 足月妊娠初产妇应用欣普贝生、Foley导管、米索前列醇的催引产效果优于缩宫素组。欣普贝生价格昂贵,Foley导管、米索前列醇操作简单、安全、价格便宜,可根据临床具体情况及孕妇经济情况选择使用。

       

      Abstract: Objective To compare the effectiveness and safety of Propess (dinoprostone suppositories), misoprostol, Foley urinary catheter and oxytocin in promoting cervical maturation in full-term pregnant women. Methods A total of 268 women with full-term pregnancy and indications for induction of labor who delivered in the Affiliated Hospital of Xuzhou Medical University from May 2018 to May 2019 were selected and their clinical data were retrospectively analyzed. According to their corresponding methods of labor induction, they were divided into four groups: a Propess group, a Foley catheter group, a misoprostol group and a low-dose oxytocin group. Their cervical maturation degree, delivery time and cesarean section were compared and neonate condition and post-delivery complications were recorded. Results Compared with the oxytocin group, remarkable improvement in cervical maturation was found in the Propess group, the Foley catheter group and the misoprostol group (P<0.05). For those with a Bishop score of 0 to 3, misoprostol treatment resulted in better cervical maturation than Foley catheter (P<0.05). In contrast, no statistical difference was found in cervical maturation for those with a Bishop score of 4 to 5 (P>0.05). The Propess group presented remarkable decreases in the duration of the first stage of labor, the total stage of labor, and cesarean section rate compared with the oxytocin group (P>0.05). There was no statistical difference in neonate body weight, 5 min Apgar score, and the cases of neonate asphyxia, meconium-stained amniotic fluid and referring to neonatal intensive care unit (NICU) among these group (P>0.05). There were 3 cases of metrypercinesia in the Propess group, 1 case in the Foley catheter group, and no case in the misoprostol group and the low-dose oxytocin group. Conclusions Propess, Foley catheter, and misoprostol are more effective than oxytocin for induction of labor in full-term pregnant women. Propess is expensive, while Foley catheter and misoprostol are safe, cheap and easy to operate, which can be individually selected.

       

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