普贝生用于足月妊娠促宫颈成熟及引产的临床观察

Clinical observation of Propess used in promoting cervical ripening and induced labor of term pregnancy

目的:评价普贝生促宫颈成熟的有效性和安全性。方法:采用对照研究的方法,选择231例足月妊娠、宫颈Bishop评分≤5分、有阴道分娩适应症、无引产禁忌症、无严重内科合并症的单胎头位孕妇分为两组:138例给予普贝生一枚促宫颈成熟作为研究组,93例给予美利生200mg/d静推促宫颈成熟作为对照组。比较两组用药后的宫颈Bishop评分、宫缩、用药到临产时间、分娩情况、阴道分娩率、产后出血、对胎儿及新生儿的影响。结果:研究组孕妇用药后6、12h宫颈Bishop评分分别为(6.5±2.2)分和(7.9±1.8)分,明显高于对照组(4.3±1.9)分和(4.9±1.2)分,有显著差异(P<0.04)。24h内研究组81.1%(112/138)的孕妇临产,对照组8.8%(8/93)孕妇临产,两组间有显著性差异(P<0.01)。研究组阴道分娩率为66.2%(91/138),用药至胎儿娩出时间为(20.86±17.23)h,对照组阴道分娩率31.6%(27/93),用药至胎儿娩出时间(79.32±21.65)h,阴道分娩率及用药至胎儿娩出时间两组间均有显著差异(P<0.05)。两组间胎儿窘迫发生率、新生儿窒息率、产后出血率均无统计学差异(P>0.05)。宫缩过强为主要副作用,但取药后好转。结论:普贝生能够有效地促进宫颈成熟,缩短临产时间,增加阴道分娩率,可以较安全地用于临床。

Objective： To evaluate the efficacy and safety of intravaginal prostaglandin E2 （PGE2 ） pessary （proposs） for cervical ripening. Methods： Tow hundred and thirty one who had Bishop score of 5 or less, carried singleton pregnancies in cephalic presentation and had reached a gestat/onal age of at least 37 weeks, without severe medical diseases were scheduled to undergo indicated of labor. Study group received a propess pessary insert into vaginal for cervical ripening, while control group received transvenous administered sodium prasterone sulfate of 200 mg per day. The Bishop score of cervical, the contraction of the uterus, the time interval from induction to delivery, delivery method, postpartum hemorrhage rate and the fetal and neonate condition were compared. Results： Six and twelve hours after admin- istration, Bishop score in study group were added 6. 5±2. 2 and 7. 9 ± 1. 8, they were higher than those in the control group, 4. 3 ± 1. 9 and 4. 9 ±1. 2, the difference was significant （P〈0. 01）. The onset of labor occurred in 24 hours in 81. 1% （112/138） of the study group, which was significantly higher than that in control group （P 〈0. 01 ）, in which 8. 8% （8/93） occurred active labor. The rate of delivery in study group was 66. 2% （91/138） and in control group was 31. 6%, the difference was significant （P 〈0. 05）. The meantime to vaginal delivery in study group was （20. 86 ± 17. 23） h, was significant shorter than that in control group （79. 32 ±51. 65） h （P 〈 0. 05）. No significant difference were found in amniotlc fluid, fetal d/stress or neonatal Apgar scores, postpartum hemorrhage rate between the two groups （P 〉 0. 05）. The major side-effect was overstimulation of uterine contraction. Conclusion： Propess is affeetire in producing cervical ripening, shorten labor time, increasing the rate of vaginal delivery, and can be used safely in clinic.