控释地诺前列酮与缩宫素用于足月胎膜早破引产的临床观察

Clinical evaluation of dinoprostone for labour induction in full-term premature rupture of membranes

目的 观察控释地诺前列酮用于足月胎膜早破引产的安全性及有效性.方法 将2009年6至12月我院胎膜早破孕妇115例分成2组,地诺前列酮组45例,孕妇使用控释地诺前列酮引产,缩宫素组70例孕妇使用缩宫素引产,记录2组孕妇的分娩方式、产程情况、产后出血量、新生儿体重及新生儿生物物理评分.结果 地诺前列酮组引产失败率2.2%（1例）,缩宫素组为11.4%（8例）,2组对比差异有统计学意义（P＜0.05）;地诺前列酮组胎儿窘迫发生率8.9%（4例）,缩宫素组为21.4%（15例）,2组比较差异有统计学意义（P＜0.05）;缩宫素组的剖宫产率较高[54.3%（38例）比28.9%（13例）,P＜0.01];地诺前列酮组的第一产程较缩宫素组明显缩短;但地诺前列酮组发生宫缩过度刺激的比例较缩宫素组高;产后出血、新生儿窒息率2组差异无统计学意义.结论 控释地诺前列酮用于足月胎膜早破引产成功率较高,可以缩短产程,不增加产后出血及新生儿窒息率,但要注意宫缩过度刺激情况.

Objective To explore the efficacy and safety of continuously released dinoprostone used for induction of full-term premature rupture of membranes. Methods This study recruited 115 full-term premature rupture of membranes from June 2009 to December 2009. They were divided into tow groups： the dinoprostone group （45 cases） and the oxytocin group（70 cases）. The modes of delivery, stage of labor, cesarean section rate, postpartum hemorrhage, fetal and neonatal condition were analyzed. Results The failure rate of induction induced by dinoprostone was 2.2%. The failure rate of oxytocin was 11.4%. The difference reached statistical significant difference （ P = 0.020）, as was the rate of fetal distress（8.9% vs 21.4% ） and the cesarean section rate（28.9% vs 54.4% ）. And delivery was shortened obviously in dinoprostone group than that in oxytocin group. The over stimulation of uterine contraction occurred in dinoprostone group. There was no significant difference between 2 groups in postpartum hemorrhage and neonatal conditions. Conclusions Dinoprostone increases the success rate of induction in full-term premature rupture of membranes and shortened the delivery time. Dinoprostone does not result in postpartum hemorrhage or neonatal distress. The over stimulation of uterine contraction should be taken into account when dinoprostone is used for induction of full-term premature rupture of membranes.