小剂量米非司酮在于足月高危妊娠引产中的应用

LABOR INDUCTION IN WOMEN AT TERM WITHLOW-DOSAGE OF MIFEPRISTONE AND MISOPROSTOL

目的：探讨小剂量术非司团配伍米索前列醇用于足月高危妊娠引产的效果及安全性。方法：150例足月高危孕妇、单胎、头位、宜颈Bishop评分≤5分．随机分成A、B、C组3组，每组50例。A组米非司酮200mg、B组米非司酮100mg预治疗，C组无预治疗。48h后均放置米索前列醇50μg于阴道后穹窿，每3h1次，直至出现宫缩。结果：进入研究后48h，AB组宫颈Bishop评分增加≥3分者达44％，较C组的12％明显为高，P＜0．01。应用米索前列醇引产成功者A组26％、B组20％，较C组4％明显为高，P＜0．05。用1～2次米索前列醇引产成功者A组78．4％、B组77．5％，较C组56．25％明显为高．P＜0．05，A、B组羊水粪染率分别为10％、12％，明显低于C组的28％P尸＜0．05。产后胎盘、蜕膜组织学检查，未能发现口服米非司酮对纺毛、蜕膜的特异性损害。结论：①术非司酮100g于足月病危妊娠引产前48h口服有良好的促宫颈成熟作用，能减少它编剂需要量，对高危妊娠有益。②小剂量米非司酮对足月妊娠胎盘绒毛、蜕膜不产生明显病理损害，因而这种剂量用于足月妊娠引产是安全的。

Aim: To determine the efficacy and the safety of different dosage of Mifepristone and misoprostol as induc-tion agent for initiation of laber at term. Methods: 150 pregnant women at term who had clear clinical indications for labor in-duction but had unfavorable cerivices (Bishop<5) were randomly assigned to A, B, C groups. Each group contained 50 cas-es, In group A all women took 200mg of Mifepristone on days l of 2 - day observation Period; 100mg of Mifepristone in group B and no tablelet in group C. 48 hours Iater 50μg of Misopristol was placed in the opterior vaginal fonix every 3 hours with a potential maximum of 4 doses. Result: 44 % of cases in group A and B had mature cervices (Bishop m inereed>3) but only l2% of cases in group C had such increas (P <0.01 ). 25 cases entered spontaneous labor without using Misoprostol.13 in group A, 10 in group B and 2 in group C (P<0.05). There was a significant difference in the bo of Misoprostol re-quirement between the group A, B and the group C. In group A, B 1 ~ 2 doses Misoprostol requirement accounted for 78.4% and 77. 5 % of cases respectively, versus 56. 25 % of cas in group C while 3 ~ 4 doses Mboprostol need is 10. 8% and 12. 5 % of cases in group A, B versus31. 3 % cases in group C (P < 0.05). There was a higher prevalenee of meconium passage in group C (28%, P <0.05). Among 3 groups the observation of pathomorPhology of placenta and decidua show no speific lesion. Conlusion: ①Administration of loomg of Mifepristone, 48 - hour before induction of labor can improve the Bishop score of un favorable cervices of the women at term and reduce the doese of Misoprostol, which is gdri for high risk pregnancy. ②Low - dosage of Mifepristone seerns not making obvious patholOgicaI lesion in term placenta and decidua, and therefore, it has proved safe in the cases.