地诺前列酮栓在促宫颈成熟中的应用

Application of dinoprostone suppository in promoting cervical mature

[目的]对不同Bishop评分孕足月产妇应用地诺前列酮栓和缩宫素,比较促宫颈成熟效果和引产成功率,以探讨地诺前列酮栓最佳应用时机,减少临床不良反应,提高母婴健康水平.[方法]将449例足月孕妇随机分为观察组（地诺前列酮栓）和对照组（缩宫素）,将每组病人按照Bishop评分分为〈4分、4分～6分和≥7分3个等级.观察两组产妇用药后4h、8h、12hBishop评分、促宫颈成熟效果、产妇临产时间、产后出血量、分娩方式、软产道裂伤、不良反应率和围生儿结局.[结果]用药后4h、8h、12h观察组〈4分组和4分～6分组Bishop评分明显高于对照组（P〈0.05）,≥7分组用药后4hBishop评分高于对照组（P〈0.05）;Bishop评分〈4分和4分～6分病人使用地诺前列酮栓效果优于缩宫素（P=0.000）,两组≥7分病人比较差异无统计学意义（P=0.894）;使用地诺前列酮栓产妇Bishop评分〈4分和4分～6分者临产时间早于对照组（P〈0.01）;产后出血量观察组低于对照组（P〈0.01）;引产成功率观察组〈4分和4分～6分者高于对照组（P〈0.01）,剖宫产率低于对照组（P〈0.05或P〈0.01）;不良反应共6例,均出现在观察组中,其中Bishop评分〈4分者5例;胎儿窘迫发生率观察组高于对照组（P〈0.05或P〈0.01）,尤其是Bipshop评分〈4分者,窘迫发生率17.54%.[结论]孕足月产妇使用地诺前列酮栓可以缩短临产时间,提高引产成功率,但应考虑使用前孕妇宫颈成熟程度,最好在Bishop评分4分以上时使用,对评分〈4分者使用地诺前列酮栓时应严密监控,以防出现母婴意外.

Objective:Applying dinoprostone suppository and oxytocin for pregnant women at term with different Bishop score,to compare the effect of promoting cervical maturity and success rate of induced labor between them,so as to probe into the optimal timing of application of dinoprostone suppository,reduce clinical adverse reaction and improve the health level of maternal and child.Methods:A total of 449cases of full term pregnant women were randomly divided into observation group(dinoprostone suppository)and control group(oxytocin),in accordance with the Bishop score,patients in each group were divided into three levels respectively<4points,4~6and 7or more points.Then to observe the Bishop score,the effect of promoting cervical maturity, maternal labor time,postpartum haemorrhage amount,delivery mode, soft birth canal laceration,adverse reaction rates and perinatal outcome of children at 4h,8h,12hafter medication between both groups.Results:At 4h,8h,12hafter medication,Bishop score in observation groups<4score group and<4~6score group was significantly higher than that in control group(P<0.05),at 4hafter medication Bishop score in≥7points group was higher than that in control group(P<0. 05);in patients with Bishop score<4points and 4~6points,effectiveness of ketone bolt was better than that of oxytocin(P=0.000),there was no statistically significant difference in patients with Bishop score≥7 between both groups(P=0.894);maternal using dinoprostone suppository and Bishop score<4points and 4~6points in labor time was earlier than the control group(P<0.01);postpartum haemorrhage amount of observation group was lower than control group(P<0.05or P<0.01);success rate of induced labor group<4points and 4~6 points was higher than that in control group(P<0.01),number of cesarean section was lower than the control group(P<0.05);adverse reactions in a total of 6cases and all appeared in observation group,the Bishop score of 5cases<4points;the incidence of fetal distress in observation group was higher than that in control group(P<0.05or P< 0.01),especially Bipshop score<4points,distress rate was 17.54%. Conclusion:Full-term pregnancy lying-in women used dinoprostone suppository can shorten labor time,improve the success rate of induced labor,but should consider the cervical maturity of pregnant women before using,best used when Bishop score was more than four points;the patients' condition should be closely monitored by using dinoprostone suppository when the score<4points,to prevent from accident.