足月妊娠米索前列醇阴道用药引产与催产素引产比较

RANDOMIZED COMPARISON OF INTRAVAGINAL MISOPROSTOL AND OXYTOCIN FOR LABOR INDUCTION IN TERM PREGNANCY

目的 :探讨足月妊娠引产中米索前列醇阴道给药剂量、间隔时间及引产结局、效果等 ,并与同期静脉催产素引产结局、效果等进行比较。方法 :选择单胎头位足月妊娠初产妇 10 0例随机分为米索引产组 (A组 )和催产素引产组 (B组 )。A组米索前列醇采取阴道后穹隆给药 ,单次剂量 5 0 μg ,根据宫缩情况每隔 2h追加剂量。B组采取传统静脉滴注方法。结果 :两组病例在年龄、身高、体重、平均孕周、孕次及引产前宫颈Bishop评分等方面均无显著性差异 ,具可比性。A组用药至临产时间、用药至宫口开全时间、第一产程时间均较B组明显缩短 ,且差别有极显著性意义 (P <0 0 0 1)。两组在第二产程时间和第三产程时间上无明显差异 (P >0 0 5 )。A组在宫颈Bishop评分 <4分时引产效果明显优于B组 ,且差别有极显著性意义 (P <0 0 1)。在引产效果上A组优于B组 ,差别有明显意义 (P <0 0 5 )。两组在分娩方式、剖宫产率、新生儿出生时阿普加评分方面均无明显差异 (P >0 0 5 )。结论 :米索前列醇采取阴道给药 ,单次剂量 5 0 μg ,间隔时间 2h用于单胎足月妊娠初产妇引产方法安全、效果明显 ,可明显缩短第一产程 ,尤适用于宫颈Bishop评分 <4时。

Objective:To compare the efficacy and safety of intravaginal misoprostol versus intravenous oxytocin in women undergoing induction of labor. Methods:We assigned 100 women undergoing indicated induction of labor randomly to misoprostol 50μg intravaginally every 2 hours as needed or intravenous oxytocin. Results:Baseline data including maternal age, height, weitht, gestation, Bishop score were similar. Among 100 patients evaluated, 50 were allocated to the misoprostol group and 50 to the intravenous oxytocin group. The median interval from induction to parturition, from induction to full dilatation and the duration of first stage were significantly shorter in the misoprostol group(P<0.01). The durations of the second and third stages of labor were similar. There were significant difference in efficacy when Bishop score<4(P<0.01), intravaginal misoprostol is better than intravenous oxytocin. There were no differences in maternal secondary outcomes including cesarean section or gastrointestinal side effects. Neonatal outcomes including Apgar scores or birth weight were not different. Conclusion:Labor induction with misoprostol 50μg intravaginally every 2 hours was effective, safe, and resulted in shorter induction to parturition, shorter induction to full dilatation and shorter duration of first stage. Intravaginal misoprostol is significantly more effective when Bishop score<4.