宫颈扩张球囊在瘢痕子宫阴道试产中的应用探讨

Application of cervical expansion balloon in attempting vaginal delivery in pregnant women with cicatrical uter

目的探讨宫颈扩张球囊在瘢痕子宫足月妊娠阴道试产过程中促宫颈成熟的安全性及有效性,提高瘢痕子宫足月妊娠阴道试产成功率。方法采用回顾性收集资料的方法,随机选取2015年7月—2016年3月入住深圳市南山区妇幼保健院有引产指征且具备阴道试产意愿及条件的50例瘢痕子宫足月妊娠孕妇为观察组,随机选取同等条件下的50例非瘢痕子宫孕妇为对照组,两组均使用宫颈扩张球囊促宫颈成熟并引产,对比分析两组促宫颈成熟的效果、分娩结局及母儿不良结局发生率。结果观察组促宫颈成熟的有效率和引产成功率(66%、76%)与对照组(76%、84%)相比差异无统计学意义(P>0.05)。两组孕妇在产程时间、产后出血量、新生儿出生即刻Apgar评分、新生儿出生体质量、阴道分娩率、急性绒毛膜羊膜炎及宫颈裂伤等方面差异均无统计学意义(P>0.05)。观察组有1例孕妇出现先兆子宫破裂中转剖宫产;对照组有1例新生儿发生轻度窒息,观察组中无新生儿轻度窒息发生,差异无统计学意义(P>0.05)。两组孕妇均无产后大出血发生。结论在严格把握适应证前提下,宫颈扩张球囊可用于瘢痕子宫足月妊娠阴道试产的促宫颈成熟,有助于提高瘢痕子宫阴道试产成功率、降低重复剖宫产率,且不增加母儿不良结局的发生率。

Objective To explore the safety and efficiency of cervical expansion balloon in promoting cervical ripening of cicatrical uter women with full-term pregnancy attempting vaginal delivery. Methods Fifty cases of pregnant women at the third trimester with cicatrical uter admitted to Nanshan District Maternal and Child Health Care Hospital of Shenzhen from July 2015 to March 2016 were retrospectively and randomly collected as the observation group. Another 50 pregnant women at the third trimester with normal uter admitted to the same hospital in the same period were retrospectively and randomly collected as the control group. All the cases had indications for labor induction, and had intention and conditions of vaginal delivery. Cervical expansion balloons were used in the two groups to promote cervical ripening. The effective rate of promoting cervical ripening, the outcomes of delivery and the incidences of adverse outcomes were compared between the two groups. Results The differences in effective rate of promoting cervical ripening and success rate of induced labor of cervical ripening of pregnant women between the observation group （66%, 76%） and the control group （76%, 84%） were not statistically significant （P〉0.05）. There were no significant differences in the time of birth process, amout of postpartum bleeding, birth immediate Apgar score, neonatal birth weight, and vaginal delivery rate, and the incidences of acute chorioamnionitis and cervical laceration of pregnant women between the two groups （P〉0.05）. Incomplete uterine rupture occurred in one case in the observation group, while none in the control group; neonatal mild asphyxia occurred in one case in the control group, while none in the observation group; the differences were not statistically significant （P〉0.05）. No postpartum hemorrhage occurred in the two groups. Conclusions Under the premise of strictly following the indications, cervical expansion balloon can be used in promoting cervical ripening at the third trimester of pregnant women with cicatrical uter attempting vaginal delivery, improve the success of attempting vaginal delivery, reduce the occurrence of reduplicated cesarean section, and not increase the incidence of maternal and fetal adverse outcomes.