米索前列醇和缩宫素用于瘢痕子宫妊娠催产的临床效果和安全性比较

Comparison of clinical efficacy and safety of misoprostol tablets with oxytocin for inducing labor of pregnant women with scar pregnancy

目的:比较米索前列醇片和缩宮素用于瘢痕子宫妊娠催产的临床效果和安全性。方法:选取本院2015年1月-2016年12月符合阴道试产条件的疤痕子宫再次妊娠产妇144例,随机分为对照组、米索前列醇组和缩宫素组各48例,米索前列醇组阴道放置米索前列醇片,缩宫素组静脉滴注缩宫素,对照组自然分娩。比较3组产妇宫颈成熟、产程、分娩方式、母婴预后等。结果:用药后4h、8h、12h、24h时3组孕产妇Bishop评分存在差异,且米索前列醇组评分高于缩宫素组(P<0.05);3组诱发临产时间、总产程和阴道产率存在差异,且米索前列醇组产妇诱发临产时间和总产程均较缩宫素组显著缩短(P<0.05),而米索前列醇组和缩宫素组产妇的分娩方式差异无统计学意义(P>0.05);3组产妇产后并发症总发生率差异具有统计学意义(P<0.05),但是米索前列醇组和缩宫素组产妇并发症总发生率差异均无统计学意义(P>0.05);3组新生儿并发症总发生率差异具有统计学意义(P<0.05),但是米索前列醇组和缩宫素组无差异(P>0.05)。结论:米索前列醇和缩宫素均可以促进瘢痕子宫妊娠产妇宫颈成熟,缩短产程,降低剖宫产的风险,降低产妇和新生儿并发症,两者对瘢痕子宫妊娠母婴结局影响相当,但是米索前列醇促宫颈成熟效果和缩短产程作用优于缩宫素。

Objective：To compare the clinical efficacy and safety of misoprostol tablets with oxytocin for inducing labor of pregnant women with scar pregnancy.Methods：A total of 144 pregnant women with cicatricial uterus pregnancy,who were suitable for vaginal trial labor,were randomly divided into three groups（48 cases in control group,misoprostol group and oxytocin group）.The women in misoprostol group received vaginal misoprostol tablets,the women in oxytocin group were given intravenous infusion of oxytocin,and the women in control group were given natural childbirth.Cervical maturation,parturient duration,delivery mode,prognosis of maternal and child were compared among the three groups.Results：The first,Bishop score of pregnant women in the three groups had significant different at4 h,8 h,12 hand 24 hafter treatment（P 〈0.05）,and the Bishop score of pregnant women in misoprostol group was significant higher than that of pregnant women in oxytocin group（P 〈0.05）.The second,the labor time,total parturient duration,and rate of vaginal birth of pregnant women in three groups had significant different（P 〈0.05）.The labor time and total parturient duration of pregnant women in misoprostol group were significant shorter than those of pregnant women in oxytocin group（P 〉0.05）,but rate of vaginal birth of pregnant women in misoprostol group and in oxytocin group had no significant different（P 〉0.05）.The third,the total incidence of postpartum complications of pregnant women in the three groups had statistical significant different（P 〈0.05）,but there was no significant difference of pregnant in women incidence of postpartum complications between misoprostol group and oxytocin group（P 〉0.05）.The fourth,the total incidence of neonatal complications had statistical significant different among the three groups（P 〈0.05）,but there was no significant difference between misoprostol group and oxytocin group（P 〉0.05）.Conclusion：Misoprostol tablets and oxytocin can promote the maturation of maternal cervix uteri,shorten parturient duration,and reduce the risk of cesarean delivery of pregnant women with scar uterine pregnancy.Both of misoprostol and oxytocin have a similar effect on prognosis of maternal and child,but misoprostol has better effect to promote the maturation of maternal cervix uteri and to shorten parturient duration.