30 mL和60 mL容量宫颈扩张球囊对足月妊娠促宫颈成熟效果比较

Comparision of 30 mL and 60 mL Foley Catheter for Cervical Ripening in Full-term Pregnancy

目的:探讨两种不同容量的宫颈扩张球囊用于足月妊娠促宫颈成熟的临床疗效观察,为提高引产成功率,降低产后不良影响提供临床依据。方法:随机抽取2017年6月—2017年12月同济大学附属第一妇婴保健院收治的具有引产指征且宫颈评分<6分的足月单胎孕妇400例作为观察对象,根据不同的球囊注水容量随机分为2组,Foley单球囊注水30 m L促宫颈成熟组(F30组)200例,Foley单球囊注水60 m L促宫颈成熟组(F60组)200例,比较2组患者的促宫颈成熟效果、引产效果以及孕产妇和新生儿转归情况。结果:2组患者治疗前Bishop评分比较,差异无统计学意义(χ~2=1.280,P=0.201),治疗后2组患者Bishop评分均上升,治疗后Bishop评分比较,差异有统计学意义(χ~2=-4.137,P=0.000)。2组初产妇的引产-分娩时间比较差异有统计学意义(t=4.204,P=0.000)。多因素分析显示球囊容量是初产妇24 h内成功阴道分娩的影响因素(OR=1.990,95%CI:1.444～2.742,P=0.000)。研究中20例瘢痕子宫孕妇用宫颈扩张球囊促宫颈成熟,其中18例顺利阴道分娩,无相关并发症。2组孕产妇和新生儿结局比较,差异均无统计学意义(均P>0.05)。结论:对足月宫颈条件不成熟的孕妇(包括剖宫产术后再次妊娠者)采用宫颈扩张球囊引产,安全有效,Foley 60 m L球囊在促宫颈成熟方面效果更好,且适当缩短引产-分娩时间。

Objective：To compare the cervical ripening effect of two different volume cervical dilatation balloon in fullterm pregnancy. Methods：From June 2017 to December 2017, 400 cases of full-term pregnant women with cervical Bishop score 6 who were admitted to our hospital for induction were selected randomly. According to the volume of Foley catheter（30 m L and 60 m L）, the patients were divided into two groups（200 cases in each） and then the cervical ripening and other pregnancy related prognosis were compared. Results：There is no significant differences between the Bishop scores of two groups before Foley balloon placement（ χ~2=1.280, P=0.201）. However, after cervical ripening, an obvious difference was demonstrated（ χ~2=-4.137, P =0.000）. The induction-labor interval of 60 m L Foley catheter was shorter than 30 m L Foley catheter for the nulliparous women（t=4.204, P=0.000）. By multivariate analysis, the volume of Foley catheter exerted significant effect on the delivery within 24 hours of induction（OR =1.990, 95% CI： 1.444 ～2.742, P =0.000）. Among 20 cases with previous cesarean section, 18 cases delivered vaginally successfully without any complications. There was no obvious difference observed between the neonatal prognosis of two groups（P0.05）. Conclusions：Foley catheter is safe and efficient in promoting cervical ripening for full-term pregnant women（including VBAC）. Compare to 30 m L volume Foley catheter, 60 m L volume Foley catheter is more effective in promoting cervical maturation, and can shorten the labor induction-delivery time.