人工促宫颈成熟对孕足月剖宫产术后再次妊娠阴道试产母儿预后的影响

Effect of artificial cervical ripening on the prognosis of pregnant women undergoing trial of labor after cesarean delivery

目的探讨人工促宫颈成熟是否有利于孕足月剖宫产术后再次妊娠阴道试产(TOLAC)患者分娩提前发动,以提高TOLAC成功率。方法选取孕38~41周、单胎、具备阴道分娩条件且有阴道分娩意愿的TOLAC患者39例,按照病历号尾数的单双数随机分为人工促宫颈成熟组(M组,n=19)和对照组(C组,n=20)。孕38周后,首次内诊时做宫颈Bishop评分,M组进行人工促宫颈成熟和骨盆内测量,C组仅进行骨盆内测量,比较2组患者分娩孕周和产时母儿情况。结果2组比较,患者年龄、首次内诊孕周、新生儿体质量的差异均无统计学意义(P>0.05)。M组患者平均分娩孕周为(274.74±4.54)d,与C组[(281.13±3.64)d]比较有统计学差异(P<0.05);M组住院时宫颈Bishop评分明显高于C组(P<0.05)。2组比较,胎膜早破率、产后出血量、新生儿窒息率、新生儿体质量和阴道分娩成功率无统计学差异(P>0.05)。结论人工促宫颈成熟可以作为一种有效提高TOLAC患者宫颈Bishop评分的手段,不增加母儿的不良预后。提倡孕38周时行人工促宫颈成熟,以促进TOLAC患者的自然分娩发动。

Objective To assess the benefits of artificial cervical ripening for early onset of labor under trial of labor after cesarean(TOLAC)delivery.Methods Totally,39 women with singleton pregnancies at 38 to 41 weeks of gestation who were qualified to give birth vaginally were included.The patients were divided into two groups:artificial cervical ripening group(group M,n=19)and control group(group C,n=20).The Bishop score during the first pelvic examination after 38 weeks of gestation was determined.Pelvic measurements were performed for both groups;however,cervical ripening was performed only for group M.The labor week of gestation and condition of both mother and neonate during delivery were compared between the two groups.Results The average gestational ages of delivery were 274.74±4.54 and 281.13±3.64 days in groups M and C respectively,indicating a statistically significant difference(P<0.05).The group M inpatients’Bishop score was significantly higher than that of group C(P<0.05).There was no significant difference in the rate of premature rupture of membranes,postpartum hemorrhage,neonatal asphyxia,neonatal weight,and rate of vaginal birth after cesarean section between the two groups.Conclusion Artificial cervical ripening increases the Bishop score of TOLAC deliveries without any negative effects on the prognosis of both mother and neonate.We advise patients to undergo artificial cervical ripening during the 38 weeks of gestation to accelerate the delivery process.