地诺前列酮与宫颈扩张球囊用于足月产妇促宫颈成熟及引产的可行性及安全性分析

Feasibility and safety analysis of dinoprostone and cervical dilator balloon for cervical ripening and induction of labor in full-term puerperae

目的探讨地诺前列酮与宫颈扩张球囊用于足月产妇促宫颈成熟及引产的可行性及安全性。方法选取2020年1月至2023年3月在徐州医科大学附属徐州市立医院住院分娩的足月产妇80例为研究主体进行前瞻性研究,根据其住院ID号将其分至两组中,即地诺前列酮组与球囊组。地诺前列酮组年龄(28.67±2.17)岁;初产妇30例,经产妇10例;孕周37~41(39.12±1.23)周;采用地诺前列酮栓促宫颈成熟。球囊组年龄(28.44±2.12)岁;初产妇31例,经产妇9例;孕周37~42(39.23±1.19)周;采用宫颈扩张球囊促宫颈成熟。比较两组宫颈Bishop评分、促宫颈成熟效果、分娩情况、不良反应发生情况、引产结局。采用独立样本t检验和χ^(2)检验。结果地诺前列酮组引产后Bishop评分为(8.58±0.51)分,与球囊组(8.62±0.58)分比较,差异无统计学意义(t=0.328,P=0.744);地诺前列酮组总有效率92.50%(37/40),与球囊组95.00%(38/40)比较,差异无统计学意义(χ^(2)=0.213,P=0.644);地诺前列酮组干预至临产时间、第一产程、总产程及干预至阴道分娩时间分别为(14.68±3.81)h、(5.67±2.23)h、(6.12±2.24)h及(34.21±5.49)h,均短于球囊组的(20.22±4.26)h、(7.23±1.12)h、(8.02±1.22)h及(45.25±6.58)h(t=6.131、3.954、4.711、8.148,均P<0.001);球囊组胎膜早破及宫缩过频发生率分别为2.50%(1/40)及0,低于地诺前列酮组的22.50%(9/40)及25.00%(10/40)(χ^(2)=7.314、11.429,均P<0.05);地诺前列酮组与球囊组引产结局比较,差异均无统计学意义(均P>0.05)。结论对于足月分娩的产妇,选择宫颈扩张球囊或地诺前列酮促宫颈成熟及引产都是安全有效的,然而采用地诺前列酮可缩短产妇的临产时间和总产程,适用于需要缩短产程的高危产妇,但其易导致子宫过度刺激及血压波动大,导致产妇宫缩过频、胎膜早破,因此,要根据个体病例选择适宜的方式。

Objective To explore the feasibility and safety of dinoprostone and cervical dilation balloon for cervical ripening and induction of labor in full-term puerperae.Methods Eighty cases of full-term puerperae who gave birth in Xuzhou First People's Hospital from January 2020 to March 2023 were selected as the research subjects for the prospective study.According to their hospitalization ID number,they were divided into two groups,namely dinoprostone group and balloon group.The age of the dinoprostone group was(28.67±2.17)years old;there were 30 cases of primipara and 10 cases of parturient;the gestational age was 37-41(39.12±1.23)weeks;dinoprostone suppository was used to promote cervical ripening.The age of the balloon group was(28.44±2.12)years old;there were 31 cases of primipara and 9 cases of parturient;the gestational age was 37-42(39.23±1.19)weeks;cervical dilation balloon was used to promote cervical ripening.The cervical Bishop score,cervical ripening effect,maternal delivery,occurrence of adverse reactions,and induced labor outcomes were compared between the two groups.Independent sample t test andχ^(2) test were used.Results The Bishop score of the dinoprostone group after induced labor was(8.58±0.51)points,and there was no statistically significant difference compared with that of the balloon group[(8.62±0.58)points](t=0.328,P=0.744).The total effective rate of the dinoprostone group was 92.50%(37/40),and there was no statistically significant difference compared with that of the balloon group[95.00%(38/40)](χ^(2)=0.213,P=0.644).The time from intervention to labor,the first stage of labor,the total stage of labor,and the time from intervention to vaginal delivery in the dinoprostone group were(14.68±3.81)h,(5.67±2.23)h,(6.12±2.24)h,and(34.21±5.49)h,which were shorter than(20.22±4.26)h,(7.23±1.12)h,(8.02±1.22)h,and(45.25±6.58)h in the balloon group(t=6.131,3.954,4.711,and 8.148,all P<0.001).The incidences of premature rupture of membranes and overcontraction in the balloon group were 2.50%(1/40)and 0,which were lower than those in the dinoprostone group[22.50%(9/40)and 25.00%(10/40)](χ^(2)=7.314 and 11.429,both P<0.05).There were no statistically significant differences in the induced labor outcomes between the dinoprostone group and the balloon group(all P>0.05).Conclusions For puerperae with full-term delivery,it is safe and effective to choose cervical dilation balloon or dinoprostone to promote cervical ripening and induced labor.However,the use of dinoprostone can shorten the labor time and total labor process,which is suitable for high-risk puerperae who need to shorten the labor process.However,it is easy to cause excessive uterine stimulation and large fluctuations in blood pressure,resulting in excessive uterine contractions and premature rupture of membranes.Therefore,the appropriate method should be selected based on individual cases.