体表子宫肌电监测技术在控释地诺前列酮栓促宫颈成熟中的临床探索

Clinical exploration of surface uterine electromyography in patients with dinoprostone suppositories for cervical ripening induction

目的 应用体表子宫肌电监测技术探讨控释地诺前列酮栓促宫颈成熟时子宫肌电活动及其与临床结局的关系。方法 选择2020年1月至2023年1月在广州市妇女儿童医疗中心促宫颈成熟的单胎、头位孕妇89例,观察放置控释地诺前列酮栓后子宫肌电活动情况,并比较放置控释地诺前列酮栓不同时间出现子宫肌电爆发波的孕妇间临床结局的差异。结果 (1)控释地诺前列酮栓放置后肌电爆发波出现时间与促宫颈成熟耗时、临产间隔、放置至分娩用时呈正相关(P<0.05);(2)放置控释地诺前列酮栓后,3 h内出现子宫肌电爆发波组孕妇肌电强度显著高于3 h后出现组(P<0.05),且具有更短促宫颈成熟耗时、临产间隔、放置至分娩用时,以及更高24 h内分娩率(P<0.05),两组间总产程时长、产后出血率比较无统计学差异(P>0.05)。结论 放置控释地诺前列酮栓较早出现子宫肌电活动的孕妇促宫颈成熟时间更短、24 h阴道分娩率更高,但需重视产后出血发生风险。

Objective:To explore the relationship between uterine electromyographic activity and clinical outcomes with surface uterine electromyography(EMG)monitoring technology in the application of controlled release of dinoprostone suppositories(PGE 2)for cervical ripening induction.Methods:Eighty-nine singleton and cephalic pregnant women who underwent cervical ripening induction with PGE 2 in Guangzhou Women’s&Children’s Medical Center from January 2020 to January 2023 were recruited to observe the uterine EMG.The clinical outcomes of patients with different occurrence of EMG burst were compared.Results:There was a positive correlation between the occurrence time of EMG burst and the duration of cervical ripening induction,the interval from placement to the beginning of labor and the interval from placement to delivery respectively(P<0.05).After the treatment of PGE 2,the EMG intensity of patients whose uterine EMG burst appeared within 3 h was significantly higher than that of patients whose uterine EMG burst appeared after 3 h,and the patients whose uterine EMG burst appeared within 3 h had shorter duration of cervical ripening induction,the interval from placement to the beginning of labor and the interval from placement to delivery as well as higher delivery rate within 24 h(P<0.05).There were no significant differences in the total length of labor and the postpartum hemorrhage rate between the patients with two different reactions to PGE 2(P>0.05).Conclusions:Pregnant women with early burst of myoelectric activity after placement of PGE 2 had a shorter duration of cervical ripening induction and a higher 24-hour vaginal delivery rate.Attention should be paid to the risk of postpartum hemorrhage.