Is Induction of Labor with Early Rupture of Membranes Associated with an Increased Rate of Clinical Chorioamnionitis?

Objective: The objective of this study was to determine if early rupture of membranes (ROM) in women undergoing induction of labor (IOL) at term is associated with an increased rate of clinical chorioamnionitis. Study Design: A retrospective cohort study was performed on women undergoing IOL. Early ROM was defined as ROM at a modified Bishop score less than 5, cervical dilation less than 4 cm, or cervical effacement less than 80%. The rate of clinical chorioamnionitis was compared between women with early and late ROM. Results: The rate of clinical chorioamnionitis was 8.6% (24/279). ROM at an effacement of less than 80% was associated with a rate of clinical chorioamnionitis of 15.4% (12/78) compared to 6.0% (12/201) at an effacement of equal to or greater than 80%, p = 0.017. The rate of cesarean delivery was higher for patients with early ROM by any definition: 32% compared to 17.5% by modified Bishop score (p = 0.031), 32.4% versus 18.2% by cervical dilation (p = 0.049), and 33.3% versus 14.9% by cervical effacement (p = 0.001). Conclusions: In patients undergoing IOL, early ROM may be associated with an increased rate of clinical chorioamnionitis when performed at a cervical effacement of less than 80% and an increased rate of cesarean delivery.

The Efficacy and Safety of Dinoprostone Vaginal Insert for Labor Induction Following Optimization of Standard Operating Procedure: A Retrospective Study in China

Background:The study aimed to assess the efficacy and safety of dinoprostone vaginal insert in labor induction following optimization of standard operating procedure(SOP)and to discover independent predictors of vaginal delivery.Methods:This study comprised 551 pregnant women who required cervical ripening with dinoprostone before induction of labor.Using univariate and multivariate analyses,independent predictors of vaginal delivery were identified.Results:443 of the 551 women(80.4%)gave birth vaginally.Vaginal delivery was predicted by maternal age(24-30 vs.<24,P<0.001;30-35 vs.<24,P=0.03),gestational age(P=0.005),birth weight(P<0.001),parity(P=0.001),pre-pregnancy BMI(P<0.001),premature rupture of membranes(P=0.001),meconium-stained amniotic fluid(P<0.001),fundal height(P<0.001)and the Bishop score(P<0.001).None of the women exhibited severe postpartum hemorrhage.Conclusions:The maternal age,gestational age,birth weight,parity,body mass index,premature membrane rupture,amniotic fluid contamination,fundal height,and the Bishop score were independent predictors of vaginal delivery.These may guide the clinical use of dinoprostone for induction of labor.

Effectiveness of Dinoprostone and Cook's Balloon for Labor Induction in Primipara Women at Term

Labor induction is commonly used for achieving successful vaginal delivery.This study aimed to compare the effectiveness of dinoprostone and Cook's balloon as labor-inducing agents in primipara women at term.A retrospective cohort study among primipara women was conducted in Hubei Maternity and Child Health Hospital.Basic clinical characteristics were collected.The main outcomes were vaginal delivery rate,cesarean section rate and forceps delivery rate.Obstetric and perinatal outcomes were also compared.Univariate and multivariate analyses were further performed to evaluate the predictors for vaginal delivery within 24 h.A total of 845 eligible primipara women undergoing labor induction were recruited.Of them,141 women were induced with dinoprostone(dinoprostone group,DG),and 704 with Cook's balloon(Cook's balloon group,CG).Groups were homogeneous except more women with premature rupture of membranes in DG,with gestational hypertension in CG(P<0.05).The vaginal delivery rate within 12 h was 1.98%and 16.52%in CG and DG respectively(P=0.0001).Besides,the vaginal delivery rate within 24 h was 37.62%and 52.26%in CG and DG respectively(P=0.0079).DG showed the lower rate of oxytocin augmentation,artificial rupture of membrane and postpartum hemorrhage and the shorter interval from insertion to active labor than CG(P<0.05).Multivariate regression analysis revealed that abortion history,oxytocin augmentation,artificial rupture of membrane,and obstric analgesia were independent predictors for vaginal delivery within 24 h.In conclusion,dinoprostone was more effective than Cook's balloon to induce labor and achieve vaginal birth in the sample of primipara women at term.

Effects of two different protocols of oxytocin infusion for labor induction on obstetric outcomes: A cohort study

Objective: Concerns remain about the safety and efficacy of high dose and low dose protocols of oxytocin for labor induction. We have compared 2 regimens of oxytocin induction (low-dose vs high dose) on perinatal outcomes over a 1-year period. Study Design: Included were all women undergoing induction of labor at term with live singleton gestations. Cesarean delivery (CD) and a composite adverse neonatal outcome (5-min Apgar score < 7, umbilical artery pH < 7.10, or need for admission to NICU) were assessed using logistic regression analysis. Admission-to-delivery intervals was compared between the two groups by log-rank test. Results: A total of 544 women fulfilled the study criteria. The two groups were comparable for demographic and obstetric variables. There was no significant association between oxytocin regimen and rates of CD (P = 0.77) or adverse neonatal outcome (P = 0.99) even after controlling for confounders. The admission-to-delivery interval was significantly shorter for the high-dose group than for the low-dose group (median interval = 11.7 vs 14.3 hours, respectively, P = 0.026). Conclusion: Use of a high-dose protocol of oxytocin administration for induction of labor at term is associated with similar rates of cesarean section and adverse neonatal outcome as a low-dose protocol, but with an average of 2.5 hours shorter duration of labor.

Spontaneous versus Induced Labor Delivery, a Retrospective Analysis

Background: Induction of labor is the stimulation of the uterus to initiate the labor process whether by administering oxytocin, prostaglandin or reputing the membrane [1]. It was realized that the number of induction of labor patients was thought to be increasing in comparison with the spontaneous labor patients. Therefore, the complications of induced labor were higher. A detailed analysis was needed to confirm that. Objective: The aim of the study is to analyze the outcomes between spontaneous versus induced labor. Materials and Methods: A retrospective analysis was conducted at our tertiary care university hospital, in the period from December 2015 to December 2016 when 311 women were divided into two groups: group 1, women who had spontaneous labor (n = 106) compared with group 2, women who were labor induced (n = 205). Complications of pregnancy, delivery type, tear, episiotomy, blood transfusion and instruments used were analyzed retrospectively. Results: The mean ± SD of baseline characteristics, like age, height, weight, BMI and hemoglobin level for all study samples was 28.59 ± 5.95 years, 1.58 ± 0.06 m, 71.77 ± 13.42 kg, 28.59 ± 5.89 kg/m2 and 11.08 ± 1.45 g/dl respectively. A statistically significant difference was noticed in the duration of labor between spontaneous and induced labor (95% CI: 9.194 - 152.130;p-value 0.004 and OR: 0.239). There was no significant difference in complications, delivery type (Spontaneous Vaginal Delivery (SVD) or other), blood transfusion, and instrument used between women who had spontaneous labor versus induced labor. However, significant differences in tear (95% CI: 4.354 - 0.996;p-value 0.035) and episiotomy (95% CI: 0.928 - 0.224;p-value 0.028) were found between the two groups. In conclusion, the induced labor was found to be associated with high incidence of duration of labor, tear and episiotomy. Patients should always be counseled when there it is an option between the two delivery types.

不同孕周产妇采用依沙吖啶配伍米非司酮引产的分娩结局分析

目的研究不同孕周产妇采用依沙吖啶配伍米非司酮引产的分娩结局。方法收集2043例羊膜腔内依沙吖啶配伍米非司酮引产产妇的临床资料,其中成功引产2027例,引产失败16例。按孕周不同将引产成功的产妇分为三组,其中A组192例产妇孕周为14~16^(+)6周,B组1634例产妇孕周为17~27^(+)6周,C组201例产妇孕周为≥28周。比较三组产妇的临床特征、成功引产产妇产后出血的相关因素,并分析16例依沙吖啶配伍米非司酮引产失败产妇的基本信息。结果三组产妇年龄、身高、孕次、瘢痕子宫、合并子宫肌瘤、双胎妊娠、产后出血、胎盘滞留比较,差异无统计学意义(P>0.05)。三组产妇体重、体质量指数(BMI)、产次、产时出血量、引产至分娩时间、引产至分娩时间、前置胎盘、糖尿病、高血压、甲状腺疾病、胎儿发育异常、死胎/稽留流产、胎盘胎膜残留、会阴裂伤、产后贫血比较,差异有统计学意义(P<0.05)。B组和C组的体重、BMI高于A组,C组高于B组(P<0.05);B组和C组的产次少于A组,引产至分娩时间短于A组(P<0.05);C组的产时出血量多于B组和A组,差异均有统计学意义(P<0.05)。A组产妇瘢痕子宫发生率为7.69%,B组为26.15%,C组为50.00%;A组会阴裂伤发生率为0,B组为6.15%,C组为50.00%。三组产妇瘢痕子宫、会阴裂伤发生率比较,差异有统计学意义(P<0.05),三组产妇前置胎盘、胎盘胎膜残留、胎儿发育异常、死胎/稽留流产、产后贫血发生率比较,差异无统计学意义(P>0.05)。16例产妇引产失败,其中14~16^(+)6周8例:1例二次依沙吖啶引产术失败后剖宫取胎,术中发现胎盘植入穿透型;其余7例均通过药物引产或钳刮手术顺利引产。17~27^(+)6周5例,3例通过钳刮术顺利引产,1例因梗阻性难产,1例因产前出血剖宫取胎。≥28周3例,均行剖宫取胎术:1例先兆子宫破裂,1例梗阻性难产,1例巨大子宫肌瘤。失败产妇通过药物引产、钳刮或剖宫取胎终止妊娠。结论羊膜腔内依沙吖啶注射配伍米非司酮引产安全有效,此方法同样适用于<17周的中期妊娠引产;产后出血量随着孕周的增加而增多,但整体产后出血率趋于一致;14~16^(+)6周产妇引产成功所需时间相对较长,但在可接受范围内。

产时Ⅱ度及以上会阴裂伤风险预测模型的构建和验证

目的 构建产时Ⅱ度及以上会阴裂伤风险预测随机森林算法模型,并初步评价模型的预测性能。方法 采用方便抽样法,选取经阴道分娩的1 366例产妇为研究对象,将其按照7∶3的比例随机分为训练集和验证集。采用LASSO回归分析筛选产时Ⅱ度及以上会阴裂伤的风险因素,采用随机森林算法构建预测模型,计算ROC曲线下面积、预测准确率、灵敏度和特异度等评价模型的性能。结果 共计8个预测因子被纳入随机森林模型中,分别为孕前BMI、孕期体质量增加、初产妇、剖宫产史、硬膜外麻醉、催产、引产和胎儿估计体质量,其中胎儿估计体质量对产时Ⅱ度及以上会阴裂伤的影响最大,其次是初产妇和催产。随机森林模型在验证集中的ROC曲线下面积为0.698(95%CI:0.645~0.751),预测准确率为80.0%(95%CI:75.8%~83.8%),灵敏度和特异度分别为50.5%和89.1%。结论 基于随机森林算法构建的产时Ⅱ度及以上会阴裂伤风险预测模型具有一定的预测价值,但预测性能仍有待提高。

三维超声测量宫颈容积在妇产领域的应用进展

近年来,随着超声技术的不断发展,三维超声成像在妇产领域的应用越来越广泛,主要用于胎儿畸形诊断、宫腔病变评估及胎盘体积测量等。三维超声测量宫颈容积通过超声探头在妇女阴道内测量宫颈长度、直径和容积,提供完整和立体的宫颈结构图像,优于传统二维超声,为临床医师提供关于宫颈功能和疾病的重要信息。三维超声测量宫颈容积可预测早产,但目前不能代替宫颈管长度;宫颈容积可评价孕晚期宫颈成熟度,从而预测引产结局;对宫颈疾病的诊断及预防有潜在临床意义。宫颈容积的测量为临床医师提供新的研究方向及参考价值。由于目前研究较少,今后需更多文献及研究验证三维超声测量宫颈容积在妇产领域的应用价值。

Efficacy and Safety of Misoprostol Vaginal Insert to Induce Labor beyond 40 + 0 Weeks of Gestation

Objective: Misoprostol vaginal insert (MVI) is proven to induce labor by a continuously release of PGE1. Previous reports showed that MVI reduced induction to delivery time as well as active labor time but it also increased uterine tachysystole. Here we attempted to clarify whether MVI is safe and efficient for women with pregnancies >40 weeks in a single institute. Methods: This study was performed in Lutheran Hospital Bergisch Gladbach, Germany 2014-2019. A total of 304 women between 40 + 0 to 42 + 0 weeks underwent labor induction with MVI. Outcomes were: 1) maternal: time from insertion to delivery, interventions, mode of delivery, and uterine tachysystole, 2) neo-natal: cord blood pH, APGAR scores, and admission to a neonatal clinic. This study ended unexpectedly due to the withdrawal of MVI (MisodelTM) in September 2019. Results: 75.7% (n = 230) of women gave birth within 24 hours after MVI placement. 72.2% (n = 140) nulliparous women and 81.8% (n = 90) parous women delivered within 24 hours. In two cases emergency CS was required. 67.8% (n = 206) of women delivered vaginal. 2.3% (n = 7) of cord pH levels were below 7.10. 3.3% (n = 10) of newborns were transmitted to a neonatal clinic. Conclusion: MVI is an efficient method to induce labor for pregnant women beyond 40 + 0 weeks. However, considering various complications observed (uterine tachysystole and fetal distress leading to a high number of CS), we cannot universally advocate the use of MVI.

产程进展角对妊娠晚期引产结局的预测价值

目的探讨经会阴超声(TPU)测量产程进展角(AOP)对妊娠晚期引产结局的预测价值。方法选取2020年4月至2021年2月在南京大学医学院附属鼓楼医院住院引产的单胎足月初产妇共106例。引产前,由一位高年资产科医生行宫颈Bishop评分,由另一位高年资产科医生采用TPU测量引产前产妇的AOP。纳入宫颈Bishop评分<6分的产妇,对其均采用欣普贝生引产,根据最终的分娩方式,将其分为阴道分娩组(84例)与剖宫产组(22例),比较两组的AOP,并绘制受试者工作特征(ROC)曲线,寻找预测阴道分娩的AOP最佳临界值。结果引产前,阴道分娩组的AOP明显大于剖宫产组[(100.4±11.6)°vs.(88.3±9.8)°],差异具有统计学意义(t=4.486,P<0.05);阴道分娩组的引产一分娩时间明显短于剖宫产组[1473.5(942.3,2175.8)min vs.1910.0(1599.0,2614.0)min],差异具有统计学意义(Z=-2.750,P<0.05)。当除去非产程因素剖宫产后分析显示,AOP临界值为89°;当引产前AOP>89°时,产妇能经阴道分娩的阴性预测值为96.1%,灵敏度为80.0%,特异度为86.9%。结论AOP可作为初产妇引产成功(阴道分娩)的预测指标,当AOP>89°时,引产后阴道分娩成功率高。

可疑巨大儿孕妇孕39周与孕41周引产对妊娠结局的影响

目的:比较可疑巨大儿孕妇孕39周与孕41周引产的妊娠结局,探讨可疑巨大儿的最佳引产时机。方法:前瞻性选取北京太和妇产医院和北京市上地医院2018年7月1日-2021年6月30日分娩的孕39周产前检查时可疑巨大儿的单胎头位孕妇共726例,按照孕妇个人意愿分组,孕39周行选择性引产为观察组共298例,孕41周前自然临产或孕41周引产为对照组共428例,比较两组母婴结局。结果:观察组剖宫产率(18.8%)低于对照组(45.6%),且观察组分娩孕周(39.3±1.2)、新生儿体重(4030±485g)、巨大儿发生(75.5%)、新生儿5min Apgar评分<7分(3.7%)和新生儿脐血气<7.20(3.0%)发生率均低于对照组(4180±465g、92.5%、5.1%、14.4%)(P<0.05)。结论:可疑巨大儿孕妇孕39周引产,可在不增加母婴不良结局情况下,增加阴道分娩成功率,降低新生儿不良结局风险。

分析地诺前列酮栓与缩宫素在足月引产中的应用效果及安全性

目的 对比和分析在足月引产中应用地诺前列酮栓及缩宫素的效果及安全性。方法 随机选取82例进行足月引产的孕产妇,选用随机数字表法,将孕产妇分为对照组和观察组,对照组(n=41)孕产妇应用缩宫素,观察组(n=41)孕产妇应用地诺前列酮栓,比较两组孕产妇引产效果、分娩方式、诱发临产时间、产后出血量及用药后不良反应,对比两组自然分娩孕产妇产程。结果 观察组引产效果明显优于对照组,两组引产总有效率差异有统计学意义(P<0.05)。观察组阴道分娩率高于对照组,剖宫产率低于对照组,两组分娩方式差异有统计学意义(P<0.05)。两组对比,观察组诱发临产时间更短,产后出血量更少,两组差异有统计学意义(P<0.05)。观察组第一产程、第二产程及总产程均短于对照组(P<0.05),两组第三产程差异无统计学意义(P>0.05)。两组孕产妇用药后不良反应总发生率差异无统计学意义(P>0.05)。结论 足月引产孕产妇应用地诺前列酮栓能够有效缩短诱发临产时间、提高自然分娩率、缩短产程,而且具有较高的用药安全性,值得临床应用。

胎膜早破孕妇宫颈评分与分娩结局分析

目的分析胎膜早破破水临产时间与宫颈评分的关系,分析宫颈成熟程度及不同引产方法对胎膜早破分娩母婴结局的影响。方法 2014年2月至2016年8月期间收治的300例胎膜早破孕妇纳入研究,按孕妇及其家属意向选择等待8~12 h后引产的90例患者纳入对照组,将自愿进行立即引产的210例孕妇纳入观察组,又按宫颈成熟度将观察组分为成熟组(110例)和不成熟组(100例)。对比不成熟组和成熟组破水临产时间,用等级相关行分析法分析破水临产时间与宫颈评分的关系;对比观察组与对照组分娩方式、羊水浑浊发生情况;记录并发症。结果观察组中宫颈成熟组破水临产时间(9.06±1.03 h)短于不成熟组(13.34±2.40 h);观察组患者中破水临产时间与宫颈评分呈负相关关系(rs=-2,P=0.028);观察组产程用时(8.75±2.01 h)短于对照组(11.21±2.13 h);观察组中成熟组产程(8.22±1.84 h)短于不成熟组(10.45±2.49 h),观察组中成熟组羊水浑浊发生率低于不成熟组和对照组,观察组中成熟组阴道分娩率(78.18%)高于不成熟组(59.00%)和对照组(67.78%);观察组新生儿围生期并发症发生率(6.36%)和产妇并发症发生率(8.18%)均低于对照组(15.56%,24.24%)。结论(1)宫颈评分与胎膜早破破水临产时间呈负相关;(2)宫颈成熟的患者破水临产时间更短,促进宫颈成熟能缩短破水至临产时间,提高阴道分娩率;(3)宫颈成熟度是指导胎膜早破引产方式的重要指标。

足月子痫前期产妇分娩方式对分娩结局的影响

目的比较足月子痫前期产妇引产和择期剖宫产对分娩结局的影响。方法回顾研究2009年2月1日～2011年3月31日,在杭州市第一人民医院住院分娩的171例足月子痫前期产妇的病例资料。引产组52例,阴道内放置普贝生(地诺前列酮栓)促宫颈成熟或静脉滴注催产素引产;择期剖宫产组119例,根据病情和产妇意愿,由医疗组选择择期剖宫产。比较两组分娩结局及影响产妇分娩方式的因素。结果轻度和重度子痫前期产妇,择期剖宫产率分别为57.3%和85.3%,差异有统计学意义(P<0.001)。子痫前期程度、产妇血压和既往分娩方式等是决定足月子痫前期产妇分娩方式的影响因素。引产组和择期剖宫产组新生儿Apgar评分,新生儿入住NICU率、羊水Ⅲ°浑浊发生率以及母亲产后出血等指标比较,差异均无统计学意义(P>0.05)。结论足月子痫前期产妇引产不影响分娩结局,对病情平稳且有引产指征的产妇鼓励阴道分娩是可行的。

足月孕引产时的“过度干预”对分娩结局的影响

目的 研究晚期妊娠引产时“过度干预”对母儿预后的影响。方法 选择 16 8例引产病例进行回顾性分析 ,并与 12 9例自然临产产妇进行对照。比较两组孕妇及围产儿预后。结果 引产组剖宫产率、胎儿宫内窘迫及新生儿窒息发生率明显高于自然临产组 (P <0 .0 5 ) ,且随引产时间逐渐延长 ,羊水浑浊、胎儿宫内窘迫及新生儿窒息的发生率逐渐增高。结论 减少产时不必要的、过度的干预 ,是降低围产期母儿病率及围产儿死亡率的关键之一。

活跃期后继续与停止应用缩宫素对初产妇引产的影响比较

目的比较初产妇引产确定活跃期后继续与停止应用缩宫素的分娩过程和母婴结局。方法选择通过静脉滴注缩宫素引产的初产妇673例,缩宫素连续应用组350例,缩宫素停止应用组323例。比较两组的分娩过程及母婴结局。结果两组在活跃期持续时间、第二产程时间及绒毛膜羊膜炎等方面比较差异无统计学意义。缩宫素停止应用组的缩宫素总使用量、总使用时间、剖宫产率、子宫过度刺激发生率、胎儿心率异常发生率、产后出血发生率均低于缩宫素连续应用组(P<0.05)。结论活跃期后停止继续应用缩宫素,可以减少缩宫素总量,缩短缩宫素时间,降低剖宫产、子宫过度刺激、胎心异常和产后出血的发生率,且不会延长产程,不会增加绒毛膜羊膜炎的发生率,是引产方案的一种可行性选择。

应用分娩时机计算表改善分娩结局的探讨

目的探究应用分娩时机计算表与降低剖宫产率、改善分娩结局的相关性。方法将2010年1月至2011年12月在民航总医院妇产科行围生期保健和住院分娩的579例初产妇随机分为两组,研究组(200例)采用主动管理妊娠高危因素指导分娩时机的最佳分娩时限(AMOR-IPAT-UL-OTD)分娩时机计算表,计算最佳分娩时机,给予预防性引产;对照组(379例)给予常规处理。比较两组孕妇的剖宫产率和母儿结局。结果研究组和对照组的引产率分别为47.0%(94/200)和33.8%(128/379),两组比较,差异有统计学意义(P<0.01);研究组和对照组剖宫产率分别为18.5%(37/200)和27.4%(104/379),两组比较,差异有统计学意义(P<0.05)。两组的产后出血率(11.5%和18.5%)及巨大儿发生率(4.5%和10.3%)比较,差异均有统计学意义(P<0.05)。结论主动管理妊娠高危因素,评估最佳分娩时限,给予预防性引产利于降低剖宫产率和改善分娩结局。

静点葡萄糖酸钙在催产素引产中的增效作用研究

目的:探讨在催产素引产中应用静点葡萄糖酸钙的临床效果。方法:选取2016年5月-2017年5月本院接收的68例初产妇,均符合引产指征,将入选者随机分为对照组(n=34,采取催产素引产)与观察组(n=34,静点葡萄糖酸钙联合催产素进行引产)。观察两组产妇产后2 h和24 h出血量、产前和产后24 h血红蛋白及变化情况;引产效果;产程、分娩方式、新生儿及胎儿情况,包括新生儿体质量、5 min Apgar评分、胎儿窘迫、新生儿窒息情况以及静脉点滴10%葡萄糖酸钙后产妇的不良反应发生情况。结果:观察组引产成功率、阴道分娩率均高于对照组,差异均有统计学意义(P<0.05)。观察组第一、二产程均短于对照组(P<0.05),产后2、24 h出血量均少于对照组(P<0.05),24 h血红蛋白下降值低于对照组(P<0.05)。两组新生儿体质量、5 min Apgar评分、胎儿窘迫率比较,差异均无统计学意义(P>0.05);观察组新生儿窒息率低于对照组,差异有统计学意义(P<0.05)。观察组产妇静脉点滴10%葡萄糖酸钙后,无全身发热、心律失常等不良反应发生,耐受性较好。结论:在催产素引产中静点葡萄糖酸钙,能够提高引产效果,缩短产程,减少产后出血,降低剖宫产率,且使用简便、安全、经济,值得在临床上广泛使用。

探讨乳头刺激与点滴缩宫素引产对产程及分娩结局的影响

目的探讨乳头刺激与点滴缩宫素引产对产程及分娩结局的影响。方法将2017年1月～2018年6月我院收治需行人工破膜术分娩的100例产妇作为研究对象。根据人工破膜后观察1h未出现规律子宫收缩给予乳头刺激的50例产妇为试验组。将人工破膜后观察1h未出现规律子宫收缩给予点滴小剂量缩宫素的50例产妇为对照组。观察两组规律宫缩开始时间、第一、二产程及分娩方式、胎儿结局及产后2h出血量。结果试验组规律宫缩开始时间早于对照组,第一、二产程短于对照组(P<0.05)。试验组顺产率高于对照组,胎儿心率正常率高于对照组,产后2h出血量少于对照组(P<0.05)。结论乳头刺激成本低、效益好,且操作简便、安全、有效。

COOK球囊配合缩宫素引产临床护理路径的研究

目的探讨临床护理路径(CNP)在COOK球囊配合缩宫素引产中的应用效果。方法选择2017年7~12月江西省妇幼保健院COOK球囊配合缩宫素引产的49例产妇作为对照组,选择2019年7~12月行COOK球囊配合缩宫素引产的49例产妇作为观察组。对照组采用常规护理,观察组采用CNP干预。比较两组的引产效果、分娩情况、各产程时间、产后出血量、满意度评分,观察并发症发生情况。结果观察组的引产总有效率、阴道分娩率为97.96%、93.88%,高于对照组的81.63%、69.39%,差异均有统计学意义(P<0.05)。观察组的第一产程为(8.57±0.76)h、第二产程为(1.06±0.12)h、第三产程为(0.12±0.01)h、总产程为(9.74±2.52)h,均短于对照组的(11.50±1.84)、(1.53±0.24)、(0.18±0.02)、(12.67±2.54)h,产后出血量为(291.18±20.54)mL,少于对照组的(300.15±20.52)mL,满意度评分为(93.26±5.13)分,高于对照组的(82.97±5.24)分,差异均有统计学意义(P<0.05)。观察组的并发症总发生率(4.08%)低于对照组(18.37%),差异有统计学意义(P<0.05)。结论CNP干预能提高COOK球囊配合缩宫素引产效果和自然分娩率,缩短各产程,减少产后出血量,降低并发症发生,提高产妇的满意度。