地诺前列酮栓引产出现宫缩过频后不同取药时机对分娩结局的影响
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摘要
目的:了解地诺前列酮栓(欣普贝生)促宫颈成熟引产过程中出现宫缩过频后不同取药时机对分娩结局的影响。方法:回顾性分析本院使用欣普贝生促宫颈成熟引产患者88例的临床资料。根据发生宫缩过频后的处理结果将其分为立即取药组(立即取出欣普贝生)54例和继续放置组(继续放置至宫颈成熟再取药)34例,比较两组分娩结局。结果:继续放置组的药物放置时长长于立即取药组,放药至分娩时长短于立即取药组,24 h内阴道分娩比例高于立即取药组,剖宫产率低于立即取药组,羊水污染程度轻于立即取药组,比较差异均有统计学意义(P<0.05);两组经阴道分娩的产道及会阴裂伤情况、新生儿体重、入住NICU比例、产后2 h出血量、血红蛋白差值比较,差异均无统计学意义(P>0.05)。结论:欣普贝生促宫颈成熟引产过程中出现宫缩过频时,在严密监测下继续放置直至宫颈成熟再取出欣普贝生,能提高24 h内阴道分娩比例,减少剖宫产,且不增加分娩的母婴并发症。
Objective:To understand the effect of different timing of taking out medicine on outcome of labor after Dinoprostone Suppositories induced labor on the occurrence of uterine tachysystole.Method:The clinical data of 88 cases of cervical ripening induced labor used Dinoprostone Suppositories in our hospital were retrospectively analyzed.According to the results of treatment after uterine contraction overfrequency,they were divided into 54 cases of immediate take out medication group(immediate take out Dinoprostone Suppositories) and 34 cases of continued placement group(continued placement until cervical ripening before taking out medicine).The delivery outcomes of two groups were compared.Result:The drug placement time in continued placement group was longer than that of immediate take out medication group,the medication until delivery time was shorter than that of immediate take out medication group,the proportion of vaginal delivery within 24 h was higher than that of immediate take out medication group,the cesarean section rate was lower than that of immediate take out medication group,the level of amniotic fluid pollution was lighter than that of immediate take out medication group,the differences were statistically significant(P<0.05).The vaginal delivery of birth canal and perineal laceration,neonatal weight,NICU ratio,2 h postpartum hemorrhage and hemoglobin difference in two groups were compared,the differences were not statistically significant(P>0.05).Conclusion:When Dinoprostone Suppositories induced labor to cause uterine tachysystole,continuous placement of drugs under close monitoring until cervical ripeness before removal can increase the proportion of vaginal delivery within 24 hours,reduce cesarean section,and do not increase maternal and infant complications.
Objective:To understand the effect of different timing of taking out medicine on outcome of labor after Dinoprostone Suppositories induced labor on the occurrence of uterine tachysystole.Method:The clinical data of 88 cases of cervical ripening induced labor used Dinoprostone Suppositories in our hospital were retrospectively analyzed.According to the results of treatment after uterine contraction overfrequency,they were divided into 54 cases of immediate take out medication group(immediate take out Dinoprostone Suppositories) and 34 cases of continued placement group(continued placement until cervical ripening before taking out medicine).The delivery outcomes of two groups were compared.Result:The drug placement time in continued placement group was longer than that of immediate take out medication group,the medication until delivery time was shorter than that of immediate take out medication group,the proportion of vaginal delivery within 24 h was higher than that of immediate take out medication group,the cesarean section rate was lower than that of immediate take out medication group,the level of amniotic fluid pollution was lighter than that of immediate take out medication group,the differences were statistically significant(P<0.05).The vaginal delivery of birth canal and perineal laceration,neonatal weight,NICU ratio,2 h postpartum hemorrhage and hemoglobin difference in two groups were compared,the differences were not statistically significant(P>0.05).Conclusion:When Dinoprostone Suppositories induced labor to cause uterine tachysystole,continuous placement of drugs under close monitoring until cervical ripeness before removal can increase the proportion of vaginal delivery within 24 hours,reduce cesarean section,and do not increase maternal and infant complications.
引文
[1]Ellen L Mozurkewich,Julie L Chilimigras,Deborah R Berman,et al.Methods of induction of labour:a systematic review[J]BMCPregnancy and Childbirth,2011,11(1):84-102.
[2]中华医学会妇产科学分会产科学组.妊娠晚期促子宫颈成熟与引产指南(2014)[J].中华妇产科杂志,2014,49(12):881-885.
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[4]盖铭英,张建平,李扬,等.控释前列腺素E2栓剂--普贝生用于足月引产的临床研究[J].中华妇产科杂志,2003,38(4):210-212.
[5]邹丽颖,范玲,段涛,等.0.8 mm控释地诺前列酮栓用于足月胎膜早破促宫颈成熟的多中心研究[J].中华妇产科杂志,2010,45(7):492-496.
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[7]孔令丹,夏义欣.水润后欣普贝生促宫颈成熟的临床效果[J].中华灾害救援医学,2015,3(4):209-211.
[8]Wang X,Yang A,Ma Q,et al.Comparative study of titrated oral misoprostol solution and vaginal dinoprostone for labor induction at term pregnancy[J].Arch Gynecol Obstet,2016,294(3):495-503.
[9]何秋.足月妊娠引产应用不同方法对促宫颈成熟的预后效果分析[J].中国计划生育和妇产科,2016,8(4):62-64,66.
[10]翁碧芬,李筱芸,余艳萍.宫颈球囊、欣普贝生及催产素引产对母婴结局的影响[J].海南医学,2017,28(3):414-416.
[11]刘海燕,叶旭萍,杨燕,等.欣普贝生用于足月胎膜早破低宫颈评分引产的效果观察[J].现代妇产科进展,2017,26(3):194-198.
[12]陈华清,肖梅.欣普贝生用于宫颈物理治疗后足月妊娠计划分娩的有效性及安全性研究[J].中国妇幼保健,2014,29(12):1847-1849.
[13]顾丽萍,汪云.妊娠期糖尿病孕足月引产的临床研究[J].中国计划生育和妇产科,2016,8(9):20-23.
[14]宁丰,韦凤莲,林红.欣普贝生用于妊娠期高血压疾病引产的临床观察[J].实用医学杂志,2013,29(18):3048-3050.
[15]张喜红.欣普贝生用于足月妊娠引产的临床观察[J].医药论坛杂志,2011,32(2):92-94.
[16]余艳萍,何淑明.普贝生用于足月妊娠引产对胎心、宫缩及羊水性状的影响[J].中山大学学报(医学科学版),2007(S1):182-183.
[17]赫英东,胡君,章小维,等.促子宫颈成熟球囊改善子宫颈条件66例临床观察[J].中华妇产科杂志,2014,49(10):741-745.
[18]World Health Organization,Dept.of Reproductive Health and Research.WHO recommendations for induction of labour[J].Geneva Switzerland Who,2011,1212(1):19-25.
[19]Shetty A,Burt R,Rice P,et al.Women’s perceptions,expectations and satisfaction with induced labour:a questionnairebased study[J].Eur J Obstet Gynecol Reprod Biol,2005,123(1):56-61.
[2]中华医学会妇产科学分会产科学组.妊娠晚期促子宫颈成熟与引产指南(2014)[J].中华妇产科杂志,2014,49(12):881-885.
[3]刘彩霞,乔宠.欣普贝生临床应用规范专家共识[J].中国实用妇科与产科杂志,2013,29(12):996-998.
[4]盖铭英,张建平,李扬,等.控释前列腺素E2栓剂--普贝生用于足月引产的临床研究[J].中华妇产科杂志,2003,38(4):210-212.
[5]邹丽颖,范玲,段涛,等.0.8 mm控释地诺前列酮栓用于足月胎膜早破促宫颈成熟的多中心研究[J].中华妇产科杂志,2010,45(7):492-496.
[6]Koc O,Duran B,Ozdemirci S,et al.Oxytocin versus sustainedrelease dinoprostone vaginal pessary for labor induction of unfavorable cervix with Bishop score≥4 and≤6:A randomized controlled trial[J].J Obstet Gynaecol Res,2013,39(4):790-798.
[7]孔令丹,夏义欣.水润后欣普贝生促宫颈成熟的临床效果[J].中华灾害救援医学,2015,3(4):209-211.
[8]Wang X,Yang A,Ma Q,et al.Comparative study of titrated oral misoprostol solution and vaginal dinoprostone for labor induction at term pregnancy[J].Arch Gynecol Obstet,2016,294(3):495-503.
[9]何秋.足月妊娠引产应用不同方法对促宫颈成熟的预后效果分析[J].中国计划生育和妇产科,2016,8(4):62-64,66.
[10]翁碧芬,李筱芸,余艳萍.宫颈球囊、欣普贝生及催产素引产对母婴结局的影响[J].海南医学,2017,28(3):414-416.
[11]刘海燕,叶旭萍,杨燕,等.欣普贝生用于足月胎膜早破低宫颈评分引产的效果观察[J].现代妇产科进展,2017,26(3):194-198.
[12]陈华清,肖梅.欣普贝生用于宫颈物理治疗后足月妊娠计划分娩的有效性及安全性研究[J].中国妇幼保健,2014,29(12):1847-1849.
[13]顾丽萍,汪云.妊娠期糖尿病孕足月引产的临床研究[J].中国计划生育和妇产科,2016,8(9):20-23.
[14]宁丰,韦凤莲,林红.欣普贝生用于妊娠期高血压疾病引产的临床观察[J].实用医学杂志,2013,29(18):3048-3050.
[15]张喜红.欣普贝生用于足月妊娠引产的临床观察[J].医药论坛杂志,2011,32(2):92-94.
[16]余艳萍,何淑明.普贝生用于足月妊娠引产对胎心、宫缩及羊水性状的影响[J].中山大学学报(医学科学版),2007(S1):182-183.
[17]赫英东,胡君,章小维,等.促子宫颈成熟球囊改善子宫颈条件66例临床观察[J].中华妇产科杂志,2014,49(10):741-745.
[18]World Health Organization,Dept.of Reproductive Health and Research.WHO recommendations for induction of labour[J].Geneva Switzerland Who,2011,1212(1):19-25.
[19]Shetty A,Burt R,Rice P,et al.Women’s perceptions,expectations and satisfaction with induced labour:a questionnairebased study[J].Eur J Obstet Gynecol Reprod Biol,2005,123(1):56-61.