地诺前列酮栓用于足月妊娠引产的放置时机及效果研究

The placement timing and effect of dinoprostone suppository for term pregnancy induced labor

摘要:

目的： 探究地诺前列酮栓用于不同宫颈成熟度足月妊娠引产的最佳放置时机及效果评价。方法： 将足月妊娠孕妇按宫颈Bishop评分分为≤3分组、4分组及5分组，各评分组按地诺前列酮栓放置时间分为上午组（08:00-12:59）、下午组（13:00-17:59）及晚上组（18:00-22:59），回顾性分析地诺前列酮栓在各组促宫颈成熟有效率、产程及妊娠结局。结果： 共纳入孕妇1 139例，促宫颈成熟有效率为93.59%，引产前宫颈评分≤3分组、4分组和5分组的促宫颈成熟有效率分别为95.75%、92.93%和90.12%（P<0.05）。有效组中羊水粪染发生率为11.07%，胎儿窘迫发生率为1.13%，产后出血发生率为2.16%。在阴道分娩产妇中，当宫颈Bishop评分≤3分，初产妇晚上放药时临产至阴道分娩的时间最短（4.82 h，P=0.005）；经产妇晚上放药时临产至阴道分娩的时间也最短（4.01 h，P=0.044）；其余组间指标均无统计学差异。结论： 地诺前列酮栓用于足月妊娠引产安全有效。对于宫颈评分≤3分的孕妇，可考虑晚上放置地诺前列酮栓引产，对于宫颈评分>3分者，可选择医护人员精力充沛、方便操作、可密切观察的时间进行放置。

Abstract:

Objective: To explore the best placement time and effect evaluation of dinoprostone suppository for full-term pregnancy induction with different Bishop’s cervical scores. Methods: Full-term pregnant women were divided into ≤3 groups, 4 groups and 5 groups according to Bishop’s cervical score. According to the placement time of dinoprostone suppository, each score group was divided into morning group (08:00-12:59) , afternoon group (13:00-17:59) and evening group (18:00-22:59) , and the effective rates of cervical ripening, stages of labor and pregnancy outcomes of all groups were retrospectively analyzed. Results: A total of 1 139 pregnant women were enrolled, and the effective rate of cervical ripening was 93.59%. The effective rates of cervical ripening were 95.75%, 92.93% and 90.12% in each group with cervical score ≤3, 4 and 5 points before induction of labor (P<0.05). In the effective group, the incidence of amniotic fluid fecal contamination was 11.07%, fetal distress was 1.13%, and postpartum hemorrhage was 2.16%. Among the vaginal delivery women, when the Bishop score of cervix was less than or equal to 3, the primipara’s time from delivery to vaginal delivery was the shortest (4.82 h, P=0.005). The time from parturient to vaginal delivery was also the shortest (4.01 h, P=0.044). There was no significant difference in other indexes between groups. Conclusion: Dinoprostolone suppository is safe and effective for induction of labor in full-term pregnancy. For pregnant women with cervical score≤3, dinoprostone suppository can be placed at night to induce labor. For those with cervical score > 3, it can be placed at a time when medical staff are energetic, convenient to operate and can observe closely.