地诺前列酮栓与宫颈扩张球囊用于足月妊娠引产临床转归的比较.DOC

宫颈质地对地诺前列酮栓及宫颈扩张球囊 用于足月妊娠引产的影响 吴小肄①，王春芳①，叶旭萍①，徐 焕①﹟ ①复旦大学附属妇产科医院 上海 200011 ﹟通讯作者 摘 要 目的?探讨在足月妊娠引产时，根据不同的宫颈质地采用相应的促宫颈成熟方式引产，，(地诺前列酮栓)或cook宫颈扩张球囊促宫颈成熟。研究组根据不同的宫颈质地决定促宫颈成熟方法，宫颈质地软者使用欣普贝生，宫颈质地中/硬者使用球囊(2014年1月—2014年12月共790例)。对照组孕妇随机采取促宫颈成熟方式(2013年1月—2013年12月共764例)，比较两组孕妇的引产效率和母儿安全性。结果?研究组宫颈评分(3.15分±1.04)分改善大于对照组的(2.85±1.40)分，差异有统计学意义(t=4.656，P＜0.001)，总产程(7.94±3.78) h、放置至分娩时间(18.78±8.51) h均短于对照组(8.3h±4.09) h、(20.14±9.54) h，差异有统计学意义(t=-1.767，P＜0.05；t=-2.989，P＜0.001)。研究组的24 h分娩率(65.4%)高于对照组(58.6%)，差异有统计学意义(χ2=7.640，P＜0.05)；人工破膜率(72.0%)及催产素引产率(68.7%)均低于对照组(7.5%、80.1%)，差异有统计学意义(χ2=6.132，P＜0.05；χ2=26.313，P＜0.001)。研究组的宫腔感染率(3.3%)和新生儿感染率(2.8%)显著低于对照组(6.4%、4.7%)，差异有统计学意义(χ2=8.244，P＜0.05；χ2=4.012，P0.05)。两组孕妇的宫缩过频、胎心率异常、羊水粪染和低Apgar评分的发生率差异无统计学意义(P＞0.05)。结论?将宫颈质地作为足月单胎孕妇选用药物法抑或机械法促宫颈成熟引产的决定要素，可以提高引产效率，降低母儿感染率，提高产房医疗资源利用。 关键词 引产；宫颈质地；双球囊导管；地诺前列酮；促宫颈成熟 doi:10.3969/j.issn.1001-568X.2017.04 [中图分类号] R719.3 [文献标识码] A [文章编号] 1001-568X(2017)04 The Impact of Eervical Consistency on Labor Induction at Term by Double Balloon Catheter or Controlled-release Dinoprostone Insert/WU Xiao-yi，WChun-fang，YXu-ping，et al. //Chinese Primary Health Care，2017，31(4)： Abstract Objective To investigate the effects of cervical consistency on labor induction at term by double balloon catheter or controlled-release dinoprostone insert. Methods A total of 1 554 women at 37 weeks of gestation or greater with a singleton live fetus in cephalic presentation，intact membrane，an unfavorable cervix were enrolled in labor induction specialized ward of Obstetrics and Gynecology Hospital affiliated to Fudan University in Shanghai from Jan 2013 to Dec 2014. In the study group，790 women were allocated to cervical ripening regimens according to cervical consistency from Jan 2014 to Dec 2014.Women with soft cervix were allocated to controlled-release dinoprostone insert. Women with firm or medium cervix were allocated to double balloon catheter.764 women were allocated to induction ripening regimens randomly from Ja