上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

双球囊导管促足月妊娠产妇宫颈成熟的临床研究

任虹 1，范剑虹 1，张琳 2，杨祖菁 2   

  1. 1. 复旦大学附属华山医院宝山分院妇产科，上海 200431；2. 上海交通大学医学院附属新华医院妇产科，上海 200092
  • 出版日期:2017-01-28 发布日期:2017-01-19
  • 作者简介:任虹 (1964—)，女，副主任医师，学士；电子信箱：wengw63@qq.com。
  • 基金资助:

    上海市宝山区科技创新医学卫生专项基金（13-E-27）

Clinical study of double-balloon catheter in full-term pregnancy to promote cevical maturity

REN Hong1, FAN Jian-hong1, ZHANG Lin2, YANG Zu-jing2   

  1. 1. Department of Gynaecology and Obstetrics, Baoshan Branch of Huashan Hospital, Fudan University, Shanghai 200431, China; 2. Department of Gynaecology and Obstetrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
  • Online:2017-01-28 Published:2017-01-19
  • Supported by:

    Special Fund for Scientific and Technological Innovation of Baoshan District in Shanghai，13-E-27

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摘要：

目的 ·探讨双球囊导管在促足月妊娠产妇宫颈成熟及引产中的有效性和安全性。方法 ·采用前瞻性对照研究的方法，选择2014年5月—2016年1月有引产指征、单胎初产、胎儿头位、胎膜完整、宫颈Bishop评分＜6分的152例足月妊娠产妇进行分析；其中51例采用双球囊导管促宫颈成熟者为球囊组，51例采用地诺前列酮栓者为对照组A，50例采用小剂量缩宫素者为对照组B，观察比较3组促宫颈成熟和引产的效果、分娩方式、围产结局、产程等。结果 · 152例产妇中，球囊组促宫颈成熟有效48例（94.1%），对照组A有效47例（92.2%），对照组B有效16例（32.7%），球囊组总有效率显著高于对照组B（P=0.000），与对照组A差异无统计学意义（P=0.872）。球囊组阴道分娩37例（72.6%），对照组A阴道分娩39例（76.5%），对照组B阴道分娩19例（38.0%），球囊组阴道分娩率明显高于对照组B（P=0.006），与对照组A差异无统计学意义（P=0.747）。而3组的总产程、羊水污染率、新生儿窒息率、产后出血等母儿结局之间差异无统计学意义（P＞0.05）。引产过程中产妇不良反应发生率球囊组明显低于对照组A（P=0.003），与对照组B差异无统计学意义（P=0.873）。结论 ·双球囊导管促宫颈成熟及引发自然分娩效果与地诺前列酮栓无明显差异，但明显优于单纯使用缩宫素，且其不良反应发生率明显低于地诺前列酮栓。

关键词: 双球囊导管, 地诺前列酮栓, 缩宫素, 足月妊娠, 促宫颈成熟, 引产

Abstract:

Objective · To evaluate the efficacy and safety of double-balloon catheters in cervical ripening and labor induction among full-term pregnant women. Methods · This prospective randomized study was conducted between May 2014 and January 2015. A total of 152 full-term primiparas in need of labor induction were recruited. These women were pregnant with single fetuses with vertex presentation and intact membranes, whose Bishop scores were below 6. They were randomly assigned to catheter group (51 cases), control group A (51 cases) and control group B (50 cases), who received cervical ripening with double-balloon catheters, dinoprostone suppositories, and continuous intravenous infusion of oxytocin, respectively. The efficiency of cervical ripening and labor induction, labor modes, perinatal outcomes, delivery courses of 3 groups were recorded and compared. Results · Forty-eight cases (94.1%) in catheter group succeeded in cervical ripening, while 47 cases (92.2%) in control group A and 16 cases (32.7%) in control group B. Double-balloon catheters exhibited to be more effective than intravenous infusion of oxytocin in control group B (P=0.000), but there was no significant difference between catheter group and control group A. Thirty-seven women (72.6%) in catheter group, compared with 39 women (76.5%) in control group A and 19 women (38.0%) in control group B achieved vaginal delivery. Higher vaginal delivery rate were found in catheter group than in control group B (P=0.006). No significant difference was found between catheter group and control group A (P=0.747). Besides, there was no significant difference in total labor duration, as well as in the incidences of amniotic fluid contamination, postpartum hemorrhage and neonatal asphyxia among the three groups (P>0.05). Less adverse reactions were found in catheter group than those in control group A (P=0.003) instead of in control group B (P=0.873). Conclusion · Double-balloon catheters present similar effects with dinoprostone suppositories in preinduction cervical ripening and labor induction, obviously more effective than single use of oxytocin. Furthermore, double-balloon catheters cause less side effects than dinoprostone suppositories.

Key words: double-balloon catheter, dinoprostone suppository, oxytocin, full-term pregnancy, cervical ripening, labor induction