Singh M, Patole S, Rane A, Naidoo D, Buettner P
Department of Obstetrics, The Townsville Hospital, Douglas, Queensland, Australia.
Arch Dis Child Fetal Neonatal Ed. 2004 Mar;89(2):F131-5. doi: 10.1136/adc.2002.025957.
To test the hypothesis that the application of intravaginal prostaglandin E(2) gel before elective caesarean section (ECS) will induce a catecholamine surge in umbilical arterial blood.
Randomised, double blind, placebo controlled trial.
A regional perinatal referral centre.
Mothers booked for ECS at or above 38 weeks gestation.
Thirty six consenting mothers were randomly allocated to receive either 2 mg intravaginal prostaglandin E(2) gel (study group; n = 18) or an equal volume of K-Y jelly as a placebo (control group; n = 18) 60 minutes before the ECS. Computer generated random numbers contained in coded, sealed envelopes were used for allocation. The obstetric and neonatal teams were blinded to the randomisation status of enrolled mothers.
Catecholamine concentrations in the umbilical arterial blood samples collected at delivery.
The median (interquartile range) neonatal gestation and birth weight were 271 (269-274) days and 3605 (3072-3970) g for the study group and 271 (270-273) days and 3340 (3000-3622) g for the control group. Median (interquartile range) noradrenaline (norepinephrine) concentrations in the umbilical arterial blood were significantly higher in the study group than the control group (15.9 (9.8-28.92) v 4.6 (1.65-14.4) ng/l, p = 0.03). Adrenaline (epinephrine) concentrations did not differ significantly between the two groups (1.6 (< 0.5-3.1) v 1.4 (< 0.5-2.75) ng/l, p = 0.6). No treatment related complications occurred.
A labour related catecholamine surge could be simulated by intravaginal prostaglandin E(2) gel.
验证择期剖宫产（ECS）前应用阴道内前列腺素E₂凝胶会导致脐动脉血中儿茶酚胺激增这一假设。
随机、双盲、安慰剂对照试验。
一个地区围产期转诊中心。
妊娠38周及以上计划行ECS的母亲。
36名同意参与的母亲在ECS前60分钟被随机分配，分别接受2mg阴道内前列腺素E₂凝胶（研究组；n = 18）或等量的K-Y胶作为安慰剂（对照组；n = 18）。采用编码密封信封中的计算机生成随机数进行分配。产科和新生儿团队对入选母亲的随机分组情况不知情。
分娩时采集的脐动脉血样本中的儿茶酚胺浓度。
研究组新生儿孕周中位数（四分位间距）为271（269 - 274）天，出生体重为3605（3072 - 3970）g；对照组新生儿孕周中位数（四分位间距）为271（270 - 273）天，出生体重为3340（3000 - 3622）g。研究组脐动脉血中去甲肾上腺素浓度中位数（四分位间距）显著高于对照组（15.9（9.8 - 28.92）对4.6（1.65 - 14.4）ng/l，p = 0.03）。两组肾上腺素浓度无显著差异（1.6（<0.5 - 3.1）对1.4（<0.5 - 2.75）ng/l，p = 0.6）。未发生与治疗相关的并发症。
阴道内前列腺素E₂凝胶可模拟与分娩相关的儿茶酚胺激增。
