Blanco J D, Collins M, Willis D, Prien S
Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, Lubbock.
Am J Perinatol. 1992 Mar;9(2):80-3. doi: 10.1055/s-2007-994676.
To determine safety and efficacy of induction with prostaglandin E2 gel, we compared the outcome of 25 patients (study group) with an unfavorable cervix, a medical indication for delivery, and one prior low cervical transverse cesarean section to 56 patients (comparison group) with one prior low cervical transverse cesarean section and spontaneous labor. We placed 1 mg of prostaglandin E2 in gel intracervically in the 25 study patients. Common indications for delivery were: diabetes, post dates, and preeclampsia. Although most labor and delivery variables were similar, the study group had a longer mean latent phase (14.2 +/- 13.8 versus 7.3 +/- 3.7 hours: p less than 0.002), but had a shorter mean length of active phase (4.0 +/- 3.5 versus 5.7 +/- 3.0 hours; p less than 0.02). None of the patients in either group had a dehiscence of the uterine scar, nor rupture of the uterus. Both groups had a similar cesarean section rate. Since from the few reported, nonrandomized studies it appears that prostaglandin E2 gel use in patients with a prior low cervical transverse cesarean section may be useful and relatively safe, it may be time to attempt randomized trials of prostaglandin E2 gel versus oxytocin for induction of patients with a prior low cervical transverse cesarean section, unfavorable cervix, and a medical indication for delivery.
为确定使用前列腺素E2凝胶引产的安全性和有效性，我们将25例宫颈条件不佳、有引产医学指征且既往有一次低位子宫下段横切口剖宫产史的患者（研究组）与56例既往有一次低位子宫下段横切口剖宫产史且自然临产的患者（对照组）的结局进行了比较。我们对25例研究组患者宫颈内放置了1mg前列腺素E2凝胶。引产常见指征为：糖尿病、过期妊娠和先兆子痫。尽管大多数分娩变量相似，但研究组平均潜伏期更长（14.2±13.8小时对7.3±3.7小时；p<0.002），但活跃期平均时长更短（4.0±3.5小时对5.7±3.0小时；p<0.02）。两组患者均无子宫瘢痕裂开或子宫破裂。两组剖宫产率相似。鉴于从少数已报道的非随机研究来看，既往有低位子宫下段横切口剖宫产史的患者使用前列腺素E2凝胶可能有用且相对安全，或许是时候尝试针对既往有低位子宫下段横切口剖宫产史、宫颈条件不佳且有引产医学指征的患者进行前列腺素E2凝胶与缩宫素引产的随机试验了。
