Sharma Yuthika, Kumar Sunesh, Mittal Sunita, Misra Renu, Dadhwal Vatsla
Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
J Obstet Gynaecol Res. 2005 Jun;31(3):210-5. doi: 10.1111/j.1447-0756.2005.00271.x.
To compare the efficacy of glyceryl trinitrate (GTN), dinoprostone and misoprostol for preinduction cervical ripening in primigravida at term.
Sixty-five term primigravida, each with an unfavorable cervix (Bishop score </=5), were randomized to receive GTN (0.5 mg perivaginally, n = 21), dinoprostone gel (0.5 mg intracervically, n = 21) and misoprostol (50 microg perivaginally, n = 23) for a maximum of two doses, 6 h apart. Statistical analysis included paired t-tests to compare pre- and post-treatment Bishop scores, one-way analysis of variance (anova) tests to compare quantitative variables and chi-squared tests to compare the proportion of subjects achieving favorable Bishop scores.
Baseline Bishop scores were similar in the GTN (3.4 +/- 0.9), dinoprostone (3.4 +/- 1.0) and misoprostol groups (3.2 +/- 1.2). The final outcome was favorable (Bishop score >6) in a greater proportion of subjects in the misoprostol (n = 18, 81.8%) and dinoprostone (n = 14, 66.7%) groups compared with the GTN group (n = 11, 55%). In subjects with a severely unfavorable cervix (Bishop score </=3), treatment with misoprostol led to a favorable response in 61.6% of patients compared with 45.6% in the misoprostol group and 33.3% in the GTN group. A significant improvement was noted in the Bishop score of all three groups (P < 0.001) but the increase in Bishop score was greater in misoprostol (3.5 +/- 2.1) and dinoprostone groups (2.8 +/- 1.5), compared with the GTN group (2.0 +/- 1.0, ANOVA F = 4.8, P = 0.01). Hyperstimulation and tachysystole were observed only in the misoprostol (9% and 4.3%) and dinoprostone groups (4.7% and 16.2%). The most common adverse effect in the GTN group was headache, which was observed in 47.6% of this group's subjects.
The findings of the present study suggest that GTN is safer, but less efficacious, compared with prostaglandins for preinduction cervical ripening at term.
比较硝酸甘油（GTN）、地诺前列酮和米索前列醇用于足月初产妇引产术前促宫颈成熟的疗效。
65例足月初产妇，宫颈条件均不佳（Bishop评分≤5分），随机分为三组，分别接受GTN（阴道给药0.5mg，n = 21）、地诺前列酮凝胶（宫颈内给药0.5mg，n = 21）和米索前列醇（阴道给药50μg，n = 23），最大给药剂量为2剂，间隔6小时。统计分析包括配对t检验比较治疗前后的Bishop评分、单因素方差分析比较定量变量以及卡方检验比较达到良好Bishop评分的受试者比例。
GTN组（3.4±0.9）、地诺前列酮组（3.4±1.0）和米索前列醇组（3.2±1.2）的基线Bishop评分相似。米索前列醇组（n = 18，81.8%）和地诺前列酮组（n = 14，66.7%）中达到良好结局（Bishop评分>6分）的受试者比例高于GTN组（n = 11，55%）。在宫颈条件极差（Bishop评分≤3分）的受试者中，米索前列醇治疗后61.6%的患者有良好反应，地诺前列酮组为45.6%，GTN组为33.3%。三组的Bishop评分均有显著改善（P < 0.001），但米索前列醇组（3.5±2.1）和地诺前列酮组（2.8±1.5）的Bishop评分增加幅度大于GTN组（2.0±1.0，方差分析F = 4.8，P = 0.01）。仅在米索前列醇组（9%和4.3%）和地诺前列酮组（4.7%和16.2%）观察到子宫过度刺激和宫缩过速。GTN组最常见的不良反应是头痛，该组47.6%的受试者出现此症状。
本研究结果表明，与前列腺素类药物相比，GTN用于足月引产术前促宫颈成熟更安全，但疗效较差。
