Zeteroglu Sahin, Sahin Guler H, Sahin Huseyin A
Department of Obstetrics and Gynecology, Faculty of Medicine, Mustafa Kemal University, Antakya, Hatay, Turkey.
Eur J Obstet Gynecol Reprod Biol. 2006 Dec;129(2):140-4. doi: 10.1016/j.ejogrb.2005.11.040. Epub 2006 Jan 6.
The objective was to compare the efficacy and complications of intravaginal misoprostol application with oxytocin infusion for induction of labor in advanced aged pregnancies with a Bishop score of < 6.
A hundred advanced aged (> or = 35 years) pregnant patients with a Bishop score of < 6 were randomized into two groups. The first group (50 patients) received 50 microg intravaginal misoprostol four times with 4 h intervals and the second group received oxytocin infusion for induction of labor starting from 2 mIU/min and was increased every 30 min with 2 mIU/min increments up to a maximum of 40 mIU/min. The time from induction to delivery, the route of delivery, fetal outcome, and maternal complications were recorded. Statistical analyses were performed using the Mann-Whitney U, Chi-squared and t tests to determine differences between the two groups. A p value < or = 0.05 was considered significant.
Misoprostol was superior for induction of labor in advanced aged pregnancies with Bishop score of < 6, as the mean time from induction to delivery was 9.61 +/- 4.12 h and 11.46 +/- 4.86 h in the misoprostol and oxytocin groups respectively, with a significant difference between the groups (p = 0.04). The rate of vaginal delivery was higher in the misoprostol group (84.0%) than in the oxytocin group (80.0%), but the difference did not reach significance (p = 0.60). The rates of placental abruption and postpartum hemorrhage were similar in both groups and no cases of uterine rupture occurred. The 1- and 5-min mean Apgar scores were 6.98 +/- 1.17 to 9.08 +/- 0.99 and 6.88 +/- 1.81 to 9.00 +/- 1.35 in the misoprostol and oxytocin groups respectively, with no significant differences between the groups (p = 0.74, p = 0.83). No cases of asphyxia were present. The rate of admission to the neonatal intensive care unit was similar in both groups.
Intravaginal misoprostol seems to be an alternative method to oxytocin in the induction of labor in advanced aged pregnant women with low Bishop scores, as it is efficacious, cheap, and easy to use. But large studies are necessary to clarify safety with regard to the rare complications such as uterine rupture.
比较阴道内应用米索前列醇与静脉滴注缩宫素用于Bishop评分<6的高龄妊娠引产的疗效及并发症。
100例Bishop评分<6的高龄（≥35岁）孕妇被随机分为两组。第一组（50例患者）每4小时阴道内给予50μg米索前列醇，共4次；第二组静脉滴注缩宫素引产，起始剂量为2mIU/min，每30分钟增加2mIU/min，最大剂量为40mIU/min。记录引产至分娩的时间、分娩方式、胎儿结局及母体并发症。采用Mann-Whitney U检验、卡方检验和t检验进行统计学分析，以确定两组间的差异。p值≤0.05被认为具有统计学意义。
米索前列醇用于Bishop评分<6的高龄妊娠引产效果更佳，米索前列醇组和缩宫素组引产至分娩的平均时间分别为9.61±4.12小时和11.46±4.86小时，两组间差异有统计学意义（p = 0.04）。米索前列醇组阴道分娩率（84.0%）高于缩宫素组（80.0%），但差异无统计学意义（p = 0.60）。两组胎盘早剥和产后出血发生率相似，未发生子宫破裂病例。米索前列醇组和缩宫素组1分钟和5分钟的平均阿氏评分分别为6.98±1.17至9.08±0.99和6.88±1.81至9.00±1.35，两组间差异无统计学意义（p = 0.74，p = 0.83）。无窒息病例。两组新生儿重症监护病房收治率相似。
对于Bishop评分低的高龄孕妇引产，阴道内应用米索前列醇似乎是缩宫素的一种替代方法，因为它有效、便宜且易于使用。但需要进行大规模研究以明确其在子宫破裂等罕见并发症方面的安全性。
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