Kavanagh J, Kelly A J, Thomas J
Social Science Research Unit, Evidence for Policy and Practice Information and Co-ordinating Centre, Institute of Education, University of London, 18 Woburn Square, London, UK, WC1H 0NR.
Cochrane Database Syst Rev. 2006 Apr 19;2006(2):CD003097. doi: 10.1002/14651858.CD003097.pub2.
Dilatation and effacement of the cervix are not only a result of uterine contractions, but are also dependent upon ripening processes within the cervix. The cervix is a fibrous organ composed principally of hyaluronic acid, collagen and proteoglycan. Hyaluronic acid increases markedly after the onset of labour. An increase in the level of hyaluronic acid is associated with an increase in tissue water content. Cervical ripening during labour is characterised by changes of the cervix and an increased water content. Cervical injection of hyaluronidase was postulated to increase cervical ripening. This is one of a series of reviews of methods of cervical ripening and labour induction using standardised methodology.
To determine the effects of hyaluronidase for third trimester cervical ripening or induction of labour in comparison with other methods of induction of labour.
We searched the Cochrane Pregnancy and Childbirth Group Trials Register (January 2006) and bibliographies of relevant papers.
Clinical trials of hyaluronidase for third trimester cervical ripening or labour induction.
A strategy was developed to deal with the large volume and complexity of trial data relating to labour induction. This involved a two-stage method of data extraction. We assessed trial quality. We contacted study authors for additional information. We collected adverse effects information from the trials.
One trial, with 168 women participating, was included in the review. When compared with placebo for cervical ripening intracervical injections of hyaluronidase resulted in women receiving significantly fewer caesarean sections (18% versus 49%, relative risk (RR) 0.37, 95% confidence interval (CI) 0.22 to 0.61), less need for oxytocin augmentation (10% versus 47%, RR 0.20, 95% CI 0.10 to 0.41), and increased cervical favourability after 24 hours (60% versus 98%, RR 0.62, 95% CI 0.52 to 0.74). No side-effects for mother or baby were reported in this trial.
AUTHORS' CONCLUSIONS: Intracervical injections of hyaluronidase for cervical ripening appear beneficial. However, this is not common practice. In addition it is an invasive procedure that women may find unacceptable in the presence of less invasive methods.
宫颈扩张和消退不仅是子宫收缩的结果，还取决于宫颈内的成熟过程。宫颈是一个主要由透明质酸、胶原蛋白和蛋白聚糖组成的纤维性器官。分娩开始后透明质酸显著增加。透明质酸水平的升高与组织含水量的增加有关。分娩期间宫颈成熟的特征是宫颈变化和含水量增加。推测宫颈注射透明质酸酶可促进宫颈成熟。这是一系列使用标准化方法对宫颈成熟和引产方法进行的综述之一。
与其他引产方法相比，确定透明质酸酶对孕晚期宫颈成熟或引产的效果。
我们检索了Cochrane妊娠与分娩组试验注册库（2006年1月）以及相关论文的参考文献。
关于透明质酸酶用于孕晚期宫颈成熟或引产的临床试验。
制定了一项策略来处理与引产相关的大量且复杂的试验数据。这涉及两阶段的数据提取方法。我们评估了试验质量。我们联系研究作者以获取更多信息。我们从试验中收集了不良反应信息。
该综述纳入了一项有168名女性参与的试验。与安慰剂用于宫颈成熟相比，宫颈内注射透明质酸酶的女性接受剖宫产的比例显著更低（18%对49%，相对危险度（RR）0.37，95%置信区间（CI）0.22至0.61），催产素加强的需求更少（10%对47%，RR 0.20，95%CI 0.10至0.41），并且24小时后宫颈评分改善（60%对98%，RR 0.62，95%CI 0.52至0.74）。该试验未报告对母亲或婴儿的副作用。
宫颈内注射透明质酸酶促进宫颈成熟似乎有益。然而，这并非常见做法。此外，这是一种侵入性操作，在存在侵入性较小的方法时，女性可能难以接受。
