Kurup A, Chua S, Arulkumaran S, Tham K F, Tay D, Ratnam S S
Department of Obstetrics and Gynaecology, National University Hospital, Singapore.
Aust N Z J Obstet Gynaecol. 1991 Aug;31(3):223-6. doi: 10.1111/j.1479-828x.1991.tb02786.x.
In a previous study nulliparas with poor cervical score (less than 5 out of 10) had a 43.5% Caesarean section (CS) rate of which 55% were for failed induction when labour was induced by artificial rupture of membranes and oxytocin infusion. In this study induction of labour by 2 doses of 3 mg prostaglandin E2 (PGE2) vaginal pessaries, 4 hours apart, and if necessary by artificial rupture of membranes and oxytocin infusion 24 hours later, resulted in a CS rate of 23.7% of which 38.9% were for failed induction. The latter regimen resulted in a significantly lower CS rate compared with labour induced by oxytocin infusion and rupture of membranes without the use of prostaglandins (p less than 0.001). In the prostaglandin group 53.3% were established in labour within 24 hours of inserting the pessary and in these patients the CS rate was 18.5%. In those who did not start labour and needed rupture of membranes and oxytocin infusion 24 hours after the first pessary, 34 (47.9%) had a good cervical score (greater than or equal to 6 out of 10) and 37 (52.1%) had a poor cervical score (less than or equal to 5 out of 10) at the time of amniotomy. The CS rates in these groups were 8.8% and 48.6% respectively (p less than 0.001). In nulliparas with poor cervical score induction is better performed with vaginal prostaglandin pessaries in order to reduce the high CS rate associated with artificial rupture of membranes and oxytocin infusion.
在一项先前的研究中，宫颈评分低（10分制中低于5分）的未产妇剖宫产率为43.5%，其中55%是在通过人工破膜和静脉滴注缩宫素引产时引产失败所致。在本研究中，采用2剂3mg前列腺素E2（PGE2）阴道栓剂引产，间隔4小时，必要时24小时后行人工破膜和静脉滴注缩宫素，剖宫产率为23.7%，其中38.9%是引产失败所致。与不使用前列腺素仅通过静脉滴注缩宫素和人工破膜引产相比，后一种方案导致的剖宫产率显著降低（p<0.001）。在前列腺素组中，53.3%的患者在放置栓剂后24小时内发动分娩，这些患者的剖宫产率为18.5%。在那些未发动分娩且在首次放置栓剂24小时后需要人工破膜和静脉滴注缩宫素的患者中，34例（47.9%）在破膜时宫颈评分良好（10分制中大于或等于6分），37例（52.1%）宫颈评分差（10分制中小于或等于5分）。这些组的剖宫产率分别为8.8%和48.6%（p<0.001）。对于宫颈评分差的未产妇，采用阴道前列腺素栓剂引产效果更好，以降低与人工破膜和静脉滴注缩宫素相关的高剖宫产率。
