Abbasi Nasreen, Danish Nargis, Shakoor Farah, Parveen Zahida, Bilal Syed Ahmad
Department of Obstetrics and Gynaecology, Frontier Medical College, Pakistan.
J Ayub Med Coll Abbottabad. 2008 Jul-Sep;20(3):33-5.
The use of prostaglandin preparations with or without oxytocin infusion, is widely recognized and accepted as a standard method of induction of labour. It has been shown to reduce induction time and the risk of failed induction. The objective of this quasi-experimental observational study was to determine the effectiveness and safety of Misoprostol administered vaginally for induction of labour to achieve vaginal delivery.
This study was conducted from October 2004 to October 2007. The study was conducted at Shaheena Jamil Teaching Hospital, Frontier Medical College, Abbottabad and Women and Children Hospital Abbottabad. A total of 6299 obstetric patients were received for delivery and 946 patients had to undergo induction of labour. Primary outcome measures were to address clinical effectiveness (delivery within 24-hours) and safety (uterine hyper-stimulation, Caesarean Section and serious Maternal Morbidity). Secondary outcome measures included neonatal outcome.
Out of 946 cases, successful vaginal deliveries were achieved in 843 (89.1%) cases. Time interval between induction and delivery was 4-24 hours. Oxytocin was required in 107 (12%) patients. Caesarean Section had to be done in 103 (10.8%) cases. The indications for Caesarean Section were foetal distress in 42 (40%), occipito-posterior position in 8 (7.7%), abruptioplacentae 2 (1.9%), cord around the neck 9 (7%), uterine hyperstimulation 6 (5.8%) and failure to progress in 20 (19%) cases. Admission to NICU was 28 (3.3%) and Neonatal deaths were 5 (0.5%). Postpartum Haemorrhage (PPH) was observed in 22 (2.3%) patients. There was no case of rupture uterus.
Vaginal Misoprostol appears to be safe and effective for cervical ripening in 3rd Trimester. It helps vaginal delivery within 24 hours, does not increase incidence of Caesarean Section and has no adverse effect on foetal outcome. It could also be used in circumstances where extensive monitoring techniques are not available though close observation and vigilance is mandatory.
使用前列腺素制剂联合或不联合缩宫素静脉滴注，作为引产的标准方法已得到广泛认可和接受。研究表明，该方法可缩短引产时间并降低引产失败的风险。本准实验性观察研究的目的是确定阴道给予米索前列醇引产以实现阴道分娩的有效性和安全性。
本研究于2004年10月至2007年10月进行。研究在阿伯塔巴德边疆医学院沙希娜·贾米尔教学医院以及阿伯塔巴德妇女儿童医院开展。共有6299名产科患者入院分娩，其中946名患者需要引产。主要结局指标包括临床有效性（24小时内分娩）和安全性（子宫过度刺激、剖宫产及严重孕产妇发病率）。次要结局指标包括新生儿结局。
946例患者中，843例（89.1%）成功实现阴道分娩。引产至分娩的时间间隔为4 - 24小时。107例（12%）患者需要使用缩宫素。103例（10.8%）患者需要进行剖宫产。剖宫产指征包括胎儿窘迫42例（40%）、枕后位8例（7.7%）、胎盘早剥2例（1.9%）、脐带绕颈9例（7%）、子宫过度刺激6例（5.8%）以及产程无进展20例（19%）。入住新生儿重症监护病房（NICU）的有28例（3.3%），新生儿死亡5例（0.5%）。22例（2.3%）患者出现产后出血（PPH）。无子宫破裂病例。
阴道给予米索前列醇在孕晚期宫颈成熟方面似乎是安全有效的。它有助于在24小时内实现阴道分娩，不会增加剖宫产发生率，且对胎儿结局无不良影响。在无法采用广泛监测技术的情况下也可使用，不过密切观察和警惕是必不可少的。
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