Tahara Mie, Nakai Yuichiro, Yasui Tomoyo, Nishimoto Sachiyo, Nakano Akemi, Matsumoto Makiko, Nobeyama Hiroyuki, Nishihara Rika, Iwanaga Naoko, Ishiko Osamu
Department of Obstetrics and Gynecology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
J Obstet Gynaecol Res. 2009 Oct;35(5):850-4. doi: 10.1111/j.1447-0756.2009.01064.x.
To clarify the effects on uterine arterial flow velocity waveforms of uterine contractions following oxytocin infusion and during spontaneous labor.
Uterine arterial flow velocity waveforms were obtained by pulsed Doppler methods from 22 women during an oxytocin challenge test (OCT), 26 women during oxytocin-induced labor, and 40 women during spontaneous labor. Mean resistance index (RI) for bilateral arteries was used for analyses. After the onset of labor, flow velocity waveforms were assessed according to cervical dilatation. During OCT, Doppler flow velocimetry was performed when three uterine contractions occurred per 10-min period.
RI values did not differ significantly between induced and spontaneous labor during relaxations at any level of cervical dilatation. However, during contractions, RI was significantly higher for induced labor than for spontaneous labor. Absence or reversal of flow was more frequent in the OCT group than in the induced labor group (P < 0.0001). However, no significant differences were found between spontaneous and induced labor groups.
Interactions between the contracting uterine body and the relaxing lower segment in oxytocin-induced labor might be associated with differences in uterine arterial flow during contraction between oxytocin-induced and spontaneous labor. However, changes in the intensity of uterine contractions during labor progression might differ between oxytocin-induced and spontaneous labor.
阐明静脉滴注缩宫素以及自然分娩时子宫收缩对子宫动脉血流速度波形的影响。
采用脉冲多普勒法获取22例接受缩宫素激惹试验(OCT)的女性、26例接受缩宫素引产的女性以及40例自然分娩的女性的子宫动脉血流速度波形。采用双侧动脉的平均阻力指数(RI)进行分析。分娩开始后,根据宫颈扩张情况评估血流速度波形。在OCT期间,每10分钟出现3次子宫收缩时进行多普勒血流测速。
在任何宫颈扩张水平的宫缩间歇期,引产和自然分娩时的RI值差异均无统计学意义。然而,在宫缩期间,引产时的RI显著高于自然分娩。OCT组血流缺失或反向的情况比引产组更常见(P<0.0001)。然而,自然分娩组和引产组之间未发现显著差异。
缩宫素引产时子宫体收缩与下段舒张之间的相互作用可能与缩宫素引产和自然分娩宫缩期间子宫动脉血流的差异有关。然而,缩宫素引产和自然分娩在产程中子宫收缩强度的变化可能有所不同。