Oliveira Maria Virginia de Oliveira e, Oberst Priscilla Von, Leite Guilherme Karam Corrêa, Aguemi Adalberto, Kenj Grecy, Leme Vera Denise de Toledo, Sass Nelson
Maternidade Escola de Vila Nova Cachoeirinha Dr. Mário de Moraes Altenfelder Silva, São Paulo, SP, Brasil.
Rev Bras Ginecol Obstet. 2010 Jul;32(7):346-51. doi: 10.1590/s0100-72032010000700007.
To compare the effectiveness of the Foley balloon with vaginal misoprostol for cervical ripening and labor induction.
Randomized clinical trial, not blind, conducted from January 2006 to January 2008. A total of 160 pregnant women with indication for induction of labor were included and divided into two groups, 80 for Foley and 80 for vaginal misoprostol. Inclusion criteria were: gestational age of 37 weeks or more, a live single fetus with cephalic presentation and a Bishop score of four or less. We excluded patients with a uterine scar, ruptured membranes, estimated fetal weight greater than 4000 g, placenta previa, chorioamnionitis and conditions that imposed the immediate termination of pregnancy. Statistical tests employed were Mann-Whitney, χ² test or Fisher's exact test, and p value was significant if less than 0.005.
Misoprostol triggered more frequently spontaneous delivery (50.0 versus 15.0% for Foley, p<0.001) and required less use of oxytocin (41.2 versus 76.2%), and this group presented more tachysystole (21.2 versus 5.0%). The Foley catheter caused more discomfort to the patient (28.7 versus 1.2%). There were no differences in the time required for development of the Bishop score (20.69 versus 21.36 hours), for triggering delivery (36.42 versus 29.57 hours) or in rates of cesarean delivery (51.2 versus 42.5%). There were no significant differences in perinatal performance, with similar rates of abnormal cardiotocography (20.0 versus 21.2%), presence of meconium (13.7 versus 17.5%) and need for neonatal intensive care unit (3.7 versus 6.2%).
The use of the Foley catheter was as effective as misoprostol for cervical ripening, but less effective in triggering spontaneous labor. Our results support the recommendation of its use for cervical ripening, especially in patients with cesarean scar.
比较弗利导尿管与阴道米索前列醇用于促宫颈成熟及引产的有效性。
2006年1月至2008年1月进行的非盲法随机临床试验。共纳入160例有引产指征的孕妇，分为两组，80例使用弗利导尿管，80例使用阴道米索前列醇。纳入标准为：孕周37周及以上，单活胎头先露，Bishop评分4分及以下。排除有子宫瘢痕、胎膜破裂、估计胎儿体重超过4000g、前置胎盘、绒毛膜羊膜炎及需立即终止妊娠情况的患者。采用的统计检验方法为曼-惠特尼检验、χ²检验或费舍尔精确检验，p值小于0.005则具有统计学意义。
米索前列醇组自发分娩发生率更高（50.0%对比弗利导尿管组的15.0%，p<0.001），催产素使用量更少（41.2%对比76.2%），且该组宫缩过速发生率更高（21.2%对比5.0%）。弗利导尿管给患者带来更多不适（28.7%对比1.2%）。在Bishop评分进展所需时间（20.69小时对比21.36小时）、引发分娩所需时间（36.42小时对比29.57小时）或剖宫产率（51.2%对比42.5%）方面无差异。围产期表现无显著差异，异常胎心监护率（20.0%对比21.2%）、胎粪排出率（13.7%对比17.5%）及新生儿重症监护病房入住需求率（3.7%对比6.2%）相似。
使用弗利导尿管促宫颈成熟的效果与米索前列醇相当，但在引发自然分娩方面效果较差。我们的结果支持推荐其用于促宫颈成熟，尤其是有剖宫产瘢痕的患者。
