Dongol A S, Shakya S, Chawla C D
Department of Gynecology and Obstetrics, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal.
J Nepal Health Res Counc. 2010 Apr;8(1):27-30.
Induction of labour is widely carried over the world in cases where continuation of pregnancy is hazardous to mother or fetus. Varieties of techniques are available for induction of labour. Prostaglandin is one of the most effective means for achieving cervical ripening and induction of labour. This study was carried out to see safety and effectiveness of Misoprostol for induction of labour.
This prospective study was carried out at Kathmandu University Hospital, Dhulikhel from Jan 2008 to Aug 2009. A total of 70 patients were included in this study. All patients received 50 μg of Misoprostol in the posterior fornix with maximum dose up to 3 doses at interval of 6 hours. Bishops scoring was reviewed each time before application of Misoprostol. When favourable cervix along with good uterine contraction is noted then augmentation with Oxytocinon was done holding Misoprostol. The measures used for the analysis of effectiveness and safety of Misoprostol were change in bishop score, total dose required, need for augmentation, side effects, duration of first, second and third stages of labour, duration from induction till delivery, mode of delivery and neonatal outcome. The primary outcome measures were induction to delivery interval and caesarean section rate.
Out of 70 patients, 21 (30%) required augmentation. Among 70 patients, 46 (65%) underwent normal delivery, 6 (8.6%) underwent instrumental delivery and 18 (25%) patients underwent cesarean section for various indications (p=0.00). Total 31 (44%) patients delivered within 10 hours of induction, 16 (22%) within 15 hours and 4 (4.7%) took more than 18 hours. Duration of second stage of labour was also found to be shortened with use of Misoprostol for induction of labour. Duration of second stage of labour was less than 30 minutes in 42 (60%) cases and more than 30 minutes in 9 (17%) cases.
Misoprostol is an effective cervical ripening agent with favorable outcome and comparable with other inducing agents.
在妊娠继续对母亲或胎儿有危险的情况下，引产在全世界广泛进行。有多种引产技术可供使用。前列腺素是实现宫颈成熟和引产最有效的手段之一。本研究旨在观察米索前列醇引产的安全性和有效性。
本前瞻性研究于2008年1月至2009年8月在加德满都大学医院杜利凯尔分院进行。本研究共纳入70例患者。所有患者在后穹窿给予50μg米索前列醇，最大剂量可达3剂，间隔6小时。每次应用米索前列醇前均复查 Bishop 评分。当宫颈条件良好且子宫收缩良好时，停用米索前列醇并用缩宫素加强宫缩。用于分析米索前列醇有效性和安全性的指标有 Bishop 评分变化、所需总剂量、加强宫缩的需求、副作用、第一、第二和第三产程的持续时间、引产至分娩的持续时间、分娩方式和新生儿结局。主要结局指标为引产至分娩间隔时间和剖宫产率。
70例患者中，21例（30%）需要加强宫缩。70例患者中，46例（65%）顺产，6例（8.6%）经器械助产，18例（25%）因各种指征行剖宫产（p = 0.00）。共有31例（44%）患者在引产10小时内分娩，16例（22%）在15小时内分娩，4例（4.7%）超过18小时。使用米索前列醇引产还发现第二产程时间缩短。42例（60%）患者第二产程时间小于30分钟，9例（17%）患者超过30分钟。
米索前列醇是一种有效的宫颈成熟剂，效果良好，与其他引产药物相当。
