Sakala E P, Kaye S, Murray R D, Munson L J
Department of Gynecology and Obstetrics, Loma Linda University Medical Center, California.
Obstet Gynecol. 1990 Mar;75(3 Pt 1):356-9.
When used for patients undergoing trial of labor after previous cesarean, oxytocin is associated with an increased failure rate. Previous reports have not studied why this occurs. From October 1984 to April 1986, 237 patients with previous cesareans underwent a trial of labor. The delivery outcomes of 73 women who received oxytocin were compared with those of the 164 who did not. Rates were similar for uterine scar dehiscence, uterine rupture, operative vaginal delivery, blood transfusions, endometritis, and low Apgar scores. Successful trial of labor occurred in 68% in the oxytocin group, compared with 89% in the no-oxytocin group. Failed trial of labor was significantly more frequent in patients who received oxytocin for induction of labor than in those who did not. When subjects who received oxytocin were divided into induction (N = 47) and augmentation (N = 26) groups, successful trial of labor occurred in 58% of the former group versus 88% of the latter group. Other characteristics of the augmentation group were spontaneous labor, greater cervical dilation and effacement at initiation of oxytocin, shorter duration of infusion, and lower oxytocin infusion rates. For patients who have had previous cesareans and who desire trial of labor, oxytocin by controlled infusion is safe. Successful trial of labor may be enhanced by awaiting spontaneous labor or inducing with a favorable cervix.
对于曾行剖宫产术且正在进行引产试验的患者，使用缩宫素会导致失败率增加。既往报告未对其原因进行研究。1984年10月至1986年4月，237例有剖宫产史的患者接受了引产试验。将73例接受缩宫素治疗的女性的分娩结局与164例未接受缩宫素治疗的女性的分娩结局进行比较。子宫瘢痕裂开、子宫破裂、阴道助产、输血、子宫内膜炎及阿氏评分低的发生率相似。缩宫素组引产成功率为68%，未使用缩宫素组为89%。接受缩宫素引产的患者引产失败的发生率显著高于未接受缩宫素引产的患者。当将接受缩宫素治疗的受试者分为引产组（N = 47）和加强宫缩组（N = 26）时，前一组引产成功率为58%，后一组为88%。加强宫缩组的其他特征包括自然发动宫缩、开始使用缩宫素时宫颈扩张和消退程度更大、输注持续时间更短以及缩宫素输注速率更低。对于有剖宫产史且希望进行引产试验的患者，控制性输注缩宫素是安全的。等待自然发动宫缩或在宫颈条件良好时引产可能会提高引产成功率。
