Department of Obstetrics, Aberdeen Maternity Hospital, Cornhill Road, Aberdeen AB25 2ZN, United Kingdom.
Eur J Obstet Gynecol Reprod Biol. 2013 Oct;170(2):364-7. doi: 10.1016/j.ejogrb.2013.07.021. Epub 2013 Aug 8.
To assess maternal and neonatal outcomes following the use of additional doses of vaginal prostaglandins (PGE2) above the recommended dose for induction of labour in post-dates pregnancies.
Retrospective cohort study set in Aberdeen Maternity Hospital, Aberdeen, UK. A total of 3514 nulliparous women with labour induced with vaginal PGE2 (3mg tablet or 2mg gel) for a post-dates singleton pregnancy from January 1994 to December 2009 were included. Women receiving≤2 doses of PGE2 were compared with those receiving>2 doses (maximum 5 doses). Binary logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Primary outcomes included mode of delivery, terbutaline use, indication for CS, postpartum haemorrhage, neonatal unit admission, and Apgar score<7. A further analysis was conducted which stratified for number of doses of PGE2 given.
Of the 3514 women who met inclusion criteria, 605 (17%) received PGE2 that exceeded the licensed dose. They were more likely to deliver by caesarean section (53.4% vs. 31.8%, OR 2.2, 95% CI 1.8-2.6), have a caesarean section for 'failed' induction of labour (11.4% vs. 1.9%, OR 4.1, 95% CI 1.3-13.2) or lack of progress in labour (37% vs. 17%, OR 2.8, 95% CI 2.3-3.4), but not for fetal concerns (8.2% vs. 8.8% OR 0.9, 95% CI 0.7-1.3). Terbutaline use and postpartum haemorrhage was no more likely (0.7% vs. 0.9% OR 0.6 95% CI 0.3-1.5 and 19.8% vs. 18.9% OR1.01, 95% CI 0.97-1.06 respectively). Apgar score<7 (1.1% vs. 1.3% OR 0.9 95% CI 0.8-1.1) and neonatal unit admission (13.7% vs. 10.7% OR 1.2 95% CI 0.8-1.6) were similar in both groups.
The use of additional doses of vaginal PGE2 above the recommended dose for induction of labour was not associated with increased maternal or neonatal morbidity and almost half of these women achieved a vaginal delivery.
评估在足月妊娠引产中使用推荐剂量以上的阴道前列腺素（PGE2）剂量对母婴结局的影响。
这是一项在英国阿伯丁妇医院进行的回顾性队列研究。共纳入 1994 年 1 月至 2009 年 12 月期间因足月单胎妊娠使用阴道 PGE2（3mg 片剂或 2mg 凝胶）引产的 3514 名初产妇。将接受≤2 剂量 PGE2 的妇女与接受>2 剂量（最多 5 剂量）的妇女进行比较。使用二项逻辑回归计算比值比（OR）及其 95%置信区间（CI）。主要结局包括分娩方式、特布他林使用、CS 指征、产后出血、新生儿病房入院和 Apgar 评分<7。还进行了进一步的分析，按 PGE2 给予的剂量分层。
在符合纳入标准的 3514 名妇女中，605 名（17%）接受了超过许可剂量的 PGE2。与接受推荐剂量的妇女相比，她们更有可能行剖宫产（53.4% vs. 31.8%，OR 2.2，95%CI 1.8-2.6）、因“诱导失败”行剖宫产（11.4% vs. 1.9%，OR 4.1，95%CI 1.3-13.2）或因产程无进展行剖宫产（37% vs. 17%，OR 2.8，95%CI 2.3-3.4），但因胎儿问题行剖宫产的可能性并无差异（8.2% vs. 8.8%，OR 0.9，95%CI 0.7-1.3）。特布他林使用和产后出血的可能性也没有增加（0.7% vs. 0.9%，OR 0.6，95%CI 0.3-1.5；19.8% vs. 18.9%，OR 1.01，95%CI 0.97-1.06）。两组的 Apgar 评分<7（1.1% vs. 1.3%，OR 0.9，95%CI 0.8-1.1）和新生儿病房入院率（13.7% vs. 10.7%，OR 1.2，95%CI 0.8-1.6）相似。
在足月妊娠引产中使用推荐剂量以上的阴道 PGE2 剂量与增加母婴发病率无关，几乎一半的妇女经阴道分娩。
