Wang WenYan, Zheng Jianlan, Fu JingLi, Zhang XiaoQiong, Ma QinLing, Yu ShuiLan, Li MeiYing, Hou Li
Department of Obstetric, The People's Liberation Army 174th Hospital , Xiamen , China .
J Matern Fetal Neonatal Med. 2014 Nov;27(17):1805-8. doi: 10.3109/14767058.2014.880880. Epub 2014 Feb 3.
To compare the effectiveness and safety of two cervical ripening methods in term primiparous women with unfavorable cervices and oligohydramnios.
Women (126 cases) with oligohydramnios [amniotic fluid index (AFI) ≤5 cm] and a low Bishop Score (≤6) were assigned randomly to use double balloon catheter (mechanical method group, 67 cases) or dinoprostone 10 mg controlled-release vaginal insert (pharmacological method group, 59 cases) for induction of labor. The study's primary outcome was caesarean section rate (CSR). The secondary outcome measures included maternal and neonatal morbidity, an incremental changes in Bishop Score, and intrapartum interventions.
There was no significant difference between the mechanical method group and the pharmacological method group in CSR and change in Bishop Score. Tacysystole, non-reassuring fetal heart patterns, and cases of newborn umbilical-cord arterial blood pH<7.1 were significantly lower with the mechanical method compared with the pharmacological method (p < 0.05). More patients needed additional intervention in the mechanical method group.
Both methods resulted in a similar CSR. Double balloon catheter resulted in fewer labor complications, but more frequent use of oxytocin and amniotomy. Compared with dinoprostone vaginal insert, double balloon catheter use may be less problematic in women with oligohydramnios.
比较两种宫颈成熟方法对足月初产妇宫颈条件不佳且羊水过少者的有效性和安全性。
将羊水过少[羊水指数（AFI）≤5 cm]且Bishop评分低（≤6分）的126例产妇随机分为两组，分别使用双球囊导管（机械方法组，67例）或地诺前列酮10 mg控释阴道栓剂（药物方法组，59例）引产。研究的主要结局为剖宫产率（CSR）。次要结局指标包括母婴发病率、Bishop评分的增量变化及产时干预措施。
机械方法组与药物方法组在CSR及Bishop评分变化方面无显著差异。与药物方法相比，机械方法组的强直性子宫收缩、胎儿心率异常及新生儿脐动脉血pH<7.1的病例显著更少（p<0.05）。机械方法组更多患者需要额外干预。
两种方法的CSR相似。双球囊导管导致的分娩并发症更少，但催产素和人工破膜的使用更频繁。与地诺前列酮阴道栓剂相比，双球囊导管在羊水过少的产妇中使用可能问题更少。
