Kreft Martina, Krähenmann Franziska, Roos Malgorzata, Kurmanavicius Juozas, Zimmermann Roland, Ochsenbein-Kölble Nicole
J Perinat Med. 2014 Sep;42(5):603-9. doi: 10.1515/jpm-2013-0215.
To compare the efficacy and safety of two misoprostol dosing regimens for induction of labour in primiparous (1P) and multiparous (>1P) women.
Retrospective study of induction of labour using vaginal misoprostol 25 μg vs. 50 μg every 6 h in 942 women at a tertiary centre. The main outcome variables are induction-to-delivery interval, latency period duration, vaginal delivery within 24 h, and maternal and foetal safety outcome.
With the 50 μg regimen, induction-to-delivery intervals were significantly shorter: 18.4 h vs. 24.6 h (1P) and 14 h vs. 17.9 h (>1P), as was latency period duration (by 5.4 and 4 h, respectively). Vaginal delivery within 24 h was significantly more frequent, as were non-reassuring foetal heart rate (1P: 20% vs. 14%) and tachysystole (1P: 31% vs. 11%; >1P: 21% vs. 7%). No uterine rupture was reported. Neonatal outcomes were similar except for significantly more frequent infant referral to neonatal intensive care in the >1P group receiving the 50 μg regimen (11% vs. 4%).
Vaginal misoprostol 25 μg seems to maintain efficacy with more acceptable maternal and neonatal safety. As induction of labour is an off-label use for misoprostol, safety should be prioritised with the lower dosage regimen despite the longer induction-to-delivery interval.
比较两种米索前列醇给药方案用于初产妇（1P）和经产妇（>1P）引产的疗效和安全性。
在一家三级中心对942名妇女使用阴道米索前列醇25μg与每6小时50μg进行引产的回顾性研究。主要结局变量为引产至分娩间隔、潜伏期时长、24小时内阴道分娩情况以及母婴安全结局。
采用50μg方案时，引产至分娩间隔显著缩短：初产妇为18.4小时对24.6小时，经产妇为14小时对17.9小时，潜伏期时长也显著缩短（分别缩短5.4小时和4小时）。24小时内阴道分娩更为常见，胎儿心率异常（初产妇：20%对14%）和子宫收缩过强（初产妇：31%对11%；经产妇：21%对7%）的情况也是如此。未报告子宫破裂。除接受50μg方案的经产妇组婴儿转诊至新生儿重症监护病房的频率显著更高（11%对4%）外，新生儿结局相似。
阴道米索前列醇25μg似乎能维持疗效，同时具有更可接受的母婴安全性。由于引产是米索前列醇的非适应证用药，尽管引产至分娩间隔较长，但较低剂量方案应优先考虑安全性。
