Agarwal Kavita, Batra Achla, Batra Aruna, Aggarwal Abha
Department of Obstetrics & Gynaecology, Safdarjung Hospital, G-14, 92 Vrindavan Apartment, Gali No. 4, Krishna Nagar, Safdarjung Enclave, New Delhi 110029, India.
NIMS, Delhi 110029, India.
Int J Reprod Med. 2014;2014:147274. doi: 10.1155/2014/147274. Epub 2014 Jul 1.
Aims. Prostaglandin E2 is the most commonly used drug for cervical ripening prior to labour induction. However, there are concerns regarding uterine tachysystole and nonreassuring fetal heart (N-RFH). Isosorbide mononitrate (IMN) has been used successfully for cervical ripening. The present study was conducted to compare the two drugs for cervical ripening at term in hospital. Methods. Two hundred women with term pregnancies referred for induction of labour with Bishop score less than 6 were randomly allocated to receive either 40 mg IMN tablet vaginally (n = 100) or 0.5 mg PGE2 gel intracervically (n = 100). Adverse effects, progress, and outcomes of labour were assessed. Results. PGE2 group had significantly higher postripening mean Bishop score, shorter time from start of medication to vaginal delivery (13.37 ± 10.67 hours versus 30.78 ± 17.29 hours), and shorter labour-delivery interval compared to IMN group (4.53 ± 3.97 hours versus 7.34 ± 5.51 hours). However, PGE2 group also had significantly higher incidence of uterine tachysystole (15%) and N-RFH (11%) compared to none in IMN group, as well as higher caesarean section rate (27% versus 17%). Conclusions. Cervical ripening with IMN was less effective than PGE2 but resulted in fewer adverse effects and was safer especially in high risk pregnancies.
目的。前列腺素E2是引产术前最常用的宫颈成熟药物。然而，人们担心子宫收缩过速和胎儿心率异常（N-RFH）。单硝酸异山梨酯（IMN）已成功用于宫颈成熟。本研究旨在比较这两种药物在医院足月时促进宫颈成熟的效果。方法。200名足月妊娠且Bishop评分小于6分的引产女性被随机分配，分别阴道给予40mg IMN片（n = 100）或宫颈内给予0.5mg PGE2凝胶（n = 100）。评估不良反应、产程进展和分娩结局。结果。与IMN组相比，PGE2组宫颈成熟后的平均Bishop评分显著更高，从用药开始到阴道分娩的时间更短（13.37±10.67小时对30.78±17.29小时），分娩间隔也更短（4.53±3.97小时对7.34±5.51小时）。然而，与IMN组无一例发生相比，PGE2组子宫收缩过速（15%）和胎儿心率异常（11%）的发生率也显著更高，剖宫产率也更高（27%对17%）。结论。IMN促进宫颈成熟的效果不如PGE2，但不良反应更少，尤其在高危妊娠中更安全。
