Kehl Sven, Weiss Christel, Wamsler Michael, Beyer Jana, Dammer Ulf, Heimrich Jutta, Faschingbauer Florian, Sütterlin Marc, Beckmann Matthias W, Schleussner Ekkehard
Department of Obstetrics and Gynecology, Erlangen University Hospital, Universitätsstraße 21-23, 91054, Erlangen, Germany.
Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Heidelberg, Germany.
Arch Gynecol Obstet. 2016 Apr;293(4):757-65. doi: 10.1007/s00404-015-3907-7. Epub 2015 Oct 5.
To evaluate the efficacy of inducing labor using a double-balloon catheter and vaginal prostaglandin E2 (PGE2) sequentially, in comparison with vaginal PGE2 alone after previous cesarean section.
A total of 264 pregnant women with previous cesarean section undergoing labor induction at term were included in this prospective multicentre cohort study. Induction of labor was performed either by vaginal PGE2 gel or double-balloon catheter followed by vaginal PGE2. The primary outcome measure was the cesarean section rate.
The cesarean section rate was 37 % without any statistically significant difference between the two groups (PGE2: n = 41, 37 % vs. balloon catheter/PGE2: n = 41, 42 %; P = 0.438). The median (range) number of applications of PGE2 [2 (1-10) versus 1 (0-8), P < 0.001] and the total amount of PGE2 used in median (range) mg [2 (1-15) vs. 1 (0-14), P = 0.001] was less in the balloon catheter/PGE2 group. Factors significantly increasing risk for cesarean section were "no previous vaginal delivery" (OR 5.391; CI 2.671-10.882) and "no oxytocin augmentation during childbirth" (OR 2.119; CI 1.215-3.695).
The sequential application of double-balloon catheter and vaginal PGE2 is as effective as the sole use of vaginal PGE2 with less applications and total amount of PGE2.
比较双球囊导管联合阴道前列腺素E2（PGE2）序贯引产与单纯阴道使用PGE2引产在既往剖宫产术后孕妇中的效果。
本前瞻性多中心队列研究纳入了264例既往有剖宫产史且足月引产的孕妇。引产采用阴道PGE2凝胶或双球囊导管联合阴道PGE2进行。主要结局指标为剖宫产率。
剖宫产率为37%，两组间无统计学显著差异（PGE2组：n = 41，37%；球囊导管/PGE2组：n = 41，42%；P = 0.438）。球囊导管/PGE2组PGE2的应用中位数（范围）[2（1 - 10）对1（0 - 8），P < 0.001]及PGE2使用总量的中位数（范围）mg[2（1 - 15）对1（0 - 14），P = 0.001]均较少。显著增加剖宫产风险的因素为“既往无阴道分娩史”（OR 5.391；CI 2.671 - 10.882）和“分娩期间未使用缩宫素加强宫缩”（OR 2.119；CI 1.215 - 3.695）。
双球囊导管联合阴道PGE2序贯应用与单纯阴道使用PGE2引产效果相同，但PGE2的应用次数和总量更少。
