Kehl Sven, Böhm Lena, Weiss Christel, Heimrich Jutta, Dammer Ulf, Baier Friederike, Sütterlin Marc, Beckmann Matthias W, Faschingbauer Florian
Department of Obstetrics and Gynecology, Erlangen University Hospital, Germany.
Department of Medical Statistics and Biomathematics, University Medical Center Mannheim, Germany.
J Obstet Gynaecol Res. 2016 Nov;42(11):1495-1501. doi: 10.1111/jog.13089. Epub 2016 Sep 19.
The best time to commence cervical ripening with a balloon catheter is unknown. The aim of this study was to evaluate whether application of a balloon catheter in the morning or in the evening is better when sequential prostaglandin application is planned.
This multicenter historical cohort study included 415 women with an unfavorable cervix undergoing labor induction at term. Labor was induced with a double-balloon catheter and the sequential use of oral misoprostol if necessary. The balloon catheter was placed in the morning group between 02:00-15:00 and in the evening group between 15:00-02:00. The primary outcome measure was the cesarean section rate. Secondary outcome measures included failed labor induction (no vaginal delivery within 72 h).
The cesarean section rate did not differ between the groups (morning 26.9%, evening 24.3%; P = 0.5553); however, more women in the morning group did not deliver within 72 h (8.8% vs 3.1%; P = 0.0138). In nulliparous women, labor induction failed more often in the morning group (12% vs. 4%, P = 0.043). In parous women, the induction-to-delivery interval was longer in the morning group (1756 vs. 1349 min; P = 0.046), and there were fewer deliveries within 24 h (35% vs. 56%, P = 0.016).
When sequential use of a double-balloon catheter and oral misoprostol for labor induction is planned, the preferable time for catheter placement is in the evening. This resulted in fewer failed inductions in nulliparous women and a shorter induction-to-delivery interval and more deliveries within 24 h in parous women.
使用球囊导管开始宫颈成熟的最佳时间尚不清楚。本研究的目的是评估在计划序贯应用前列腺素时，早上或晚上应用球囊导管是否更佳。
这项多中心历史性队列研究纳入了415名足月引产时宫颈条件不佳的女性。采用双球囊导管引产，必要时序贯口服米索前列醇。球囊导管在上午组于02:00至15:00放置，在晚上组于15:00至02:00放置。主要结局指标是剖宫产率。次要结局指标包括引产失败（72小时内未阴道分娩）。
两组的剖宫产率无差异（上午组26.9%，晚上组24.3%；P = 0.5553）；然而，上午组更多女性在72小时内未分娩（8.8%对3.1%；P = 0.0138）。在未产妇中，上午组引产失败更常见（12%对4%，P = 0.043）。在经产妇中，上午组引产至分娩间隔更长（1756对1349分钟；P = 0.046），24小时内分娩的较少（35%对56%，P = 0.016）。
当计划序贯使用双球囊导管和口服米索前列醇引产时，放置导管的更佳时间是晚上。这导致未产妇引产失败较少，经产妇引产至分娩间隔更短且24小时内分娩更多。
