Coste Mazeau P, Catalan C, Eyraud J-L, Aubard Y, Gauthier T
Service de gynécologie obstétrique, hôpital Mère-Enfant, CHU de Limoges, 8, avenue Dominique-Larrey, 87000 Limoges, France.
Service de gynécologie obstétrique, hôpital Mère-Enfant, CHU de Limoges, 8, avenue Dominique-Larrey, 87000 Limoges, France.
Gynecol Obstet Fertil Senol. 2017 Feb;45(2):77-82. doi: 10.1016/j.gofs.2016.12.018. Epub 2017 Jan 18.
Because, to date in France, 20 % of pregnant women had a scared uterus and because the best mean of cervical ripening is unknown and controversial, we want to evaluate efficacy and safety of dinoprostone for cervical ripening in women with previous cesarean.
We conducted a retrospective unicentric study, from 2010 to 2014, at Limoges regional university hospitals. Two hundred and sixty nine patients, with medical indication for induction of labor and scared uterus, were included and ripened with dinoprostone (Propess and/or Prostine). Women had unfavorable cervix with Bishop score inferior to 6.
Overall rate of vaginal delivery was 62 %. Patients have had more of one prostaglandin in 19 % of cases; the cesarean rate was significantly higher in this case (cesarean: 55.6 % vs. vaginal delivery: 44.4 %; P=0.0043). Overall, there were respectively 4 % and 0.7 % of post-partum hemorrhage and uterine rupture. One percent of newborns had a severe acidosis (pH<7 in umbilical artery) and 1 % was admitted to the Intensive Neonatal Care Unit.
Dinoprostone is an effective procedure in patients with previous cesarean section requiring labor induction, with a morbidity comparable to other methods of induction of labor.
由于在法国，目前有20%的孕妇存在瘢痕子宫，且宫颈成熟的最佳方法尚不清楚且存在争议，我们希望评估地诺前列酮对有剖宫产史的女性进行宫颈成熟的有效性和安全性。
我们于2010年至2014年在利摩日地区大学医院进行了一项回顾性单中心研究。纳入了269例有引产医学指征且有瘢痕子宫的患者，用地诺前列酮（普贝生和/或前列地尔）进行宫颈成熟。这些女性的宫颈条件不佳，Bishop评分低于6分。
阴道分娩的总体发生率为62%。19%的病例中患者使用了不止一种前列腺素；在这种情况下剖宫产率显著更高（剖宫产：55.6% vs. 阴道分娩：44.4%；P = 0.0043）。总体而言，产后出血和子宫破裂的发生率分别为4%和0.7%。1%的新生儿有严重酸中毒（脐动脉pH<7），1%入住新生儿重症监护病房。
对于有剖宫产史且需要引产的患者，地诺前列酮是一种有效的方法，其发病率与其他引产方法相当。
