Assistance Publique-Hôpitaux De Paris, Bicêtre Hospital, Department of Gynecology-Obstetrics, Le Kremlin-Bicêtre, France; Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, 94807 France.
Assistance Publique-Hôpitaux De Paris, Bicêtre Hospital, Department of Gynecology-Obstetrics, Le Kremlin-Bicêtre, France.
J Gynecol Obstet Hum Reprod. 2020 Apr;49(4):101699. doi: 10.1016/j.jogoh.2020.101699. Epub 2020 Feb 1.
To assess the efficacy and safety of prostaglandin in inducing labor in pregnant women with one previous cesarean section. Secondly, to evaluate predictors of successful vaginal delivery in cervical ripening by prostaglandin in these women.
This was an observational, retrospective, single-center study conducted in a type 3 maternity unit at Bicêtre University Hospital between January 1, 2013 and December 31, 2016. Patients with one previous cesarean section, a singleton pregnancy, a fetus in the cephalic presentation with a medical indication for induction of labor and an unfavorable cervix (Bishop score less than 6) were included in the study. Cervical ripening was performed using a dinoprostone intravaginal device for a duration of 24 h.
A total of 153 patients were included in the study. The rate of vaginal delivery was 55.6 % (85/153) overall and 78.3 % (36/46) in the subgroup of 46 women with a previous vaginal delivery before or after the cesarean section. There was no difference in neonatal and maternal morbidity (defined by intraoperative wounds or postpartum hemorrhage or uterine rupture) and mortality between women who delivered vaginally and women who had a cesarean section. The two cases of complete uterine rupture have been reported for patients whose labor was induced by intravaginal prostaglandin followed by intravenous oxytocin. The total maternal morbidity rate was 11.8 % (n = 8/68) in the case of emergency cesarean section. Predictors of vaginal delivery were a history of vaginal delivery, the onset of labor following cervical ripening, and a higher Bishop score before and after the 24 h following the cervical ripening.
Cervical ripening by prostaglandin after previous cesarean delivery has a 56 % success rate, with a 1.3 % risk of uterine rupture, especially when prostaglandin is combined with oxytocin. Low-risk patients should be identified to propose cervical ripening by prostaglandin.
评估前列腺素在有一次剖宫产史的孕妇引产中的疗效和安全性。其次，评估前列腺素在这些妇女宫颈成熟时阴道分娩成功的预测因素。
这是一项在比塞特尔大学医院 3 型产科单位进行的观察性、回顾性、单中心研究，时间为 2013 年 1 月 1 日至 2016 年 12 月 31 日。纳入研究的患者为有一次剖宫产史、单胎妊娠、头位胎儿、有引产医疗指征且宫颈条件不佳（Bishop 评分<6）。采用地诺前列酮阴道栓剂进行 24 小时宫颈成熟。
共有 153 名患者纳入研究。总体阴道分娩率为 55.6%（153/153），在剖宫产前或剖宫产后继发阴道分娩的 46 名女性亚组中为 78.3%（36/46）。阴道分娩组和剖宫产组的新生儿和产妇发病率（定义为术中伤口或产后出血或子宫破裂）和死亡率无差异。两例完全子宫破裂的患者均为阴道前列腺素引产后继以静脉催产素的患者。紧急剖宫产的产妇总发病率为 11.8%（68/576）。阴道分娩的预测因素为阴道分娩史、宫颈成熟后开始分娩以及宫颈成熟前和 24 小时后 Bishop 评分较高。
剖宫产术后应用前列腺素进行宫颈成熟的成功率为 56%，子宫破裂的风险为 1.3%，尤其是当前列腺素与催产素联合应用时。应识别低风险患者，以建议应用前列腺素进行宫颈成熟。
