Department of Obstetrics and Gynecology, Robert Debré Hospital, APHP, 42 Boulevard Sérurrier, 75019, Paris, France.
Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, 75004, Paris, France.
Arch Gynecol Obstet. 2020 Apr;301(4):931-940. doi: 10.1007/s00404-020-05473-x. Epub 2020 Mar 5.
To compare the effectiveness of cervical ripening by a mechanical method (double-balloon catheter) and a pharmacological method (prostaglandins) in women with one previous cesarean delivery, an unfavorable cervix (Bishop score < 6), and a singleton fetus in cephalic presentation.
This retrospective study, reviewing the relevant records for the years 2013 through 2017, took place in two French university hospital maternity units. This study included women with one previous cesarean delivery, a liveborn singleton fetus in cephalic presentation, and intact membranes, for whom cervical ripening, with unfavorable cervix (Bishop score < 6) was indicated for medical reasons. It compared two groups: (1) women giving birth in a hospital that uses a protocol for mechanical cervical ripening by a double-balloon catheter (DBC), and (2) women giving birth in a hospital that performed pharmacological cervical ripening by prostaglandins. The principal endpoint was the cesarean delivery rate. The secondary outcome measures were maternal and neonatal outcomes.
We compared 127 women with prostaglandin ripening to 117 women with DBC. There was no significant difference between the two groups for the cesarean rate (42.5% in the prostaglandin group and 42.7% in the DBC group; p = 0.973; crude OR 1.01 [0.61-1.68]; adjusted OR 1.55 [0.71-3.37]). The median interval between the start of ripening and delivery did not differ between the groups (28.7 h in the prostaglandin group vs 25.6 h in the DBC group; p = 0.880). Neonatal outcomes did not differ between the groups, either. There was one case of uterine rupture in the prostaglandin group, with no associated maternal or neonatal morbidity. There were no neonatal deaths. The postpartum hemorrhage rate was significantly higher in the DBC group.
For cervical ripening for women with one previous cesarean, the choice of a pharmacological or mechanical protocol does not appear to modify the mode of delivery or maternal or neonatal morbidity.
比较经机械方法（双球囊导管）和药物方法（前列腺素）对有一次剖宫产史、宫颈条件不良（Bishop 评分<6）、头位单胎妊娠的产妇进行宫颈成熟的效果。
本回顾性研究于 2013 年至 2017 年在法国两家大学附属医院进行，纳入因医学原因需要宫颈成熟且有一次剖宫产史、头位单活胎、胎膜完整、宫颈条件不良（Bishop 评分<6）的产妇。比较两组：（1）采用双球囊导管机械性宫颈成熟方案的医院分娩产妇；（2）采用前列腺素药物性宫颈成熟方案的医院分娩产妇。主要结局指标为剖宫产率。次要结局指标为母婴结局。
比较了 127 例前列腺素成熟组与 117 例双球囊导管成熟组。两组剖宫产率无显著差异（前列腺素组 42.5%，双球囊导管组 42.7%；p=0.973；粗 OR 1.01[0.61-1.68]；调整 OR 1.55[0.71-3.37]）。两组从开始成熟到分娩的中位时间间隔无差异（前列腺素组 28.7 h，双球囊导管组 25.6 h；p=0.880）。两组新生儿结局也无差异。前列腺素组有 1 例子宫破裂，无产妇或新生儿并发症。无新生儿死亡。双球囊导管组产后出血率显著升高。
对于有一次剖宫产史的产妇进行宫颈成熟，选择药物或机械方案似乎不会改变分娩方式或母婴发病率。
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