Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA.
Am J Obstet Gynecol MFM. 2020 Aug;2(3):100136. doi: 10.1016/j.ajogmf.2020.100136. Epub 2020 Jul 19.
Induction of labor is indicated for many obstetrical, maternal, and fetal indications. Induction can be offered for pregnancy at 39 weeks' gestation. No prediction method is considered sensitive or specific enough to determine the incidence of cesarean delivery after induction. A combination of 60- to 80-mL single-balloon Foley catheter for 12 hours and either 25-μg oral misoprostol initially, followed by 25 μg every 2-4 hours, or 50 μg every 4-6 hours (if no more than 3 contractions per 10 minutes or previous uterine surgery), or oxytocin infusion should be recommended for induction of labor. Adding membrane stripping at the beginning of induction should be considered. Once 5-6 cm of cervical dilation is achieved during the induction of labor, consideration can be given to discontinue oxytocin infusion if in use at that time and adequate contractions are present. Induction with oxytocin immediately (as soon as feasible) or up to 12 hours of term prelabor rupture of membranes if labor is not evident is recommended. Outpatient Foley ripening can be considered for low-risk women. Cesarean delivery should not be performed before 15 hours of oxytocin infusion and amniotomy if feasible and ideally after 18-24 hours of oxytocin infusion.
引产适用于许多产科、母体和胎儿的指征。可以在妊娠 39 周时进行引产。没有一种预测方法被认为足够敏感和特异，可以确定引产后的剖宫产发生率。推荐使用 60-80 毫升单球囊 Foley 导管放置 12 小时，同时初始给予 25μg 口服米索前列醇，之后每 2-4 小时给予 25μg，或每 4-6 小时给予 50μg（如果每 10 分钟宫缩不超过 3 次或有先前的子宫手术史），或缩宫素输注。在引产开始时添加胎膜剥脱术应被考虑。一旦在引产过程中宫颈扩张达到 5-6cm，可以考虑停止使用缩宫素输注，如果此时存在足够的宫缩。建议立即（尽快）用催产素引产，或在有临产迹象的情况下在足月胎膜早破 12 小时内用催产素引产。对于低危妇女，可以考虑门诊 Foley 球囊扩张术。如果可行，在开始使用缩宫素 15 小时内和羊膜切开术之前，不应进行剖宫产，如果理想的话，应在使用缩宫素 18-24 小时后进行剖宫产。
