Kehl Sven, Weiss Christel, Rath Werner, Schneider Michael, Stumpfe Florian, Faschingbauer Florian, Beckmann Matthias W, Stelzl Patrick
Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany.
Abteilung für Medizinische Statistik, Biomathematik und Informationsverarbeitung, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany.
Geburtshilfe Frauenheilkd. 2021 Aug;81(8):955-965. doi: 10.1055/a-1538-2200. Epub 2021 Aug 9.
While the synthetic prostaglandin E1 analogue misoprostol is the most effect labour induction agent, its use is off-label for the most part. For this reason, and in view of its potential adverse effects and varying approaches to its administration, the drug has recently once again become a focus of critical attention. The objective of this survey was thus to establish a record of labour induction with misoprostol in German clinics and determine the impact of the negative reporting on everyday obstetric practice. In this cross-sectional study, 635 obstetrics and gynaecology departments in Germany were requested by email to participate in our survey in February/March 2020. Online responses to 19 questions were requested regarding the clinic, use of misoprostol before and after the critical reporting, use of misoprostol (sourcing, method of administration, dosage, monitoring) and other labour induction methods. A total of 262 (41.3%) of the clinics solicited for the survey completed the questionnaire. There were no differences regarding the care level (Perinatal Centre Level I, Perinatal Centre Level II, Clinic with Perinatal Focus or Obstetric/Private Clinic; p = 0.2104) or birth counts (p = 0.1845). In most cases, misoprostol was prepared in the clinic's own pharmacy (54%) or imported from another country (46%) and administered orally in tablet form (95%). Misoprostol dosage levels varied (25 µg [48%], 50 µg [83%], 75 µg [6%], 100 µg [47%] and > 100 µg [5%]). Most of the clinics used premanufactured tablets/capsules (59%), although Cytotec tablets were also divided (35%) or dissolved in water (5%). Misoprostol administration intervals were mainly every 4 hours (64%) or every 6 hours (30%). CTG checks were run in most cases before and after administration of a dose of misoprostol (78% and 76%) and before and after administration of a dose of prostaglandin E2 (both 88%). Presence of contractions led to no misoprostol (59%) or no prostaglandin E2 (64%) being administered in most cases. The critical reporting resulted in discontinuation of use of misoprostol in 17% of the clinics - mainly smaller obstetric/private clinics with fewer than 1000 births. Labour cocktails were used mainly in obstetric and private clinics (61%). Misoprostol is an established agent for labour induction in German clinics. The dosing schemes used vary. Improvements of currently common management practices are required, especially in the area of labour induction (CTG checks before and after administration of labour-inducing medication, no administration of prostaglandin if contractions are ongoing). The discussion of use of misoprostol in the media resulted in stoppage of its use mainly in smaller clinics.
虽然合成前列腺素E1类似物米索前列醇是最有效的引产药物，但其使用在很大程度上属于超适应症用药。因此，鉴于其潜在的不良反应以及不同的给药方式，该药物最近再次成为备受关注的焦点。本次调查的目的是记录德国诊所使用米索前列醇引产的情况，并确定负面报道对日常产科实践的影响。在这项横断面研究中，2020年2月/3月通过电子邮件邀请德国635个妇产科科室参与我们的调查。要求在线回答19个问题，内容涉及诊所情况、关键报道前后米索前列醇的使用情况、米索前列醇的使用（来源、给药方法、剂量、监测）以及其他引产方法。总共262家（41.3%）被邀请参与调查的诊所完成了问卷。在护理级别（围产期中心一级、围产期中心二级、有围产期重点的诊所或产科/私立诊所；p = 0.2104）或分娩数量（p = 0.1845）方面没有差异。在大多数情况下，米索前列醇在诊所自己的药房配制（54%）或从其他国家进口（46%），并以片剂形式口服给药（95%）。米索前列醇的剂量水平各不相同（25μg[48%]、50μg[83%]、75μg[6%]、100μg[47%]和>100μg[5%]）。大多数诊所使用预制片剂/胶囊（59%），不过也有部分使用赛托克斯片（35%）或溶于水（5%）。米索前列醇的给药间隔主要是每4小时（64%）或每6小时（30%）。在大多数情况下，给药一剂米索前列醇前后（78%和76%）以及给药一剂前列腺素E2前后（均为88%）都进行胎心监护检查。出现宫缩时，在大多数情况下不会再给予米索前列醇（59%）或前列腺素E2（64%）。负面报道导致17%的诊所停止使用米索前列醇——主要是分娩量少于1000例的小型产科/私立诊所。引产合剂主要用于产科和私立诊所（61%）。米索前列醇是德国诊所常用的引产药物。所采用的给药方案各不相同。需要改进目前常见的管理做法，尤其是在引产方面（引产药物给药前后的胎心监护检查、宫缩持续时不给予前列腺素）。媒体对米索前列醇使用的讨论导致其使用主要在小型诊所中停止。
