López-Jiménez Nuria, García-Sánchez Fiamma, Pailos Rafael Hernández, Rodrigo-Álvaro Valentin, Pascual-Pedreño Ana, Moreno-Cid María, Hernández-Martínez Antonio, Molina-Alarcón Milagros
Department of Obstetrics and Gynecology, La Mancha Centro Hospital, 13600 Alcázar de San Juan, Spain.
Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing, University of Castilla-La Man cha IDINE, Camilo José Cela, 14, 13071 Ciudad Real, Spain.
J Clin Med. 2021 Nov 9;10(22):5221. doi: 10.3390/jcm10225221.
Vaginal dinoprostone (PGE) is currently used as the prostaglandin of choice in many obstetric units. However, few studies have evaluated its safety, especially in women who previously had a cesarean section.
To evaluate the efficacy and safety of PGE in pregnant women who are undergoing induction of labor (IOL), and who have had a previous cesarean section.
A prospective observational study was conducted in La Mancha Centro Hospital in Alcázar de San Juan, Spain, from 1 February 2019 to 30 August 2020. Obstetric and neonatal outcomes, following IOL with PGE, in 47 pregnant women who wanted a trial of labor after cesarean (TOLAC), and 377 pregnant women without a history of cesarean section, were analyzed. The outcomes were analyzed by bivariate and multivariate analyses using binary and multiple linear regression.
A total of 424 women were included in this study. The percentage of cesarean sections in the TOLAC group was 44.7% (21), compared with 31.6% (119) in the group without a history of cesarean section (adjusted odds ratio: 1.4; 95% CI: 0.68-2.86). In the multivariate analysis, no statistically significant differences were observed between both groups for obstetric and neonatal outcomes ( > 0.05). However, two uterine ruptures (4.3%) occurred in the group of patients with a history of cesarean section who underwent IOL with PGE.
The induction of labor with vaginal dinoprostone (PGE), in patients with a previous history of cesarean section, was not associated with worse obstetric or neonatal outcomes compared with the group of patients without a history of cesarean section in our study sample. However, further research is needed regarding this IOL method, and it should be used with caution in this population group.
阴道用地诺前列酮（PGE）目前在许多产科单位被用作首选前列腺素。然而，很少有研究评估其安全性，尤其是在既往有剖宫产史的女性中。
评估PGE在接受引产（IOL）且既往有剖宫产史的孕妇中的疗效和安全性。
2019年2月1日至2020年8月30日在西班牙阿尔卡萨德圣胡安的拉曼恰中心医院进行了一项前瞻性观察研究。分析了47例剖宫产术后试产（TOLAC）的孕妇和377例无剖宫产史的孕妇在使用PGE进行IOL后的产科和新生儿结局。采用二元和多元线性回归通过双变量和多变量分析对结局进行分析。
本研究共纳入424名女性。TOLAC组的剖宫产率为44.7%（21例），无剖宫产史组为31.6%（119例）（调整优势比：1.4；95%CI：0.68 - 2.86）。在多变量分析中，两组在产科和新生儿结局方面未观察到统计学显著差异（P>0.05）。然而，在有剖宫产史且使用PGE进行IOL的患者组中发生了2例子宫破裂（4.3%）。
在我们的研究样本中，与无剖宫产史的患者组相比，既往有剖宫产史的患者使用阴道地诺前列酮（PGE）引产与更差的产科或新生儿结局无关。然而，对于这种IOL方法需要进一步研究，并且在该人群中应谨慎使用。
