Obut Mehmet, Aynaoğlu Yıldız Gulşah, Bademkıran Muhammed Hanifi, Oğlak Süleyman Cemil, Yücel Çelik Özge, Ölmez Fatma
Department of Gynaecology and Obstetrics, Health Sciences University, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey.
Department of Perinatalogy, Health Sciences University, Etlik Zübeyde Hanım Woman's Health Training and Research Hospital, Diyarbakır, Turkey.
Eurasian J Med. 2022 Feb;54(1):72-76. doi: 10.5152/eurasianjmed.2022.21237.
The study aimed to evaluate the factors affecting successful vaginal delivery in induction with slow-release dinoprostone at term pregnancy with premature rupture of membranes.
Pregnancies between 370/7 and 416/7 gestation weeks with premature rupture of membranes in which slow-release dinoprostone was used for cervical ripening were sought for inclusion in the study. Pregnancies with previous uterine surgery, multiple fetal gestations, chorioamnionitis, non-cephalic presentation, fetal distress at the time of admission, HIV positivity, and estimated fetal weight >4500 on ultrasonographic evaluation were excluded. The primary outcome of measures were factors affecting the success of vaginal delivery including maternal age, gestational weeks at delivery, initial Bishop score, parity, induction time, and induction-delivery time interval. To reduce the risk of overfitting in the study, penalized maximum likelihood estimation was performed instead of traditional logistic regression in the statistical analysis.
A total of 1266 participants who met the study criteria were included in the study. Among the parameters evaluated for the prediction of successful vaginal delivery in cases with premature rupture of membranes, maternal age (P < .001), Bishop score (P < .001), parity (P=.01), induction time (P < .001), and induction-delivery time interval (P < .001) had an impact on success. The mean gestational week of the participants who had cesarean deliveries was lower than in those who had vaginal deliveries (P=.03); however, this was not a predictor factor of penalized maximum likelihood estimation (P=.70).
Basic parameters such as maternal age, induction time, parity, and Bishop score can be used to predict successful vaginal birth following dinoprostone slow-release vaginal insert administration.
本研究旨在评估足月妊娠胎膜早破时使用缓释地诺前列酮引产成功阴道分娩的影响因素。
寻找妊娠37⁰/₇至41⁶/₇周、胎膜早破且使用缓释地诺前列酮进行宫颈成熟的孕妇纳入研究。排除既往有子宫手术史、多胎妊娠、绒毛膜羊膜炎、非头位、入院时胎儿窘迫、HIV阳性以及超声评估估计胎儿体重>4500g的妊娠。主要测量指标是影响阴道分娩成功的因素，包括产妇年龄、分娩孕周、初始Bishop评分、产次、引产时间以及引产至分娩的时间间隔。为降低研究中过度拟合的风险，统计分析采用惩罚最大似然估计而非传统逻辑回归。
共有1266名符合研究标准的参与者纳入研究。在评估胎膜早破病例阴道分娩成功预测的参数中，产妇年龄（P<.001）、Bishop评分（P<.001）、产次（P=.01）、引产时间（P<.001）以及引产至分娩的时间间隔（P<.001）对成功有影响。剖宫产参与者的平均孕周低于阴道分娩者（P=.03）；然而，这不是惩罚最大似然估计的预测因素（P=.70）。
产妇年龄、引产时间、产次和Bishop评分等基本参数可用于预测缓释地诺前列酮阴道栓剂给药后成功阴道分娩。
