Department of Gynaecology and Obstetrics, Mother and Children's Hospital, Limoges Regional University Hospital, 8 Avenue Dominique Larrey, 87000, Limoges, France.
Department of Pediatrics, Mother and Children's Hospital, Limoges Regional University Hospital, 8 Avenue Dominique Larrey, 87000, Limoges, France.
Sci Rep. 2022 Sep 2;12(1):14996. doi: 10.1038/s41598-022-18948-5.
The modalities of induction of labor in the event of premature rupture of membranes are controversial. The main purpose of this study was to compare the modalities of delivery after the use of dinoprostone or misoprostol for labor induction in the preterm rupture of membranes after 35 weeks in women with an unfavorable cervix. We then studied maternal and fetal morbidity for the two drugs. Retrospective, single-center, comparative cohort study in a level 3 maternity unit in France from 2009 to 2018 comparing vaginal administration of misoprostol 50 µg every six hours (maximum 150 µg) and administration of dinoprostone 10 mg, a slow-release vaginal insert, for 24 h (maximum 20 mg), for labor induction in the preterm rupture of membranes after 35 weeks in women with an unfavorable cervix (Bishop score < 6). We included 904 patients, 656 in the misoprostol group and 248 in the dinoprostone group. Vaginal delivery rate was significantly higher in the dinoprostone group (89% vs. 82%, p = 0.016). There were more cesarean sections for abnormal fetal heart rate in the misoprostol group (p = 0.005). The time interval from induction to the beginning of the active phase of labor and the duration of labor were shorter in the misoprostol group than in the dinoprostone group (437 min vs. 719 min, p < 0.001 and 335 min vs. 381 min, p = 0.0023, respectively). Maternal and neonatal outcomes were not significantly different in the two groups. Vaginal dinoprostone used for labor induction in preterm rupture of membranes seems to be more effective for vaginal delivery than vaginal misoprostol (50 µg).
在胎膜早破的情况下，引产的方式存在争议。本研究的主要目的是比较在 35 周后胎膜早破且宫颈条件不佳的孕妇中，使用地诺前列酮或米索前列醇引产时的分娩方式。然后，我们研究了两种药物对母婴发病率的影响。这是一项在法国三级妇产医院进行的回顾性、单中心、队列比较研究，纳入了 2009 年至 2018 年期间因宫颈条件不佳而使用 50μg 米索前列醇每 6 小时阴道给药（最大剂量 150μg）或使用 10mg 地诺前列酮阴道缓释栓 24 小时（最大剂量 20mg）引产的 904 例 35 周后胎膜早破的孕妇。其中 656 例使用米索前列醇，248 例使用地诺前列酮。地诺前列酮组阴道分娩率显著高于米索前列醇组（89% vs. 82%，p=0.016）。米索前列醇组因胎心异常行剖宫产的比例更高（p=0.005）。米索前列醇组从引产开始到活跃期开始的时间间隔和产程时间均短于地诺前列酮组（437min vs. 719min，p<0.001；335min vs. 381min，p=0.0023）。两组母婴结局无显著差异。在 35 周后胎膜早破的情况下，阴道内使用地诺前列酮引产似乎比阴道内使用米索前列醇更有效，能提高阴道分娩率。
