Department of Obstetrics & Gynaecology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India.
Department of Obstetrics & Gynaecology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India.
Pregnancy Hypertens. 2023 Sep;33:1-7. doi: 10.1016/j.preghy.2023.05.002. Epub 2023 May 23.
To observe whether induction of labor (IoL) among women with severe pre-eclampsia (PE) can be expedited by initiating oxytocin early (after 6 h) than after 12 h following cervical ripening with a combined method.
Women with severe PE and Bishop's < 6 (n = 96) were randomized into two groups. All women received cervical ripening with a combined method (intracervical Foley's plus dinoprostone gel 0.5 mg) following which Group 1 women received oxytocin after 6 h (with Foley's in-situ) and Group 2 after 12 h (after removing Foley's) RESULTS: Majority were nulliparous (63% in group 1 and 77% in group 2) and the mean gestation was similar (35.3 ± 2.98 weeks in group 1 and 35.5 ± 3.09 in group 2). Nearly half the women had partial HELLP/ HELLP (47.9% and 54.1%; in groups 1 and 2, respectively). The induction-delivery interval (IDI) was significantly reduced in group 1 (16 h 6 min vs 22 h 6 min in group 2; p = 0.001). The cesarean section (CS) rate was 37.5% in group 1 and 31.3% in group 2 (p = 0.525), but the study was underpowered to assess this outcome. The neonatal outcome was similar, 92/96 neonates were discharged after a hospital stay of 3-52 days. There were 4 neonatal deaths (1 in group 1 and 3 in group 2) of extreme or very preterm neonates (27-30 + 6 wks) with birth weight of 735-965 gm.
Among women with severe PE undergoing IoL, initiating oxytocin 6 h after cervical ripening with a combined method reduced the IDI significantly as compared to initiating it after 12 h, with a similar CS rate and neonatal outcome.
观察与宫颈成熟后 12 小时（用联合方法）相比，在宫颈成熟后 6 小时（用联合方法）早期启动缩宫素是否可以加速严重先兆子痫（PE）妇女的引产（IoL）。
将 96 例严重 PE 且 Bishop's<6 的妇女随机分为两组。所有妇女均采用联合方法（宫颈内 Foley's 加地诺前列酮凝胶 0.5mg）进行宫颈成熟，然后第 1 组在 6 小时后（原位 Foley's）接受缩宫素，第 2 组在 12 小时后（取出 Foley's 后）接受缩宫素。
大多数为初产妇（第 1 组 63%，第 2 组 77%），平均孕龄相似（第 1 组 35.3±2.98 周，第 2 组 35.5±3.09 周）。将近一半的妇女有部分 HELLP/HELLP（第 1 组 47.9%，第 2 组 54.1%）。第 1 组的引产-分娩间隔（IDI）明显缩短（16 小时 6 分钟比第 2 组 22 小时 6 分钟；p=0.001）。第 1 组剖宫产率为 37.5%，第 2 组为 31.3%（p=0.525），但该研究的效能不足以评估该结局。新生儿结局相似，96 例新生儿中有 92 例在 3-52 天的住院后出院。有 4 例新生儿死亡（第 1 组 1 例，第 2 组 3 例），均为极早产儿或非常早产儿（27-30+6 周），出生体重为 735-965 克。
在接受 IoL 的严重 PE 妇女中，与宫颈成熟后 12 小时（用联合方法）相比，宫颈成熟后 6 小时（用联合方法）早期启动缩宫素可显著缩短 IDI，剖宫产率和新生儿结局相似。
