Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche sur Yon, France.
Clinical Research Center, Centre Hospitalier Departemental, La Roche sur Yon, France.
Int J Gynaecol Obstet. 2024 Sep;166(3):1068-1076. doi: 10.1002/ijgo.15480. Epub 2024 Mar 22.
To evaluate vaginal delivery in obese women who underwent cervical ripening at term using a dinoprostone vaginal insert or a cervical ripening balloon (CRB), and to assess maternal and neonatal morbidity according to the method.
A prospective cohort study including obese women with a live singleton fetus in cephalic presentation who required cervical ripening at term (≥37 weeks) for maternal and/or fetal disease using a dinoprostone vaginal insert or a CRB. The primary outcome was vaginal delivery. Secondary outcomes were a favorable cervix (Bishop score >6) after 24 h, the time from device insertion to delivery, and composite maternal and neonatal morbidity.
In total, 135 consecutive women were analyzed (107 CRB, 79.3%; 28 dinoprostone vaginal insert, 20.7%). Vaginal delivery (86 [80.4%] after CRB vs 19 [67.9%] after dinoprostone vaginal insert; P = 0.248), favorable cervix within 24 h after device placement (52 [48.6%] vs 17 [60.7%]; P = 0.264), and maternal morbidity (12 [11.2%] vs 4 [14.3%]; P = 0.646) were similar between the groups. The time from device insertion to delivery also did not differ between the groups. Neonatal morbidity was significantly higher after the dinoprostone vaginal insert (11 [39.3%] vs 20 [18.7%]; P = 0.030). Cervical ripening using the dinoprostone vaginal insert, compared with the CRB, was significantly associated with neonatal morbidity (adjusted odds ratio 4.00, 95% confidence interval 1.34-12.5), but not with maternal morbidity (adjusted odds ratio 1.23, 95% confidence interval 0.30-4.38).
Vaginal delivery, a favorable cervix after 24 h, the time from device insertion to delivery, and maternal morbidity did not significantly differ between the CRB and the dinoprostone vaginal insert for cervical ripening in obese women at term. Nevertheless, neonatal morbidity was significantly associated with the dinoprostone vaginal insert, compared with the CRB, among obese women who required cervical ripening at term.
评估足月使用地诺前列酮阴道栓剂或宫颈成熟球囊（CRB）进行宫颈成熟的肥胖妇女的阴道分娩情况，并根据方法评估母婴发病率。
前瞻性队列研究纳入了头位、单胎活产、因母体和/或胎儿疾病需要在足月（≥37 周）进行宫颈成熟的肥胖妇女，使用地诺前列酮阴道栓剂或 CRB。主要结局为阴道分娩。次要结局为 24 小时后宫颈成熟良好（Bishop 评分>6）、从放置器械到分娩的时间以及复合母婴发病率。
共分析了 135 例连续肥胖妇女（CRB 107 例，79.3%；地诺前列酮阴道栓剂 28 例，20.7%）。CRB 组 86 例（80.4%）和地诺前列酮阴道栓剂组 19 例（67.9%）行阴道分娩（P=0.248）、放置器械后 24 小时内宫颈成熟良好的比例分别为 52 例（48.6%）和 17 例（60.7%）（P=0.264），以及母婴发病率分别为 12 例（11.2%）和 4 例（14.3%）（P=0.646），两组之间无显著差异。两组之间从放置器械到分娩的时间也没有差异。地诺前列酮阴道栓剂组新生儿发病率明显高于 CRB 组（11 例[39.3%] vs. 20 例[18.7%]；P=0.030）。与 CRB 相比，地诺前列酮阴道栓剂用于宫颈成熟与新生儿发病率显著相关（调整后的优势比 4.00，95%置信区间 1.34-12.5），但与母婴发病率无关（调整后的优势比 1.23，95%置信区间 0.30-4.38）。
在足月肥胖妇女中，CRB 与地诺前列酮阴道栓剂用于宫颈成熟时，阴道分娩、24 小时后宫颈成熟良好、从放置器械到分娩的时间以及母婴发病率无显著差异。然而，与 CRB 相比，在需要宫颈成熟的足月肥胖妇女中，地诺前列酮阴道栓剂与新生儿发病率显著相关。
