Department of Obstetrics and Gynaecology, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France.
Clinical Research Centre, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France.
Eur J Obstet Gynecol Reprod Biol. 2024 Nov;302:87-93. doi: 10.1016/j.ejogrb.2024.08.038. Epub 2024 Aug 30.
To compare dinoprostone vaginal insert (PG) with cervical ripening balloon (CRB) as second line of cervical ripening in women at term with a persistent unfavorable cervix after first PG.
This retrospective cohort study comprised all women with singleton fetus in cephalic presentation who required cervical ripening at term (≥37 weeks) for maternal and/or fetal disease using repeated PG or CRB for a persistent unfavorable cervix (Bishop score <6) 24 h after first PG. Primary outcome was vaginal delivery rate. Secondary outcomes were favorable cervix (Bishop score ≥6) or labor within 24 h after second device placement, postpartum hemorrhage (PPH) and neonatal morbidity.
180 women were analyzed (127 repeated PG (70.6 %) and 53 CRB after first PG (29.4 %)). After second device, 93.3 % of women had a favorable cervix (Bishop score ≥6) or were in labor within 24 h, and the rate was significantly higher after CRB, compared to repeated PG (98.1 % vs. 91.3 %; p = 0.048). Vaginal deliveries were similar between groups (62.2 % after repeated PG vs. 54.7 % after CRB; p = 0.36). PPH was observed in 22.2 % of included women, and no difference was observed between groups (21.3 % vs. 21.4 %; p = 0.63). Neonatal morbidity was similar between groups (13.4 % vs. 9.4 %; p = 0.48).
Vaginal delivery rate and neonatal morbidity were similar when using PG or CRB as second line in women at term with a persistent unfavorable cervix after first PG. CRB seemed to be more efficient on the cervix status, compared to repeated PG, in these women.
比较地诺前列酮阴道栓剂（PG）与宫颈成熟球囊（CRB）作为一线治疗失败后持续性宫颈不成熟（Bishop 评分<6）的足月产妇的二线促宫颈成熟方法。
本回顾性队列研究纳入所有因母体或胎儿疾病需要足月（≥37 周）促宫颈成熟并经一线 PG 治疗后 24 小时持续性宫颈不成熟（Bishop 评分<6）的单胎头位产妇。主要结局为阴道分娩率。次要结局为宫颈成熟（Bishop 评分≥6）或第二次放置器械后 24 小时内临产、产后出血（PPH）和新生儿发病率。
共分析 180 例产妇（127 例重复 PG（70.6%）和 53 例首次 PG 后使用 CRB（29.4%））。第二次放置器械后，93.3%的产妇宫颈成熟（Bishop 评分≥6）或 24 小时内临产，CRB 组显著高于重复 PG 组（98.1%比 91.3%；p=0.048）。两组阴道分娩率无差异（重复 PG 组 62.2%，CRB 组 54.7%；p=0.36）。22.2%的产妇发生 PPH，两组间无差异（21.3%比 21.4%；p=0.63）。两组新生儿发病率无差异（13.4%比 9.4%；p=0.48）。
一线 PG 治疗失败后持续性宫颈不成熟的足月产妇应用 PG 或 CRB 作为二线促宫颈成熟方法时，阴道分娩率和新生儿发病率无差异。CRB 似乎比重复 PG 更能改善宫颈成熟度。
