Molina-Barrera Laura Camila, Bustamante-De la Ossa María Sady, Zuleta-Tobón John Jairo
Universidad de Antioquia Universidad de Antioquia Departamento de Obstetricia y Ginecología Especialización Ginecología y Obstetricia Medellín Colombia.
Universidad de Antioquia Universidad de Antioquia Departamento de Obstetricia y Ginecología Medellín Colombia.
Colomb Med (Cali). 2025 Mar 30;56(1):e2016719. doi: 10.25100/cm.v56i1.6719. eCollection 2025 Jan-Mar.
To describe obstetric outcomes associated with the use of dinoprostone and its effectiveness in cervical ripening in pregnant women with hypertensive disorders of pregnancy compared to normotensive pregnant women.
A retrospective cohort study was conducted at a tertiary-level hospital in Medellín, Colombia (March 2020 - October 2024). The study included pregnant women with singleton pregnancies, beyond 30 weeks of gestation, with a live fetus in cephalic presentation, and undergoing cervical ripening with dinoprostone vaginal insert. Women were excluded if they had used other ripening methods, had a favorable cervix at admission, or had an unclassified hypertensive disorder. Primary outcomes included successful cervical ripening, vaginal delivery, time to favorable Bishop score and to delivery, and indications for cesarean section. Adverse events considered were placental abruption, non-reassuring fetal status, tachysystole, and worsening of hypertensive condition.
A total of 400 patients were included (200 with hypertensive disorders, of whom 100 had severe preeclampsia). The success rate of cervical ripening was similar between patients with hypertensive disorders and healthy women (crude RR: 0.95, 95% CI: 0.88-1.03; adjusted RR for gestational age, maternal age, and parity 0.96, 95% CI: 0.88-1.04). The vaginal delivery rate was also similar (44% vs. 55%, = 0.16). The median time to favorable Bishop score and to delivery was comparable between normotensive and hypertensive groups, even in severe cases. Cesarean delivery was mainly due to failed ripening and medical decision. Adverse events, except for tachysystole, were more frequent in the hypertensive group but did not reach statistical significance.
Dinoprostone is effective in hypertensive pregnant women, including those receiving magnesium sulfate, with no significant differences compared to normotensive women.
描述与使用地诺前列酮相关的产科结局，以及与血压正常的孕妇相比，地诺前列酮在妊娠高血压疾病孕妇宫颈成熟中的有效性。
在哥伦比亚麦德林的一家三级医院进行了一项回顾性队列研究（2020年3月至2024年10月）。该研究纳入了单胎妊娠、妊娠30周以上、活胎头先露且使用地诺前列酮阴道栓剂进行宫颈成熟的孕妇。如果孕妇使用过其他成熟方法、入院时宫颈条件良好或患有未分类的高血压疾病，则将其排除。主要结局包括宫颈成熟成功、阴道分娩、达到良好 Bishop 评分和分娩的时间以及剖宫产指征。所考虑的不良事件包括胎盘早剥、胎儿状况不佳、子宫收缩过速以及高血压病情恶化。
共纳入400例患者（200例患有高血压疾病，其中100例患有重度子痫前期）。高血压疾病患者和健康女性的宫颈成熟成功率相似（粗RR：0.95，95%CI：0.88 - 1.03；根据孕周、产妇年龄和产次调整后的RR为0.96，95%CI：0.88 - 1.04）。阴道分娩率也相似（44%对55%，P = 0.16）。即使在重度病例中，血压正常组和高血压组达到良好 Bishop 评分和分娩的中位时间也相当。剖宫产主要是由于成熟失败和医疗决策。除子宫收缩过速外，不良事件在高血压组中更常见，但未达到统计学意义。
地诺前列酮对高血压孕妇有效，包括接受硫酸镁治疗的孕妇，与血压正常的女性相比无显著差异。
