羊膜外生理盐水灌注与海藻棒用于宫颈成熟的随机试验。

A randomized trial of extra-amniotic saline infusion versus laminaria for cervical ripening.

作者信息

Lin A, Kupferminc M, Dooley S L

机构信息

Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago, Illinois, USA.

出版信息

Obstet Gynecol. 1995 Oct;86(4 Pt 1):545-9. doi: 10.1016/0029-7844(95)00234-i.

DOI:10.1016/0029-7844(95)00234-i

PMID:7675377

Abstract

OBJECTIVE

To compare extra-amniotic saline infusion versus laminaria for cervical ripening and labor induction.

METHODS

Patients of at least 34 weeks' gestation with a Bishop score of 3 or less were randomized to either laminaria ripening for 6 hours or more followed by oxytocin induction versus initiation of extra-amniotic saline infusion at the start of oxytocin induction. Indications for induction included 41 weeks' gestation or greater, hypertensive disease, diabetes, oligohydramnios, suspect fetal growth, and nonreassuring fetal testing.

RESULTS

There were no significant differences in maternal age, race, parity, gestational age, or indications for induction between the two groups (extra-amniotic saline infusion group, n = 26, laminaria group, n = 26). After only 3 hours of oxytocin induction, patients in the extra-amniotic saline infusion group achieved an identical distribution of Bishop scores compared with the patients in the laminaria group after 6 hours or more of pre-induction ripening as well as 3 hours of oxytocin induction. There were no differences in rates of cesarean delivery (extra-amniotic saline infusion 35%, laminaria 35%), infectious complications, or neonatal outcomes between the two groups. The induction-to-delivery interval (+/- standard deviation) was significantly shortened with extra-amniotic saline infusion (extra-amniotic saline infusion 12.9 +/- 5.7 hours versus laminaria 16.9 +/- 7.1 hours, P = .03). In addition, fewer cesarean deliveries were performed for failed inductions (cervix less than 5 cm dilated) in the extra-amniotic saline infusion group (one of 26 versus six of 26, P = .049).

CONCLUSION

Extra-amniotic saline infusion offers potential advantages over the use of laminaria. Extra-amniotic saline infusion saves a significant amount of time both by obviating the need for pre-induction cervical ripening and in shortening the induction-to-delivery interval. Also, fewer patients required cesarean delivery for failed induction of labor with extra-amniotic saline infusion.

摘要

目的

比较羊膜外生理盐水灌注与海藻棒用于宫颈成熟和引产的效果。

方法

妊娠至少34周、 Bishop评分3分及以下的患者被随机分为两组，一组采用海藻棒促宫颈成熟6小时或更长时间后用缩宫素引产，另一组在缩宫素引产开始时即开始羊膜外生理盐水灌注。引产指征包括妊娠41周及以上、高血压疾病、糖尿病、羊水过少、可疑胎儿生长受限及胎儿检查结果异常。

结果

两组在产妇年龄、种族、产次、孕周或引产指征方面无显著差异（羊膜外生理盐水灌注组，n = 26；海藻棒组，n = 26）。缩宫素引产仅3小时后，羊膜外生理盐水灌注组患者的 Bishop评分分布与海藻棒组在引产前置入海藻棒6小时或更长时间并缩宫素引产3小时后的患者相同。两组在剖宫产率（羊膜外生理盐水灌注组35%，海藻棒组35%）、感染并发症或新生儿结局方面无差异。羊膜外生理盐水灌注显著缩短了引产至分娩的间隔时间（±标准差）（羊膜外生理盐水灌注组12.9±5.7小时，海藻棒组16.9±7.1小时，P = .03）。此外，羊膜外生理盐水灌注组因引产失败（宫颈扩张小于5 cm）而行剖宫产的患者较少（26例中的1例，而海藻棒组为26例中的6例，P = .049）。