Wing D A, Jones M M, Rahall A, Goodwin T M, Paul R H
Department of Obstetrics and Gynecology, Los Angeles County-University of Southern California Medical Center 90033, USA.
Am J Obstet Gynecol. 1995 Jun;172(6):1804-10. doi: 10.1016/0002-9378(95)91415-3.
Our purpose was to compare the safety and efficacy of intravaginal misoprostol versus intracervical prostaglandin E2 (dinoprostone) gel for preinduction cervical ripening and induction of labor.
One hundred thirty-five patients with indications for induction of labor and unfavorable cervices were randomly assigned to receive either intravaginal misoprostol or intracervical dinoprostone. Fifty microgram tablets of misoprostol were placed in the posterior vaginal fornix every 3 hours for a maximum of six doses. Prostaglandin E2 in gel form, 0.5 mg, was placed into the endocervix every 6 hours for a maximum of three doses. Medication was not given after either spontaneous rupture of membranes or beginning of active labor.
Among 135 patients enrolled, 68 received misoprostol and 67 received dinoprostone. The average interval from start of induction to vaginal delivery was shorter in the misoprostol group (903.3 +/- 482.1 minutes) than in the dinoprostone group (1410.9 +/- 869.1 minutes) (p < 0.001). Oxytocin augmentation of labor occurred more often in the dinoprostone group (65.7%) than in the misoprostol group (33.8%) (p < 0.001). There were no significant differences between routes of delivery. Ten of the misoprostol-treated patients (14.7%) and 13 of the dinoprostone-treated patients (19.4%) had cesarean deliveries. There was a higher prevalence of tachysystole (six or more uterine contractions in a 10-minute window for two consecutive 10-minute periods) in the misoprostol group (36.7%) than in the dinoprostone group (11.9%) (p < 0.001). However, there were no significant differences in frequency of uterine hyperstimulation or hypertonus. There was a higher prevalence of meconium passage in the misoprostol group (27.9%) than in the dinoprostone group (10.5%) (p < 0.05). There was no significant difference in frequency of abnormal fetal heart rate tracings, 1- or 5-minute Apgar scores < 7, neonatal resuscitations, or admissions to the neonatal intensive care unit between the two groups.
Vaginally administered misoprostol is an effective agent for cervical ripening and induction of labor; however when given at this dosage, it is associated with a higher prevalence of tachysystole and meconium passage than is dinoprostone. Further studies to compare the safety of misoprostol to that of dinoprostone and to delineate an optimal dosing regimen for misoprostol are needed.
我们的目的是比较阴道用米索前列醇与宫颈内用前列腺素E2（地诺前列酮）凝胶用于引产术前宫颈成熟和引产的安全性及有效性。
135例有引产指征且宫颈条件不佳的患者被随机分配接受阴道用米索前列醇或宫颈内地诺前列酮治疗。米索前列醇50微克片剂每3小时置于阴道后穹窿，最多6剂。0.5毫克凝胶形式的前列腺素E2每6小时置于宫颈管内，最多3剂。胎膜自然破裂或进入活跃期后不再用药。
在纳入的135例患者中，68例接受米索前列醇治疗，67例接受地诺前列酮治疗。米索前列醇组从引产开始至阴道分娩的平均间隔时间（903.3±482.1分钟）短于地诺前列酮组（1410.9±869.1分钟）（p<0.001）。地诺前列酮组引产时使用缩宫素加强宫缩的情况（65.7%）比米索前列醇组（33.8%）更常见（p<0.001）。分娩途径无显著差异。米索前列醇治疗组有10例患者（14.7%）行剖宫产，地诺前列酮治疗组有13例患者（19.4%）行剖宫产。米索前列醇组宫缩过速（连续两个10分钟时段内10分钟窗口内有6次或更多次子宫收缩）的发生率（36.7%）高于地诺前列酮组（11.9%）（p<0.001）。然而，子宫过度刺激或高张的频率无显著差异。米索前列醇组胎粪排出的发生率（27.9%）高于地诺前列酮组（10.5%）（p<0.05）。两组间异常胎心监护、1分钟或5分钟Apgar评分<7、新生儿复苏或入住新生儿重症监护病房的频率无显著差异。
阴道给药米索前列醇是一种有效的宫颈成熟和引产药物；然而，按此剂量给药时，与地诺前列酮相比，其宫缩过速和胎粪排出的发生率更高。需要进一步研究比较米索前列醇与地诺前列酮的安全性，并确定米索前列醇的最佳给药方案。
