Jackson G M, Sharp H T, Varner M W
Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City 84132.
Am J Obstet Gynecol. 1994 Oct;171(4):1092-6. doi: 10.1016/0002-9378(94)90042-6.
The purpose of this study was to compare prostaglandin E2 gel and a low-dose infusion of oxytocin for cervical ripening before labor induction.
A total of 158 women were randomized to receive either two intracervical doses of 0.5 mg prostaglandin E2 gel 6 hours apart or 12 hours of intravenous oxytocin up to 4 mlU/min. After cervical ripening labor was induced with high-dose oxytocin infusion and amniotomy.
There was no difference between the prostaglandin E2 and low-dose oxytocin groups in the likelihood of being in labor or having a Bishop score favorable for induction after ripening (64.2% vs 52.0%, p = 0.12) or in the incidence of vaginal delivery (75.9% vs 74.7%). Prostaglandin E2-treated patients were delivered sooner (20.2 +/- 8.1 hours vs 25.0 +/- 10.5 hours, p = 0.002). Among delivered patients the likelihood of vaginal delivery within 24 hours was greater with prostaglandin E2 ripening (63.7% vs 47.2%, p = 0.04), but there was no difference at 36 hours (76.2% vs 75.0%). Uterine hyperstimulation and fetal distress during ripening occurred only in the prostaglandin E2 group, at a rate of 4.8%.
After cervical ripening with prostaglandin E2 gel or low-dose oxytocin vaginal delivery can be expected in three fourths of patients within 24 to 36 hours. We recommend that patients with an unfavorable cervix who require delivery undergo cervical ripening and induction of labor rather than automatic delivery by cesarean section.
本研究旨在比较前列腺素E2凝胶和低剂量缩宫素静脉滴注用于引产术前促宫颈成熟的效果。
158名妇女被随机分为两组，一组每隔6小时宫颈内给予两剂0.5毫克前列腺素E2凝胶，另一组静脉滴注缩宫素12小时，最大剂量为4毫国际单位/分钟。宫颈成熟后，采用大剂量缩宫素静脉滴注及人工破膜引产。
前列腺素E2组和低剂量缩宫素组在引产成功率、宫颈成熟后Bishop评分适宜引产率（64.2%对52.0%，p = 0.12）或阴道分娩率（75.9%对74.7%）方面无差异。接受前列腺素E2治疗的患者分娩时间更早（20.2±8.1小时对25.0±10.5小时，p = 0.002）。在已分娩的患者中，前列腺素E2促宫颈成熟后24小时内阴道分娩的可能性更大（63.7%对47.2%，p = 0.04），但36小时时无差异（76.2%对75.0%）。促宫颈成熟过程中子宫过度刺激和胎儿窘迫仅发生在前列腺素E2组，发生率为4.8%。
使用前列腺素E2凝胶或低剂量缩宫素促宫颈成熟后，四分之三的患者可在24至36小时内阴道分娩。我们建议，宫颈条件不佳但需要分娩的患者应进行促宫颈成熟及引产，而非直接行剖宫产。
