Behrens O, Goeschen K, Jakob H, Kauffels W
Frauenklinik der Medizinischen Hochschule Hannover.
Geburtshilfe Frauenheilkd. 1994 Mar;54(3):144-50. doi: 10.1055/s-2007-1023570.
With the rising rate of Caesarean sections, the number of pregnant patients with a previous Caesarean is increasing. Taking into consideration certain contraindications, it seems to be justified, to attempt induction of labour for vaginal delivery without major risk. However, the use of prostaglandins for cervical ripening in women with an unfavourable cervical status is particularly controversial. Thus, we analysed data from 385 trials of vaginal labour induction in a total of 522 patients with previous Caesarean section. Single or multiple cervical doses of prostaglandin-E2-gel had to be administered because of an unripe cervix (Bishop-score < 8) in 161 women for induction of labour for medical indications. 84.9% of those patients, in which labour induction was attempted after previous Caesarean section, delivered vaginally; 70% after two Caesareans. The highest success rates were seen after previous Caesarean for breech presentation, while there was still a vaginal delivery rate above 60% even after Caesarean for cephalopelvic disproportion or failure to progress. Maternal and foetal complications were seen with equal incidence in both study groups. Uterine ruptures totalling 0.5% were seen only in patients without cervical priming. Taking into consideration contraindications, intracervical application of PGE2-gel is a safe and effective method, even in patients after previous Caesarean section with clear advantages in case of an unripe cervix.
随着剖宫产率的上升，有剖宫产史的孕妇数量在增加。考虑到某些禁忌症，尝试进行引产以实现阴道分娩且无重大风险似乎是合理的。然而，在宫颈条件不佳的女性中使用前列腺素进行宫颈成熟尤其具有争议性。因此，我们分析了总共522例有剖宫产史患者的385例引产试验数据。由于宫颈不成熟（Bishop评分<8），161名女性因医学指征引产而接受了单次或多次宫颈剂量的前列腺素E2凝胶给药。在这些有剖宫产史后尝试引产的患者中，84.9%经阴道分娩；两次剖宫产史的患者中这一比例为70%。既往剖宫产史为臀位时成功率最高，而即使是因头盆不称或产程停滞行剖宫产术后，阴道分娩率仍高于60%。两个研究组中母婴并发症的发生率相同。仅在未进行宫颈预处理的患者中观察到子宫破裂，发生率总计为0.5%。考虑到禁忌症，宫颈内应用PGE2凝胶是一种安全有效的方法，即使对于有剖宫产史的患者，在宫颈不成熟的情况下也有明显优势。
