Sanchez-Ramos L, Kaunitz A M, Del Valle G O, Delke I, Schroeder P A, Briones D K
Department of Obstetrics and Gynecology, University of Florida Health Science Center, Jacksonville.
Obstet Gynecol. 1993 Mar;81(3):332-6.
To compare the safety and efficacy of intravaginal misoprostol versus intravenous (IV) oxytocin infusion for labor induction.
One hundred thirty patients were randomly assigned to one of two induction groups: 1) intravaginal misoprostol or 2) IV oxytocin by continuous infusion, with prior cervical ripening using prostaglandin (PG) E2 gel if necessary.
Among 129 patients evaluated, 64 were allocated to the misoprostol group and 65 to the oxytocin group. Prostaglandin E2 gel was administered to 29 patients (45%) in the oxytocin group with unripe cervices. Uterine tachysystole occurred more frequently in patients in the misoprostol group (34.4%) than in the oxytocin group (13.8%) (P < .05). Nevertheless, no statistically significant differences were noted between the groups in intrapartum complications including uterine hyperstimulation syndrome, mode of delivery, and neonatal or maternal adverse outcomes. The interval from induction to vaginal delivery was significantly shorter in the misoprostol group (11 versus 18 hours; P = .004). In 74% of patients in the misoprostol group, only one intravaginal dose was required for successful labor induction.
Intravaginal administration of misoprostol safely and effectively induces labor while minimizing the expense associated with IV oxytocin infusion. The higher frequency of uterine tachysystole associated with the use of misoprostol did not increase the risk of adverse intrapartum or perinatal outcomes. The use of PGE2 gel for cervical ripening contributed to the longer induction-to-vaginal delivery interval noted in the oxytocin group. Clinical trials appear warranted to detail misoprostol's optimal route, dose, and schedule for labor induction and its safety.
比较阴道用米索前列醇与静脉输注缩宫素引产的安全性和有效性。
130例患者被随机分配至两个引产组之一：1）阴道用米索前列醇组或2）持续静脉输注缩宫素组，必要时使用前列腺素（PG）E2凝胶进行宫颈成熟。
在129例接受评估的患者中，64例被分配至米索前列醇组，65例被分配至缩宫素组。缩宫素组中29例（45%）宫颈未成熟的患者使用了PGE2凝胶。米索前列醇组患者子宫收缩过速的发生率（34.4%）高于缩宫素组（13.8%）（P <.05）。然而，两组在包括子宫过度刺激综合征、分娩方式以及新生儿或母亲不良结局在内的产时并发症方面未观察到统计学上的显著差异。米索前列醇组从引产到阴道分娩的间隔时间显著更短（11小时对18小时；P =.004）。米索前列醇组74%的患者仅需一剂阴道用药即可成功引产。
阴道给药米索前列醇可安全有效地引产，同时将与静脉输注缩宫素相关的费用降至最低。与使用米索前列醇相关的子宫收缩过速发生率较高并未增加产时或围产期不良结局的风险。缩宫素组使用PGE2凝胶进行宫颈成熟导致引产到阴道分娩的间隔时间更长。似乎有必要开展临床试验以详细确定米索前列醇引产的最佳途径、剂量和方案及其安全性。
