Wiriyasirivaj B, Vutyavanich T, Ruangsri R A
Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Thailand.
Obstet Gynecol. 1996 May;87(5 Pt 1):767-70. doi: 10.1016/0029-7844(96)00015-4.
To determine the effectiveness of membrane stripping at term to promote the onset of labor.
One hundred twenty gravidas at 38 weeks' gestation, who were attending an antenatal clinic and planned to deliver at Maharaj Nakorn Chiang Mai University Hospital in northern Thailand, were assigned randomly to one of two groups. One group had weekly pelvic examinations only, and the other also had membrane stripping, beginning at 38 weeks' gestation and continuing until the onset of labor or until 42 completed weeks' gestation. Outcome measures included the proportion of patients who delivered with 7 days after the first examination, Bishop scores among those who did not deliver, days from the first examination to delivery, incidence of postterm pregnancy, and maternal and fetal complication.
Twenty-five of 61 patients (41%) assigned to membrane stripping delivered within 1 week, compared with 12 of 59 controls (20.3%), a statistically significant difference (P = .014). There was also a statistically significant difference (P = .013, Mann-Whitney U test) in the Bishop scores among those who did not deliver within 1 week (4 +/- 2.5 versus 2.6 +/- 1.7 in the study and control groups, respectively). A significant difference was also observed with respect to the mean number of days to delivery (8.8 +/- 6.7 versus 13.6 +/- 7.5, respectively; P < .001). The incidence of postterm pregnancy was one of 61 (1.6%) and three of 59 (5.1%) in the stripping and control groups, respectively. No significant differences were observed in maternal and fetal complications.
Membrane stripping is safe and effective in promoting the onset of labor at term.
确定足月时人工剥膜促进分娩发动的有效性。
120名妊娠38周的孕妇，她们在泰国北部清迈大学玛哈拉吉那空医院产前门诊就诊并计划在该院分娩，被随机分为两组。一组仅每周进行一次骨盆检查，另一组从妊娠38周开始也进行人工剥膜，持续至分娩发动或至妊娠满42周。观察指标包括首次检查后7天内分娩的患者比例、未分娩者的Bishop评分、首次检查至分娩的天数、过期妊娠发生率以及母婴并发症。
61名接受人工剥膜的患者中有25名（41%）在1周内分娩，而59名对照组患者中有12名（20.3%），差异有统计学意义（P = .014）。在1周内未分娩者中，Bishop评分也有统计学差异（P = .013，Mann-Whitney U检验）（研究组和对照组分别为4 ± 2.5和2.6 ± 1.7）。在平均分娩天数方面也观察到显著差异（分别为8.8 ± 6.7和13.6 ± 7.5；P < .001）。剥膜组和对照组的过期妊娠发生率分别为61例中的1例（1.6%）和59例中的3例（5.1%）。母婴并发症方面未观察到显著差异。
人工剥膜在促进足月分娩发动方面安全有效。
