Mancuso S, Ferrazzani S, De Carolis S, Carducci B, De Santis L, Caruso A
Catholic University of Rome, Department of Obstetrics and Gynecology.
Minerva Ginecol. 1996 Mar;48(3):95-8.
We compare trends and current levels of cesarean section delivery by indication in some industrialized countries to help us understand factors underlying national differences in obstetric delivery practice and identify pathways to lower cesarean rates.
In this report we describe the schemes employed at our Department for the management of low-risk at term and postterm pregnancies and list the most important motivations for increased cesarean section rate and remedies suggested to reduce high cesarean section rate. Moreover a randomized trial to assess the role of labor induction with PGE2 gel vs i.v. Oxytocin+Amniotomy in the management of prolonged pregnancy is being evaluated presently at our center.
To date, 75 postterm pregnancies have been followed. Patients are enrolled at > or = 287 days (41 weeks). Intracervical PGE2 gel (0.5 mg) is used for cervical ripening. Induction of labor is randomly performed using intravaginal PGE2 gel (2 mg) or i.v. Oxytocin+Amniotomy.
Overall rates of 75% for spontaneous delivery, and 25% for cesarean section have been observed in our study group of prolonged pregnancies.
The accurate labelling of low- and high-risk pregnancy and the appropriate management of term and postterm pregnancy are two important steps for the reduction of a high rate of cesarean section.
我们比较了一些工业化国家剖宫产分娩的趋势和当前水平，以帮助我们了解产科分娩实践中各国差异背后的因素，并确定降低剖宫产率的途径。
在本报告中，我们描述了本部门用于管理足月和过期妊娠低风险的方案，并列出了剖宫产率上升的最重要原因以及为降低高剖宫产率建议的补救措施。此外，我们中心目前正在评估一项随机试验，以评估前列腺素E2凝胶引产与静脉注射缩宫素+人工破膜在过期妊娠管理中的作用。
迄今为止，已对75例过期妊娠进行了随访。患者在≥287天（41周）时登记入组。宫颈内使用前列腺素E2凝胶（0.5毫克）进行宫颈成熟。使用阴道内前列腺素E2凝胶（2毫克）或静脉注射缩宫素+人工破膜随机进行引产。
在我们的过期妊娠研究组中，自然分娩率总体为75%，剖宫产率为25%。
准确标记低风险和高风险妊娠以及对足月和过期妊娠进行适当管理是降低高剖宫产率的两个重要步骤。
