Goldenberg M, Dulitzky M, Feldman B, Zolti M, Bider D
Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Eur J Obstet Gynecol Reprod Biol. 1996 Jun;66(2):129-32. doi: 10.1016/0301-2115(96)02405-0.
To determine whether routine antepartum stretching of the cervix and stripping of the membranes at term would shorten the length of pregnancies, and whether this correlated with cervical status and fetal and maternal parameters.
A prospective, randomised, controlled study of 293 term gravidas, free of medical complications, divided into two groups: stretching/stripping, and non-stretching/stripping. Digital separation of the fetal membranes from the lower uterine segment, and cervical stretching, were performed during routine vaginal examination of the first group. In the second group, only routine vaginal examination was performed.
Of 293 patients, 152 underwent a trial of stretching and stripping; 141 served as a control group. The mean interval (hours to delivery after the procedure) was 136 h (S.D. 10), compared to 161 h (S.D. 11) in the control group (P = 0.095; not significant), but with only a trend towards the shorter interval in the first group. When patients were matched according to weeks of gestation and fetal and maternal parameters, only those at 41 weeks' gestation or more had a significant reduction in the interval from the procedure to delivery (mean 91 h (S.D. 8) compared to mean 125 h (S.D. 10) in the control group; P < 0.007). This observation was independent of cervical status and other maternal or fetal parameters.
Only patients > or = 41 weeks' gestation benefitted from stretching of the cervix and stripping of the fetal membranes. The effect was not dependent on the cervical status or other maternal and fetal parameters.
确定足月时常规产前宫颈扩张及胎膜剥脱是否会缩短孕期，以及这是否与宫颈状况、胎儿及母体参数相关。
一项对293例无医学并发症的足月孕妇进行的前瞻性、随机、对照研究，分为两组：扩张/剥脱组和非扩张/剥脱组。在第一组的常规阴道检查期间，将胎膜与子宫下段进行手指分离并进行宫颈扩张。第二组仅进行常规阴道检查。
293例患者中，152例接受了扩张和剥脱试验；141例作为对照组。平均间隔时间（操作后至分娩的小时数）为136小时（标准差10），而对照组为161小时（标准差11）（P = 0.095；无统计学意义），但第一组仅有间隔时间较短的趋势。当根据孕周、胎儿及母体参数进行匹配时，只有孕周在41周及以上的患者从操作至分娩的间隔时间显著缩短（平均91小时（标准差8），而对照组平均为125小时（标准差10）；P < 0.007）。该观察结果与宫颈状况及其他母体或胎儿参数无关。
只有孕周≥41周的患者从宫颈扩张及胎膜剥脱中获益。其效果不依赖于宫颈状况或其他母体及胎儿参数。
