MacKenzie I Z, Burns E
Department of Obstetrics, John Radcliffe Hospital, Oxford, UK.
Br J Obstet Gynaecol. 1997 Sep;104(9):1062-7. doi: 10.1111/j.1471-0528.1997.tb12068.x.
To compare the outcome of induction of labour using a single versus two doses of prostaglandin E2 vaginal gel.
Prospective randomised trial comparing a single dose of prostaglandin E2 2 mg vaginal gel in the evening with two doses of prostaglandin E2 (2 mg), the second being given after six hours if labour had not started or the cervix was still unripe. Amniotomy and oxytocin titration were performed when necessary for both protocols. Nulliparae and multiparae were analysed separately by treatment intention.
A maternity unit in a district general hospital annually delivering > 6000 women.
Nine-hundred and ninety-five women with viable singleton pregnancies and cephalic presentation at term without previous history of caesarean section who were advised to have labour induced with prostaglandins.
Need for formal amniotomy and oxytocin augmentation, use of epidural analgesia, rate of intrapartum interventions, mode of delivery and neonatal condition at birth.
For multiparae two prostaglandin doses resulted in a significant reduction in the need for formal amniotomy (15% vs 30%) and oxytocin augmentation (28% vs 38%) compared with those receiving a single dose; there was no significant difference for nulliparae. Other interventions during labour, length of labour, and mode of delivery were similar in both protocols. Failed induction occurred only in nulliparae and was similar in both protocols (1%). There was no discernible difference in fetal or neonatal outcome although passage of meconium was more common in labour if two doses had been given, as was neonatal admission to the special care baby unit.
There was little clinical benefit from inducing labour with two doses of prostaglandin E2 at a six-hour interval, compared with a single dose. There may be financial advantages with a two-dose regimen.
比较单剂量与两剂量前列腺素E2阴道凝胶引产的效果。
前瞻性随机试验，比较晚上单剂量2毫克前列腺素E2阴道凝胶与两剂量前列腺素E2（2毫克），若6小时后仍未开始分娩或宫颈仍未成熟，则给予第二剂。两种方案必要时均行人工破膜和缩宫素滴定。按治疗意向分别分析初产妇和经产妇。
一家每年接生超过6000名产妇的区级综合医院的产科病房。
995名单胎妊娠、足月头先露且无剖宫产史的孕妇，建议使用前列腺素引产。
正式人工破膜和缩宫素加强的需求、硬膜外镇痛的使用、产时干预率、分娩方式及出生时新生儿状况。
与单剂量组相比，经产妇使用两剂前列腺素后，正式人工破膜的需求（15%对30%）和缩宫素加强的需求（28%对38%）显著降低；初产妇无显著差异。两种方案中，产时的其他干预、产程长度和分娩方式相似。引产失败仅发生在初产妇中，两种方案相似（1%）。虽然使用两剂时分娩时胎粪排出更常见，新生儿入住特殊护理婴儿病房的情况也更常见，但胎儿或新生儿结局无明显差异。
与单剂量相比，间隔6小时使用两剂前列腺素E2引产几乎没有临床益处。两剂量方案可能有经济优势。
