Carta G, Vigilante M, Di Cesare S, Mascaretti G, Caserta D, Moscarini M
Dipartimento di Discipline Chirurgiche, Clinica Ginecologica e Ostetrica, Università degli Studi, L'Aquila.
Minerva Ginecol. 1997 Oct;49(10):427-32.
To evaluate the efficacy and safety of intracervical prostaglandin E2 gel applications (PgE2) for cervical ripening and induction of labor in relation to parity and admission cervical score.
One hundred and thirty-nine hospitalized patients with an unfavorable cervix (Bishop score < or = 4) received a dose of commercially available endocervical dinoprostone gel 0.5 mg. On the basis of cervical scores, the gel was reapplied at a 12-hour interval for a maximum of two doses. If cervical ripening was successful (Bishop score > 4) but labor did not start within 12 hours from the last dose of gel, labor was induced with oxytocin infusion or with 1 or 2 doses of intravaginal dinoprostone.
Intracervical gel was effective for preparing an unfavorable cervix in 87.1% of patients. In 53.1% of nulliparous with admission Bishop < or = 2 the interval between the first application of gel and delivery was higher than 24 hours whereas in all patients with parity > or = 1 and initial Bishop score between 3 and 4 delivery was achieved within 24 hours. The cesarean delivery rates in the two groups were 23.9% and 43% respectively.
The interval from the first application of gel to delivery is strongly influenced by parity and initial cervical score. Vaginal delivery can be expected in four fifths of patients with an unfavorable cervix who undergo pre-induction cervical ripening with prostaglandin E2 gel.
评估宫颈内应用前列腺素E2凝胶（PgE2）促进宫颈成熟及引产的有效性和安全性，并分析其与产次和入院时宫颈评分的关系。
139例宫颈条件不佳（Bishop评分≤4分）的住院患者接受一剂0.5mg市售的宫颈内米索前列醇凝胶。根据宫颈评分，每12小时重复应用一次凝胶，最多应用两剂。如果宫颈成熟成功（Bishop评分>4分）但自最后一剂凝胶后12小时内未发动分娩，则用缩宫素静脉滴注或1或2剂阴道米索前列醇引产。
宫颈内凝胶使87.1%的患者宫颈条件不佳的情况得到改善。入院时Bishop评分≤2分的初产妇中，53.1%的患者从首次应用凝胶到分娩的间隔时间超过24小时，而所有产次≥1且初始Bishop评分为3至4分的患者在24小时内分娩。两组的剖宫产率分别为23.9%和43%。
从首次应用凝胶到分娩的间隔时间受产次和初始宫颈评分的强烈影响。五分之四宫颈条件不佳且接受前列腺素E2凝胶引产术前宫颈成熟的患者有望经阴道分娩。
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