Wing D A, Paul R H
Department of Obstetrics and Gynecology, Women's and Children's Hospital, University of Southern California School of Medicine, Los Angeles 90033, USA.
Am J Obstet Gynecol. 1998 Jul;179(1):94-9. doi: 10.1016/s0002-9378(98)70256-x.
Our purpose was to compare vaginally administered misoprostol (Cytotec) with intravenous oxytocin for labor induction in women with premature rupture of membranes beyond 36 weeks' gestation.
Two hundred subjects with rupture of membranes without labor were randomly assigned to receive vaginally administered misoprostol or intravenous oxytocin. Twenty-five micrograms of misoprostol (Cytotec) was placed in the posterior vaginal fornix. If cervical ripening (Bishop score of > or = 8 or cervical dilatation of > or = 3 cm) or active labor did not occur, a single repeat dose of misoprostol was given 6 hours later. Oxytocin was administered intravenously by a standardized incremental infusion protocol to a maximum dose of 22 mU per minute.
Of the 197 subjects evaluated, 98 received misoprostol and 99 oxytocin. The average interval from start of induction to vaginal delivery was about 1 hour longer in the misoprostol group (811.5 +/- 511.4 minutes) than in the oxytocin group (747.0 +/- 448.0 minutes) (P = .65, log transformed data). Oxytocin administration was necessary in 37 of 98 (37.8%) of misoprostol-treated subjects. Vaginal delivery occurred in 85 misoprostol-treated subjects (86.7%) and 82 (85.9%) oxytocin-treated subjects (relative risk 1.17, 95% confidence interval 0.78 to 1.78, P = .45) with the remainder undergoing cesarean birth. There was no difference in the incidence of tachysystole (six or more uterine contractions in a 10-minute window for two consecutive 10-minute periods) or hypertonus between the two groups. There was no significant difference in frequency of abnormal fetal heart rate tracings between the two groups (29.6% in the misoprostol group and 28.9% in the oxytocin group, P = .91). Chorioamnionitis was diagnosed in 28 (28.6%) misoprostol-treated subjects and 26 (26.3%) oxytocin-treated subjects (P = .72, relative risk 1.06, 95% confidence interval 0.78 to 1.45). No significant differences were found in the incidence of fetal meconium (8.1% and 9.1%), 1- or 5-minute Apgar scores < 7 (11.0% and 10.2% of 1-minute Apgar scores, and 2.0% and 2.0% of 5-minute Apgar scores), neonatal resuscitation (24.5% and 27.6%), or admission to the neonatal intensive care unit (25.5% and 32.3%) between the two groups.
Vaginal administration of misoprostol (Cytotec) is an effective alternative to oxytocin infusion for labor induction in women with premature rupture of the membranes near term. The incidence of untoward effects is similar with use of the two agents.
我们的目的是比较阴道给予米索前列醇（喜克溃）与静脉滴注缩宫素用于妊娠36周后胎膜早破孕妇引产的效果。
200例未临产的胎膜早破患者被随机分为两组，分别接受阴道给予米索前列醇或静脉滴注缩宫素。将25微克米索前列醇（喜克溃）置于阴道后穹窿。如果未出现宫颈成熟（ Bishop评分≥8或宫颈扩张≥3 cm）或活跃产程，则在6小时后单次重复给予米索前列醇。缩宫素通过标准化的递增输注方案静脉给药，最大剂量为每分钟22 mU。
在197例接受评估的患者中，98例接受米索前列醇治疗，99例接受缩宫素治疗。米索前列醇组从引产开始至阴道分娩的平均间隔时间（811.5±511.4分钟）比缩宫素组（747.0±448.0分钟）长约1小时（P = 0.65，对数转换数据）。98例接受米索前列醇治疗的患者中有37例（37.8%）需要加用缩宫素。85例接受米索前列醇治疗的患者（86.7%）和82例接受缩宫素治疗的患者（85.9%）经阴道分娩（相对危险度1.17，95%可信区间0.78至1.78，P = 0.45），其余患者行剖宫产。两组间子宫收缩过速（连续两个10分钟时段内10分钟窗口内出现6次或更多次子宫收缩）或子宫收缩过强的发生率无差异。两组间异常胎儿心率监测频率无显著差异（米索前列醇组为29.6%，缩宫素组为28.9%，P = 0.91）。28例（28.6%）接受米索前列醇治疗的患者和26例（26.3%）接受缩宫素治疗的患者被诊断为绒毛膜羊膜炎（P = 0.72，相对危险度1.06，95%可信区间0.78至1.45）。两组间胎儿胎粪排出率（8.1%和9.1%）、1分钟或5分钟Apgar评分<7（1分钟Apgar评分分别为11.0%和10.2%，5分钟Apgar评分分别为2.0%和2.0%）、新生儿复苏率（24.5%和27.6%）或新生儿重症监护病房入住率（25.5%和32.3%）均无显著差异。
对于近足月胎膜早破的孕妇，阴道给予米索前列醇（喜克溃）是一种有效的引产替代方法，可替代缩宫素静脉滴注。两种药物使用时不良反应的发生率相似。
