宫腔镜电切手术中米索前列醇扩张宫颈的探讨

目的探讨米索前列醇在宫腔镜电切手术中扩张宫颈的作用。方法选择需行宫腔镜电切手术患者96例,分为两组:米索前列醇组48例,患者行宫腔镜手术前3h阴道放置米索前列醇400μg;对照组48例,宫腔镜手术前2min宫颈注射2%利多卡因5mL。结果米索前列醇组宫颈软化良好率达85.40%,明显高于利多卡因对照组的6.25%,P<0.005;米索前列醇组扩张宫颈所需时间为(3.1±0.5)min,短于对照组的(7.4±1.2)min,P<0.05;米索前列醇组心脑综合征的发生率4.2%,低于对照组的18.8%,P<0.05。结论宫腔镜手术前3h阴道放置米索前列醇400μg能有效地扩张松弛宫颈。     

Methods for cervical ripening and induction of labor

Induction of labor is common in obstetric practice. According to the most current studies, the rate varies from 9.5 to 33.7 percent of all pregnancies annually. In the absence of a ripe or favorable cervix, a successful vaginal birth is less likely. Therefore, cervical ripening or preparedness for induction should be assessed before a regimen is selected. Assessment is accomplished by calculating a Bishop score. When the Bishop score is less than 6, it is recommended that a cervical ripening agent be used before labor induction. Nonpharmacologic approaches to cervical ripening and labor induction have included herbal compounds, castor oil, hot baths, enemas, sexual intercourse, breast stimulation, acupuncture, acupressure, transcutaneous nerve stimulation, and mechanical and surgical modalities. Of these nonpharmacologic methods, only the mechanical and surgical methods have proven efficacy for cervical ripening or induction of labor. Pharmacologic agents available for cervical ripening and labor induction include prostaglandins, misoprostol, mifepristone, and relaxin. When the Bishop score is favorable, the preferred pharmacologic agent is oxytocin.     

Histological aspects of cervical ripening.

There is a close relationship between the rate of the uterine cervix opening during parturition and the presence or absence of a completely ripened cervix. In order to learn the basic pattern of the ripening of cervix, histological and histochemical studies were performed on the human uterine cervix during pregnancy. It was noted that the collagen bundles disintegrated into fine fibers and also underwent quantitative changes during the ripening process of the cervix. During pregnancy, the number of connective tissue cells was increased, but that of mast cells was decreased. Acid mucopolysaccharides in the cervical ground substance were found to increase in late pregnancy.     

米索前列醇用于人工流产扩张宫颈的临床观察

目的探讨米索前列醇在人工流产术（妊娠7～11周）前应用的临床效果。方法采用术前12h口服米索前列醇0.4mg的方法，观察术时宫颈口扩张大小、出血量、手术时间以及人工流产综合征的发生率。结果术前口服米索前列醇可以使宫口松弛，子宫收缩良好，出血量减少，平均手术时间短，人工流产综合征发病率低，术后随访显示患者阴道流血时间短。结论口服米索前列醇简便、安全、有效，可以作为人工流产术前常规用药。     

Current trends in cervical ripening and labor induction.

Labor is induced in more than 13 percent of deliveries in the United States. Postdate pregnancy is the most common indication. Oxytocin is the drug of choice for labor induction when the cervical examination shows that the cervix is favorable. The use of this agent requires experience and vigilant observation for uterine hyperstimulation, hypertonus or maternal fluid overload. In a patient whose cervix is unfavorable, the use of prostaglandin analogs for cervical ripening markedly enhances the success of inductions. Misoprostol, a prostaglandin E1 analog marketed as a gastrointestinal mucosal protective agent, is safe, efficacious and inexpensive for use in cervical ripening and labor induction. Further studies will better delineate its optimal use. Family physicians need to be familiar with the various methods of cervical ripening and labor induction.     

普贝生促临产妇宫颈成熟的临床观察

目的评价普贝生促宫颈成熟的有效性和安全性.方法将157例妊娠足月、宫颈Bishop评分≤5分、有阴道分娩适应证、无引产禁忌证的单胎头位孕妇分为两组:78例给予普贝生一枚(10mg)塞阴道促宫颈成熟作为实验组;79例给予美利斯200mg/d静推促宫颈成熟作为对照组.对两组用药后宫缩、胎心、宫颈成熟度改变、用药至临产时间、胎儿娩出时间及新生儿情况等进行观察.结果用药12h后,实验组宫颈Bishop评分平均提高(3.17±1.38)分,对照组平均提高(0.52±0.13)分,两组间有显著性差异(p＜0.01).24h内实验组64.1%(50/78)的孕妇临产,对照组5.1%(4/79)的孕妇临产,两组间有显著性差异(p＜0.01);实验组69.2%(54/78)的孕妇经阴道分娩,用药至胎儿娩出平均时间(25.73±18.22)h,对照组29.1%(23/79)的孕妇经阴道分娩,用药至胎儿娩出平均时间(77.72±54.86)h,阴道分娩率、用药至胎儿娩出时间两组间均有显著性差异(p＜0.05).两组间胎儿窘迫的发生率,新生儿Apgar评分均无统计学差异(p＞0.05).结论普贝生能够有效促进宫颈成熟,可以较安全用于临床.     

米索前列醇-耦合剂凝胶用于足月妊娠促宫颈成熟的临床观察

目的观察小剂量米索前列醇-耦合剂凝胶用于足月妊娠促宫颈成熟的效果及安全性。方法足月妊娠具备引产指征的产妇122例纳入研究,试验组62例,对照组60例,前者采用米索前列醇-耦合剂凝胶对比后者米索前列醇阴道后穹隆给药促宫颈成熟。结果试验组足月妊娠促宫颈成熟的总有效率为83.9%,显著高于对照组的65.0%(P<0.05),剖宫产率亦低于对照组(P<0.05),但新生儿出生体质量及新生儿窒息率与对照组比较差异无统计学意义(P>0.05)。结论小剂量阴道后穹窿米索前列醇-耦合剂凝胶用于足月妊娠促宫颈成熟是一种安全有效的方法,对母儿无明显不良影响。     

Acupuncture for cervical ripening and induction of labor at term--a randomized controlled trial.

OBJECTIVE: The aim of this study was to evaluate whether acupuncture at term can influence cervical ripening, induce labor and thus reduce the need for postdates induction. METHODS: On the estimated date of confinement (EDC) women were prospectively randomized to an acupuncture group (AG) or a control group (CG). Data of 45 women were evaluated (AG, n = 25; CG, n = 20). Inclusion criteria were as follows: confirmed EDC, uncomplicated course of pregnancy, singleton pregnancy in cephalic presentation. Exclusion criteria were as follows: cervical dilation > 3 cm, active labor, premature rupture of membranes, previous cesarean section, pathologies in mother or fetus. Women were examined at 2-day intervals. The cervical length was measured with vaginal ultrasonography, cervical mucus was obtained for a fetal Fibronectin test and the cervical status was assessed according to the Bishop score. In the AG, the points Hegu (Large Intestine 4) and Sanyinjiao (Spleen 6) were pierced on both sides every second day. If women were not delivered 10 days after EDC, labor was induced by administering vaginal prostaglandin tablets. RESULTS: The cervical length in the AG was shorter than that in the CG on day 6 and day 8 after EDC (P = 0.04 for both). In the AG the time period from the first positive Fibronectin test to delivery was 2.3 days, while that in the CG was 4.2 days (P = 0.08). The time period from EDC to delivery was on average 5.0 days in the AG and 7.9 days in the CG (P = 0.03). Labor was induced in 20% of women in the AG (n = 5) and in 35% in the CG (n = 7) (P = 0.3). Overall duration of labor, and first and second stage of labor were not different in the two groups. In 56% of women who underwent acupuncture (n = 14) and in 65% of controls (n = 13), Oxytocin was used to augment labor. (P = 0.54). CONCLUSION: Acupuncture at points LI4 and SP 6 supports cervical ripening at term and can shorten the time interval between the EDC and the actual time of delivery.     

双球囊用于足月妊娠促宫颈成熟的效果观察

目的探讨双球囊用于足月妊娠促宫颈成熟、提高引产成功率的可行性及护理策略。方法将62例采用库克医疗公司促宫颈成熟球囊(Cook Medical’s Cervical Ripening Balloon,简称Cook球囊)引产的产妇作为观察组,将采用普通分娩方式的100例产妇作为对照组,观察两组产程、出血情况、分娩结局及新生儿情况,并进行比较。结果观察组采用Cook球囊促宫颈成熟总有效率为93.5%,且观察组经阴道分娩率高于对照组,产程短于对照组,差异有统计学意义(P<0.05),而产妇出血量、新生儿情况两组比较差异无统计学意义(P>0.05)。结论采用Cook球囊引产可有效地促进宫颈成熟和提高引产成功率,值得推广应用。     

三种药物促进宫颈成熟的临床应用观察

目的 观察普贝生、米索前列醇、缩宫素三种促进宫颈成熟药物的有效性和安全性。方法采用随机对照研究方法,将180例初产妇分为3组,A组：普贝生;B组：小剂量米索前列醇组;C组：缩宫素组。比较三组用药前、后4、8、12h宫颈Bishop评分,用药后分娩情况、胎儿窘迫及新生儿窒息的发生率。结果A、B、C三组的有效率分别为88．3％、85．0％、35．0％;用药后剖宫产率分别为21．7％、25．0％、60．0％。A,B组分别与C组比较差异有统计学意义（P〈0．05）。结论普贝生及米索前列醇均是安全、有效的,临床应用成功率高;缩宫素则疗效欠佳。     

欣普贝生在妊娠晚期促宫颈成熟及引产中的应用

[目的]评价欣普贝生在妊娠晚期促宫颈成熟及引产的疗效及安全性.[方法]选取2009年1月-2010年6月住院分娩的符合纳入标准的初产妇共244例进行回顾性分析,按使用药物的不同分为缩宫素组和欣普贝生组,比较两组产程以及分娩结局.[结果]欣普贝生组24 h内临产率达到84.55%,明显高于缩宫素组;欣普贝生组从用药到临产时间是(5.58±3.85)h、总产程为(5.85±2.20)h、第1产程为(4.51±1.85)h,均短于缩宫素组(P<0.05).[结论]欣普贝生促宫颈成熟及引产有效、方便、安全.     

经会阴B超宫颈评分对头位分娩方式的预估

目的：了解宫颈成熟度与分娩方式的关系、方法：排除骨盆异常、巨大儿及其他产科、内科合并症,对102例孕兀一42周、头位、单胎、初产孕妇经会阻B超,观察宫颈长度、宫颈内目扩张程度及羊膜囊嵌入宫内日程度进行宫颈成熟度评分,并与其分娩方式相比较。结果：0－3分（34例）,4－6分（34例）,Z7分（34例）的手术产率分别为对．59％。14．71%及8．82%（x2＝36.70,P＜0．001）。0－3分组剖宫产率（52．94％）为＞7分组（2．94%）的18倍。结论：宫颈成熟度评分对头位分娩方式有一定提示作用。     

控释前列腺素E2栓剂用于50例促宫颈成熟和引产的临床观察

目的探讨控释前列腺素E2栓剂（普贝生）用于足月妊娠促宫颈成熟的有效性及安全性。方法对50例足月妊娠孕妇阴道后穹隆放置普贝生,若无不良反应,12h取出。研究对孕妇宫颈Bishop评分,宫缩情况,胎心的变化,分娩方式,分娩发动时间及新生儿结局的影响。结果用药后80．0％的孕妇Bishop评分提高了≥3分,14．0％的孕妇平均提高了≥2分。普贝生明显地提高了宫颈Bishop评分。有2例发生子宫过度刺激,2例发热,取药后很快好转,未导致不良后果。结论普贝生是一种有效、安全的促宫颈成熟的药物,引产成功率较高。因其宫缩过强,过频,发热等不良反应,用药后要加强监护。     

促宫颈成熟球囊引产疗效及对分娩与新生儿结局的影响

目的探讨促宫颈成熟球囊引产疗效及对分娩和新生儿结局的影响,为临床治疗提供一定依据。方法收集2013年6月至2015年7月西安交通大学第二附属医院收治的200例具有引产指征的孕妇作为研究对象。随机分为对照组100例和观察组100例,对照组给予控释前列腺素E2(PCE2)治疗;观察组给予促宫颈成熟球囊治疗。比较两组孕妇促宫颈成熟疗效、Bishop评分、分娩方式、剖宫产术率及分娩状况等。结果观察组患者促宫颈成熟有效率高达94.0%,明显高于对照组的有效率(83.0%),差异有统计学意义(P0.05)。观察组患者Bioshop评分高达(8.39±0.92)分,明显高于对照组的(7.12±0.35)分,差异有统计学意义(P0.05)。观察组剖宫产术率仅为8.0%,明显低于对照组的19.0%,差异有统计学意义(P0.05)。观察组孕妇诱发临产时间为(14.7±2.8)h,明显少于对照组的(16.4±3.4)h,差异有统计学意义(P0.05);观察组孕妇产后出血(160.2±49.3)mL,明显少于对照组的(180.8±56.1)mL,差异有统计学意义(P0.05)。结论促宫颈成熟球囊引产疗效明显,可明显降低孕妇剖宫产术率,并减少产妇产后出血,值得在临床上进一步深入探讨研究与推广应用。     

Transvaginal ultrasound measurement of cervical length and efficacy of misoprostol in first-trimester pregnancy failure.

OBJECTIVE: The aim of this study was to assess the role of cervical length measurement in predicting successful treatment, by misoprostol administration, of early (first-trimester) pregnancy failure. METHOD: A prospective study was conducted of all patients who agreed to medical treatment of pregnancy failure. Cervical length and other sonographic variables were measured using pelvic ultrasound before medical treatment began. Measurements were compared between the group with successful medical treatment and the group in whom treatment failed. RESULTS: In 125 women included in the study, the success rate of misoprostol treatment was 64.8%. There were no significant differences between the groups with successful and failed treatment for cervical length (29.9 +/- 9.3 vs. 30.4 +/- 6.8 mm, P = 0.75), distance between gestational sac and 'virtual' cervical internal os (23.9 +/- 13 vs. 26.6 +/- 13 mm, P = 0.26), crown-rump length (8.7 +/- 9.7 vs. 6.7 +/- 8.6 mm, P = 0.25), or gestational sac diameter (31.3 +/- 14 vs. 30.1 +/- 15 mm, P = 0.73). CONCLUSION: Cervical length does not predict the success of misoprostol treatment of first-trimester pregnancy failure.     

球囊促宫颈成熟联合缩宫素引产 40 例效果观察

目的观察宫颈扩张球囊促宫颈成熟联合小剂量缩官素引产的临床效果。方法选择具有引产指征、Bishop宫颈评分≤6分的孕妇40例,先放置宫颈扩张球囊12h,未临产者,即予缩宫素静脉滴注,观察效果。结果本组12小时内出现规律宫缩8例,联合缩宫素静脉滴注后出现规律宫缩31例。仅有1例连续使用3天缩宫素引产均未进入正式产程,后因孕妇要求改剖宫产术。引产有效率97．5％。结论宫颈扩张球囊促宫颈成熟联合小剂量缩宫素引产是一种安全有效、成功率高的引产方法。     

替勃龙配伍米索前列醇联合宫颈扩张棒用于绝经后取器的临床观察

目的为绝经后取器寻找新的术前宫颈准备方法。方法收集783例绝经取器妇女的相关资料,取器时随机分为A、B、C 3组,A组于术前半月口服替勃龙2.5mg,隔日一次,总量17.5mg,手术当日术前2h舌下含服米索前列醇400mg,术中置入宫颈扩张棒;B组常规消毒阴道后暴露宫颈,置入一次性宫颈扩张棒,5min后取出;C组术前2h舌下含服米索前列醇400mg准备宫颈,比较3组取器术的临床效果。结果 A组宫颈软化程度最好,均顺利取器,有轻度疼痛,手术时间短,出血少。B组次之,取器成功率为92.34%,均有轻度至明显疼痛。A、B两组宫口扩张大小、手术时间、出血量及成功率均优于C组,差异有统计学意义(P<0.05)。结论术前、术中应用药物及宫颈扩张棒可提高取器成功率。