经会阴B超行子宫颈成熟度评分

经会阴Ｂ超，对１００例孕３８～４２周的孕妇进行子宫颈成熟度评分。其中８６例为正常妊娠，１４例有产科合并症及并发症。胎位均为头位。阴道分娩５９例，剖宫产４１例（其中１１例未临产）。通过观察宫颈长度、官颈内口扩张程度、先露高度、宫颈回声强度和宫颈位置，参照宫颈Ｂｉｓｈｏｐ评分，建立超声宫颈成熟度评分标准。结果：评分≥９分者１４例，临产所需时间３．９±３．１小时，均临产；５～８分者５４例，临产所需时间为２０．８±３．９小时，均临产；≤４分者３２例，临产所需时间为４６．９±３．９小时，２１例临产；三者间比较，临产时间差异有极显著性（Ｐ＜０．００１）。当羊膜囊突入宫颈管内时，临产所需时间为５．３±３．７小时。提示：经会阴Ｂ超行子宫颈成熟度评分是一种简单可行的评分方法。     

三种引产方法的前瞻性比较研究

目的：前瞻性研究米索前列醇（Ｍｉｓｏ）、低位水囊（ＬＰＷＢ）及小剂量催产素（ＯＸ）静脉滴注３种引产方法的有效性及对母、婴的影响。方法：将１２４例单胎、头位、、宫颈Ｂｉｓｈｏｐ评分＜５分、足月妊娠初产妇随机分为３组：Ｍｉｓｏ组４１例，ＬＰＷＢ组４３例，ＯＸ组４０例；３种方法引产后，如宫颈Ｂｉｓｈｏｐ评分≥７分，则行人工破膜术。结果：ＬＰＷＢ组及Ｍｉｓｏ组较ＯＸ组、宫颈Bｉｓｈｏｐ评分＜５分显著提高（Ｐ＜０．００１，P＜０．０１），引产到临产时间明显缩短（Ｐ＜０．００１，Ｐ＜０．０５），但３组间母、婴并发症差异无显著性。结论：对宫颈不成熟孕妇采用ＬＰＷＢ及Ｍｉｓｏ引产安全、有效、经济，可靠，ＯＸ静脉滴注引产不宜作为首选引产方法     

前列腺素E2促宫颈成熟的临床应用和效果

本文综述了足月姊妹引产前宫颈局部使用前列腺素Ｅ２（ＰＧＥ２）凝胶促子宫颈成熟的方法，临床效果，副作用及其处理。ＰＧＥ２能明显改善宫颈Ｂｉｓｈｏｐ评分，提高引产成功率，缩短监产至分娩时间和减少时催产素用量。ＰＧＥ２的副作用发生少，症状轻。     

应用阴道B超观察临产前宫颈的变化

目的探讨应用阴道Ｂ超,观察临产前宫颈变化对预测分娩结局的临床价值。方法对８３例单胎足月分娩的初产妇自妊娠３６周起,应用阴道Ｂ超测量宫颈长度、宽度及颈管直径,每周１次至临产前。观察以上指标与孕周及距临产时间的关系。按分娩方式分为两组,阴道分娩组５２例,剖宫产组３１例。比较两组间宫颈变化及临产所需时间的差异。结果自孕３６周至临产,宫颈长度逐渐缩小,而颈管直径逐渐增大,与孕周呈明显的相关关系（ｒ＝－０．３７,Ｐ＜０．００００１;ｒ＝０．１６,Ｐ＝０．００２）。距临产时间与宫颈长度和颈管直径呈明显的相关关系（ｒ＝０．３２,Ｐ＜０．００００１;ｒ＝－０．１９,Ｐ＝０．０２）。两组的宫颈长度及距临产所需时间比较,差异无显著性（Ｐ＞０．０５）。在临产前２～３周,宫颈长度＞３．５ｃｍ者,剖宫产率明显大于宫颈长度≤３．５ｃｍ者。结论阴道Ｂ超可以准确地测量宫颈长度、宽度及颈管直径。临产前测量宫颈长度可反映宫颈的成熟状况,并对产程进展和分娩结局有一定的预测意义。     

人宫颈粘液葡萄糖、果糖变化规律的研究

本文对月经周期规律的１５例育龄妇女２０个月经周期宫颈粘液及血清葡萄糖、果糖水平进行测定，同时对血清促黄体激素（ＬＨ）、促卵泡激素（ＦＳＨ）、雌二醇（Ｅ２）和孕酮（Ｐ）放免测定；阴道Ｂ超、宫颈粘液Ｉｎｓｌｅｒ评分；尿ＬＨ酶联免疫测定和基础体温（ＢＢＴ）测定，综合评价预测和确定排卵日。２０个周期均为有排卵周期。结果：宫颈粘液葡萄糖、果糖水平均表现为卵泡期稍高，排卵前最低，排卵后逐渐升高，黄体中期达高峰；卵泡期果糖水平与Ｅ２呈负相关（ｒ＝－０．７３，Ｐ＜０．０１）；黄体期葡萄糖、果糖水平均与Ｐ呈正相关（ｒ＝０．９９，Ｐ＜０．０１；ｒ＝０．９８，Ｐ＜０．０１）；血葡萄糖、果糖水平无周期性变化且与宫颈粘液葡萄糖、果糖水平无明显相关性（ｒ＝０．２３，Ｐ＞０．０５）。结论：宫颈粘液葡萄糖、果糖水平变化具有明显规律性，可能与雌孕激素调节有关。     

安定纱布宫颈局部应用于引产

选择引产妇７４例随机分实验组与对照组各３７例，均为静脉点滴催产素两天未临产者于第三天行人工破膜加催产素静脉点滴，实验组于人工破膜后再以小纱布一块浸透安定１０ｍｇ置于宫颈管内继之静脉点滴催产素。结果：实验组宫颈评分提高４．４１±１．５０分，对照组评分提高１．４６±０．８７分（Ｐ＜０．００１）。实验组引产成功率为８９．１９％，对照组为５１．３５％（Ｐ＜０．００１）。实验组剖宫产率为３７．８４％，对照组为７５．６８％（Ｐ＜０．０５）。结论：安定纱布宫颈局部应用于引产中可有效改善宫颈评分，提高引产成功率，降低引产失败的剖宫产率     

米非司酮配伍米索前列醇用于晚期妊娠引产的效果观察

目的：探讨米非司酮醇配伍米索前列醇在晚期妊娠引产中的作用。方法；对６８例妊娠３８－４１周的正常孕妇有引产指征者，分别在１－３日服和米非司酮１５０－２００ｍｇ，并地用药前的观察吕颈长度及宫颈评分的变化。同时检测血清雌二醇（Ｅ２）及孕酮（Ｐ）的水平。第４日分次加服米索胶列醇１００－３００μｇ，观察引产效果。结果：服用米非司酮后宫颈缩短１３ｃｍ，Ｂｉｓｈｏｐ评分提高了４－５分，Ｅ２明显升高（Ｐ〈０．０１     

米索前列醇用于足月妊娠引产的临床观察

目的：探讨米索前列醇用于足月妊娠引产的安全性及效果。方法：将６０例有引产指征的孕足月单胎头位、无宫缩的初产妇，随机分成两组，研究组（３０例）用米索前列醇５０μｇ阴道用药，每３小时１次至正式临产；对照组（３０例）用蓖麻油鸡蛋餐口服。结果：两组引产总有效率无显著差异，研究组引产时间显著少于对照组（Ｐ＜０．０５），研究组需静脉滴注催产素人数为１０．０％，显著少于对照组的４０．０％，（Ｐ＜０．０５），用药６小时后研究组宫颈评分提高５．５分，对照组提高３．１分，评分结果比较，差异有显著性（Ｐ＜０．０５），研究组子宫收缩过频的发生率为１６．７％，对照组为３．０％。结论：阴道放置米索前列醇用于足月妊娠引产能促宫颈成熟及发动子宫收缩，是安全、有效的引产方法     

宫颈粘液葡萄糖果糖水平与不明原因不孕关系的探讨

本文对２３例不孕患者的２３个周期及对照组１５例２０个周期的宫颈粘液葡萄糖果糖水平进行测定。放免法测定血清促黄体素（ＬＨ）、促卵泡素（ＦＳＨ）、雌二醇（Ｅ２）和孕酮（Ｐ）；阴道Ｂ超监测卵泡发育；宫颈粘液改良Ｉｎｓｌｅｒ评分，尿ＬＨ酶联免疫测定和基础体温测定（ＢＢＴ）综合评价预测和确定排卵日。被研究对象均于围排卵期进行性交后试验（ＰＣＴ）。结果：４３个月经周期均为有排卵周期。不孕组（ＰＣＴ正确组７周期，ＰＣＴ异常组１６周期）宫颈粘液改良Ｉｎｓｌｅｒ评分与对照组无显著差异（Ｐ均＞０．０５）；不孕ＰＣＴ异常组卵泡期、排卵前、排卵后、黄体期宫颈粘液葡萄糖果糖水平均明显低于对照组（Ｐ＜０．０１）。而ＰＣＴ正常组与对照组无明显差异（Ｐ＞０．０５）。结论：宫颈粘液葡萄糖果糖水平低落可影响精子的穿透和存活，是不明原因性不孕的重要因素之一。     

卵泡发育不良的临床分析

目的探讨卵泡发育不良（ＦＭ）的表现及其结局。方法对２９６例不孕患者中的ＦＭ患者８０例（ＦＭ组）及２０例正常排卵者（对照组）进行连续宫颈评分、Ｂ超监测卵泡发育、放射免疫法测定血雌二醇（Ｅ２）值等检查,并行腹腔镜和子宫内膜活体组织检查。结果（１）在不孕妇女中ＦＭ发生率为２７０％;（２）ＦＭ组宫颈评分最高分为７３±１８分（ｘ±ｓ,下同）,对照组为１３２±１８分;月经中期血Ｅ２水平,ＦＭ组为３００±１００ｐｍｏｌ／Ｌ,对照组为９００±４００ｐｍｏｌ／Ｌ,两组比较,差异有显著性（Ｐ＜０．０１）;（３）Ｂ超检查显示,ＦＭ组卵泡模糊,常为多个小卵泡;（４）腹腔镜检查ＦＭ组约２／３以上病例卵巢上可见黄体,但无排卵裂孔,约１／３病例无黄体;（５）ＦＭ组子宫内膜呈分泌改变者占５６７％,呈增生期改变者占３３３％左右。结论（１）ＦＭ是不孕的一个重要原因;（２）ＦＭ结局有二,一为卵泡闭锁,另一为未成熟卵泡黄素化。     

Predictive value of pelvic scores for induction of labor by local PGE2.

The predictive value of pelvic scores, parity, age and gestational age for induction of labor by local prostaglandin-E2 (PGE2) was examined in 336 women attempting induction of labor by intracervical or vaginal PGE2. The patient characteristics were correlated to: (1) vaginal delivery within 48 h, (2) the period from induction to onset of labor (latency period), and (3) the duration of labor. The Bishop score (P < 0.01) and even more the Lange score (P < 0.0001) were significantly inversely correlated to both latency period and induction-delivery period. This was caused by cervical dilatation (P < 0.001), fetal station (P < 0.05) and cervical length (P < 0.05), whereas position and consistency of the cervix were of no importance. All three periods studied were significantly (P < 0.0001) shorter in parous women. In primiparous women, gestational age was of no importance for the latency period; however, higher gestational age was associated with longer labor (P < 0.001). We conclude that the predictive value of pelvic scores on induction hardly differs using local PGE2 compared to conventional methods; furthermore, the Bishop score should be substituted, disregarding position and consistency of the cervix, but putting more weight to cervical dilatation. A new pelvic score is proposed.     

阴道超声及细胞因子预测宫颈成熟度和临产时间的初步探讨

目的　探讨阴道超声、细胞因子———白细胞介素 (IL) 6、8及人绒毛膜促性腺激素 (hCG)对足月妊娠宫颈成熟度、临产时间的预测价值。方法　检测 79例足月初产妇宫颈阴道分泌液IL 6、IL 8及hCG水平 ;通过阴道超声测量孕妇宫颈长度、宫颈内口楔形区宽度、前羊膜囊长度 ;同时进行宫颈Bishop评分。结果　 (1)IL 6、IL 8、hCG临产后水平 [分别为 (782± 5 0 8)ng/L、(10 5 3 9± 8680 )ng/L、(114± 86)IU/L]较临产前 [分别为 (15 5± 75 )ng/L、(7113± 60 5 0 )ng/L、(3 5± 2 1)IU/L]显著升高 ,差异有极显著性 (P <0 0 5 )。 (2 )IL 6、IL 8、hCG、宫颈长度、前羊膜囊长度均与宫颈Bishop评分显著相关(r=0 42、0 2 4、0 44、- 0 5 6、0 3 5 ,P <0 0 5 )。 (3 )IL 6、IL 8、宫颈长度、前羊膜囊长度、宫颈Bishop评分均与临产时间显著相关 (r=- 0 42、- 0 46、0 64、- 0 5 2、- 0 41,P <0 0 1) ;且均能预测 1周内临产 ,其中宫颈长度的预测效果最好。宫颈长度≤ 3 0mm者 ,预测其在 1周内分娩的灵敏度、特异度、阳性预测值、阴性预测值分别为 0 83、0 89、0 91、0 81。 (4)多因素分析显示 :阴道超声测量宫颈长度 ,预测宫颈成熟度和临产时间的价值优于其他指标。结论　孕妇宫颈阴道分泌液IL 6、     

Transperineal versus transvaginal ultrasonographic evaluation of the cervix at each trimester in normal pregnant women

AIMS: To compare transvaginal and transperineal ultrasonography in the assessment of cervical length and cervical changes in normal gravid patients at each trimester. METHODS: Transperineal and transvaginal ultrasonographic cervical length was measured on 104 asymptomatic pregnant women between 10 and 14, 20-24, and 30-34 weeks' gestation and the presence of a funnel was also noted. The study used the McNemar chi2 test to assess the difference between two methods in their ability to obtain a measurement, and the Pearson correlation coefficient to determine the relationship between the paired transperineal and transvaginal cervical lengths. RESULTS: Cervical length measurements were obtained by transvaginal ultrasonography in all 104 patients and by transperineal ultrasonography in 101 patients (97.1%) (P = 0.1). By gestational age, the greatest length discrepancy (2.8 mm) between the two ultrasonographic methods was found at 10-14 weeks (P < 0.001). At 20-24 and 30-34 weeks' gestation, the mean length differences were less than 1 mm (P < 0.01 and P = 0.337, respectively). Cervical funnelling was observed in 16 patients by both methods, whereas in two patients from the 20-24 week gestational age group, funelling was observed by transvaginal ultrasonography and not by transperineal ultrasonography. CONCLUSIONS: Cervical length measurements by transperineal ultrasonography show good correlation with transvaginal ultrasonographic measurements and it is a satisfactory alternative to a transvaginal evaluation of the cervix throughout pregnancy.     

Comparison of labor progression between induced and noninduced multiparous women

OBJECTIVE: The incidence of labor induction is rising rapidly in the United States. Among multiparas, labor is often followed with traditional labor curves derived from noninduced pregnancies. We sought to determine how labor progression of multiparous women who presented in spontaneous labor differed from those who were electively induced with and from those induced without preinduction cervical ripening. METHODS: We analyzed data on all low-risk multiparous women with an elective induction or spontaneous onset of labor between 37(+0) and 40(+6) weeks of gestation from January 2002 to March 2004 at a single institution. The median duration of labor by each centimeter of cervical dilatation and the risk of cesarean delivery were computed for 61 women with preinduction cervical ripening and oxytocin induction, 735 women with oxytocin induction, and 1,885 women with a spontaneous onset of labor. An intracervical Foley catheter was used to ripen the cervix. RESULTS: Those women who experienced electively induced labor without cervical ripening had a shorter active phase of labor than did those admitted in spontaneous labor (99 minutes in induced labor versus 161 minutes in spontaneous labor, P < .001). However, the cesarean delivery rate was elevated in the induction group (3.9% versus 2.3%, P < .05). Women who underwent preinduction cervical ripening also had a shorter active phase than those admitted in spontaneous labor (109 minutes versus 161 minutes, P = .01). CONCLUSION: The pattern of labor progression differs for women with an electively induced labor without cervical ripening compared with those who present with spontaneous onset of labor.     

Comparison of ultrasonographic cervical length and the Bishop score in predicting successful labor induction

BACKGROUND: The aim of this study was to compare the performance of the Bishop score and transvaginal ultrasonography to predict successful labor induction, and to estimate the most useful cut-off points for the two methods. METHODS: The five components of the Bishop score were assessed by digital examination and cervical length was measured by transvaginal ultrasonography in 177 women with a single pregnancy, 36-42 weeks of gestation, and a live fetus in cephalic presentation before induction of labor. RESULTS: Multiple regression analysis showed that the Bishop score, cervical length, and parity provided independent contribution in the prediction of the likelihood of delivering vaginally within 60 h. The only component of the Bishop score that was independently predictive of the probability of vaginal delivery within 60 h was station. The best cut-off points for predicting successful induction using receiver operating characteristic curves were 24 mm for cervical length and 4 for the Bishop score. Cervical length was a better predictor than the Bishop score (sensitivity and specificity of 66 and 77% versus 77 and 56%, respectively). Kaplan-Meier survival curves showed that cervical length was the best discriminator of successful induction. CONCLUSION: Measurement of cervical length by transvaginal ultrasonography is a better predictor of success in labor induction with both topical prostaglandin and oxytocin.     

Extra-amniotic Foley catheter and prostaglandin E(2) gel for cervical ripening at term gestation.

OBJECTIVE: This study evaluated the efficacy of intravaginal prostaglandin E(2) gel in comparison with that of a Foley catheter for cervical ripening and induction of labor. STUDY DESIGN: Consecutive patients with unfavorable cervix requiring preinduction cervical ripening and induction of labor at term gestation were asked to participate in the study. One hundred and two patients were assigned to treatment with intravaginal prostaglandin E(2) gel (group 1) and 122 patients underwent the placement of an intracervical Foley catheter (group 2). After a maximum of three applications of intravaginal prostaglandin E(2) gel (18h) or after 18h from Foley catheter insertion oxytocin was administered to patients not in active labor. Labor profiles and pregnancy and neonatal outcome were compared between groups. RESULTS: The groups were comparable in term of demographic characteristics, indications for induction of labor, Bishop score at admission. The induction to labor time and the induction to delivery time were similar between groups. The cesarean sections rate was higher in group 1 than in group 2 (26.5 versus 14.7%, P<0.05). This remained significant when the analysis was restricted to nulliparous patients (32.3 versus 14.2%). The incidence of urinary tract infections, chorioamnionitis, and febrile morbidity was similar between groups. CONCLUSION: For preinduction cervical ripening, the Foley catheter is a valid alternative to the application of intravaginal prostaglandin E(2) gel and it is associated with a lower cesarean rate in nulliparous women.     

Transvaginal ultrasonography of the uterine cervix before induction of labor]

OBJECTIVE: To compare the Bishop score and transvaginal ultrasonographic measurement of cervical length for predicting the mode of delivery following medically indicated induction of labor in term patients. METHOD: The study was conducted prospectively among 134 women who required medically indicated induction of labor. Inclusion criteria were singleton pregnancy, gestational age > or = 37 weeks of amenorrhea, cephalic presentation, and intact fetal membranes. Transvaginal ultrasonography was performed for measurement of the cervical length but the patients were managed without considering this parameter. A receiver-operating characteristic curve was constructed to determine the best cut-of value of cervical length for predicting the risk of cesarean section following induction of labor. RESULTS: Thirty six patients (26.9%) underwent cesarean section and cervical dilatation at time of the cesarean section was < 8 cm in 25 cases. The Bishop score was not predictive for the mode of delivery in this study. In contrast, the cesarean section rate was significantly lower in women with a uterine cervix < 26 mm (18.9 vs 36.6%, p = 0.02). Moreover, the difference has concerned only the cesarean sections performed before 8 cm dilatation (9.5 vs 30.0%, p = 0.002). CONCLUSION: Cervical length measured with transvaginal ultrasonography is a better predictor than the Bishop score for predicting the risk of cesarean section following medically indicated induction of labor.     

Prediction of cervical response to prostaglandin E2 using fetal fibronectin

BACKGROUND: To determine whether presence of fetal fibronectin in cervico-vaginal secretions at term will predict the cervical response to prostaglandin E2 (PGE2) pessaries and successful induction of labor amongst subjects with unfavorable cervices. METHODS: Cervico-vaginal secretion was tested for the presence of fetal fibronectin prior to cervical ripening with PGE2 pessaries in women with a singleton term or post-term pregnancy undergoing induction of labor. The total number of PGE2 pessaries, interval from induction to labor and induction to delivery, latent phase and active phase of labor and cesarean section rate were compared. RESULTS: Women with fetal fibronectin in their cervico-vaginal secretion had better cervical response to PGE2 pessaries and required fewer doses for induction of labor and they took a shorter time interval from induction to delivery. They tend to have a lower cesarean section rate but the figures did not reach statistical significance. CONCLUSIONS: The presence of fetal fibronectin from cervico-vaginal secretions in subjects with a Bishop score <5 is predictive of a favorable response to induction by prostaglandin pessary     

Oral misoprostol vs. intravaginal prostaglandin E2 for preinduction cervical ripening. A randomized trial

OBJECTIVE: To compare orally administered misoprostol with intravaginal prostaglandin E2 for cervical ripening and labor induction. STUDY DESIGN: Patients presenting with medical or obstetric indications for labor induction whose Bishop's score was < or = 6 were randomly allocated to receive either 50 micrograms of oral misoprostol or 4 mg of intravaginal prostaglandin E2. If adequate cervical ripening (Bishop score of 9 or cervical dilatation of 3) or active labor did not ensue, repeat doses of each medication were administered every four hours. A maximum of six doses of either oral misoprostol or intravaginal prostaglandin E2 was permitted. Intravenous oxytocin was subsequently administered according to a standardized infusion protocol. RESULTS: Sixty patients were enrolled, with 29 randomized to the oral misoprostol arm and 31 to the prostaglandin E2 group. The data on 58 patients were eligible for analysis. Delivery occurred within 48 hours in 96.4% (27/28) of those administered oral misoprostol as compared to 76.7% (23/30) of those who received intravaginal prostaglandin E2 (P = .03). The mean time intervals from the start of induction to delivery were similar between the two groups (1,496 +/- 120 vs. 1,723 +/- 230 minutes, P = .40). No statistically significant differences existed between the two groups with respect to intrapartum complications, tachysystole, uterine hyperstimulation or adverse neonatal outcomes. CONCLUSION: Oral administration of misoprostol is an effective alternative to intravaginal prostaglandin E2 for preinduction cervical ripening.     

Labor progression and risk of cesarean delivery in electively induced nulliparas

OBJECTIVE: To describe the pattern of labor progression and risk of cesarean delivery in women whose labor was electively induced. METHODS: We analyzed data on all low-risk, nulliparous women with an elective induction or spontaneous onset of labor between 37 + 0 and 40 + 6 weeks from January 2002 to March 2004 at a single institution. The median duration of labor by each centimeter of cervical dilation and the risk of cesarean delivery were computed for 143 women with preinduction cervical ripening and oxytocin induction, 286 women with oxytocin induction, and 1,771 women with a spontaneous onset of labor. An intracervical Foley catheter was used to ripen the cervix. RESULTS: Electively induced labor with cervical ripening had substantially slower latent and early active phases. After controlling for potential confounders, women who had an elective induction with cervical ripening had 3.5 times the risk of cesarean delivery during the first stage of labor (95% confidence interval 2.7-4.5), compared with those admitted in spontaneous labor. Elective induction without cervical ripening, on the other hand, was associated with a faster labor progression from 4 to 10 cm (266 compared with 358 minutes, P < .01) and did not increase the risk of cesarean delivery, compared with those in spontaneous labor. CONCLUSION: The pattern of labor progression differs substantially for women with an electively induced labor compared with those with spontaneous onset of labor. Furthermore, elective induction in nulliparous women with an unfavorable cervix has a high rate of labor arrest and a substantially increased risk of cesarean delivery. LEVEL OF EVIDENCE: II-2.