A randomised comparison of early versus late amniotomy following cervical ripening with a Foley catheter

Objectives Ripening of the cervix with a Foley catheter commonly results in cervical dilatation without contractions. We examined the outcome of labour in women who underwent induction of labour using a Foley catheter, followed by either 1. early amniotomy, or 2. augmentation of labour by oxytocin and late amniotomy
Design Prospective randomised clinical trial
Setting Labour and delivery ward of a university teaching hospital
Participants Pregnant women ≥38 weeks of a singleton gestation, who had had no prior caesarean section
Methods All women underwent cervical ripening using a Foley catheter. Following removal of the catheter, women were randomly assigned to either early (   n = 80  ) or late amniotomy (   n = 88  ).
Main outcome measures Comparison of mode of delivery and duration of labour between the two groups
Results The rate of caesarean section was significantly higher in the early amniotomy group compared with the late amniotomy group (25% vs 7.9%; relative risk 1.74; 95% CI 1.3 – 2.34). The increase in caesarean section rate was due primarily to dystocia (15% vs 3.3%; relative risk 1.8; 95% CI 1.32 – 2.45). When excluding caesarean deliveries, no significant difference was found in duration of labour between the groups (8.3 hours (3.8) vs 7.7 hours (2.9))
Conclusions In women who undergo cervical ripening with a Foley catheter, augmentation of labour by oxytocin followed by amniotomy during active labour results in a lower rate of caesarean delivery for dystocia     

Cervical ripening. A review and recommendations for clinical practice.

Cervical ripening occurs before the onset of labor. The cervix is metabolically active during ripening and passive during active labor. A ripe cervix indicates readiness for labor and predicts successful induction of labor. Practitioners evaluate cervical readiness for labor using the Bishop score. Membrane stripping, mechanical dilators and prostaglandins are ripening methods used frequently because they are simple, effective, efficient, safe and well tolerated. Stripping of membranes, a Foley catheter and misoprostol tablets are less expensive than other available methods. Because prostaglandins may cause excessive myometrial activity and even labor, hospitalization and fetal monitoring are recommended. Despite their effectiveness, these methods often do not decrease the cesarean section rates. This finding may be explained by the fact that each study reviewed only included a small number of patients and that in most cases, amniotomy was done and induction started, when feasible, before the women reached a Bishop score > or = 9. Larger studies may have different outcomes. The type of ripening methods used depends on the urgency of the situation; balloon catheters and prostglandins often act within 12 hours, while membrane stripping is less predictable.     

Using of Misoprostol for preinduction and induction of labor in term pregnancy

Labour induction is frequently indicated in women with an unfavourable cervix. Oxytocin and prostaglandins are the most common drugs used for labour induction. Induction of labour with prostaglandins offers the advantage of promoting both cervical ripening and myometrial contractility. The purpose of the study was to evaluate the safety and efficacy intravaginal administration prostaglandin E1 methyl analogue, misoprostol in cervical ripening and induction of labour in term pregnancy and in women with unfavourable cervix (Bishop score < = 4). The approval for this study was given by the Board of Medical Ethics, University Medical School of Lublin in Poland. MATERIALS AND METHODS: 64 women with indication for termination of pregnancy received either misoprostol (Cytotec-Searle) vaginally (group M, n = 30) or intravenous drip infusion of oxytocin(group Ox, n = 34). We evaluated profile of the studied women (gravidity, weight, height, maternal age, gestational age), effectiveness and safety of the misoprostol and need for oxytocin administration in group M, start of induction-to-active labour interval (contractions), start of induction-to-vaginal delivery interval, hyperstimulation syndrome, delivery within 24 hours of drug application and caesarean section rate. Before starting labour induction a Bishop score was obtained. Statistical analysis was performed. Baseline and outcome variables were tested with student's t-test and c2 analysis. We needed p < 0.05 for statistical significance. RESULTS: There were no differences in the patient profiles (gravidity, weight, height, maternal age, gestational age) between groups except the score of cervical ripening. The Bishop score before induction was lower in group M. The interval between the initiation of induction to active labour was shorter in the misoprostol group (334.23 +/- 126.35 versus 610.00 +/- 352.14 minutes). The mean time between the initiation of induction to delivery was shorter in group M (707.69 +/- 341.15 +/- versus 1025.77 +/- 369.16 minutes). These differences were statistically significant. 28 (93.33%) patients in the misoprostol group delivered within 24 hours compared with 24 (70.59%) women in the oxytocin group. 8 patients in the misoprostol group and 8 patient in the oxytocin group had caesarean section. Labor induction was successful in 30 (100%) women in the misoprostol group compared with 24 (70.59%) patients in the group Ox. CONCLUSIONS: Intravaginal misoprostol is an effective, easy to use and cheap drug for the induction of labour, especially for cervical ripening in women with unfavourable cervix (Bishop score < = 4).     

Cervical ripening: how long can the Foley catheter safely remain in the cervical canal?

This was a prospective study involving 85 patients admitted for induction of labour with unfavourable cervix at Usman Danfodiyo University Teaching Hospital, Sokoto, Nigeria. A size 16-20 Foley catheter was passed transcervically into the extra-amniotic space under aseptic technique and the balloon inflated with 30-50 mls sterile water. Each patient was placed on prophylactic antibiotics. The balloon was expelled within 12 hours in 22 (39%) patients. Twenty eight patients expelled the balloon in 12-24 hours, 14 in 25-48 hours, 6 in 49-72 hours and 4 after 72 hours. The average duration of catheter placement when the gestational age was 20-27 weeks was 44.8 hours, which was significantly longer than 19.6 hours obtained for term pregnancies (p < 0.05). Induction of labour was successful in 77 (91%) patients and there was no significant maternal morbidity. The results of our study suggest that the balloon of the Foley catheter can safely remain in the extra-amniotic space longer than 24 hours for cervical ripening if the cervix is unfavourable, provided the membranes are intact and the feto-maternal conditions remain satisfactory.     

Geburtseinleitung am Termin

Mechanical methods (balloon catheter, natural or synthetic dilators, amniotomy, sweeping of membranes) are the oldest methods to ripen the cervix or to induce labor. Synthetic prostaglandins have, however, increasingly replaced the use of mechanical methods in industrialized countries while in developing countries these methods are still the most frequently used as they are cheap, reversible, and usually do not require fetal monitoring. The mechanical methods in use today usually employ a Foley catheter. Compared with prostaglandins or oxytocin, Foley catheters are equally safe and effective. Moreover, in women with unfavorable cervix, cervical ripening with a Foley catheter seems to be more effective and associated with a lower operative delivery rate. In particular, in women with a previous cesarean delivery, the use of the intracervical Foley catheter must be considered the method of choice for maturation of the cervix, since it is safe with a uterine rupture rate similar to that associated with spontaneous labor.     

Cervical ripening with transcervical foley catheter and the risk of uterine rupture

OBJECTIVE: To estimate whether the rate of uterine rupture in patients with a previous cesarean delivery is related to labor induction and/or cervical ripening using transcervical Foley catheter. METHODS: Charts of all patients who had a trial of labor after a previous cesarean delivery in our institution between 1988 and 2002 were reviewed. The rates of successful vaginal birth after cesarean delivery and uterine rupture in patients with spontaneous labor (control group) were compared with those of patients who underwent a labor induction by means of amniotomy with or without oxytocin and patients who underwent a labor induction/cervical ripening using a transcervical Foley catheter. Logistic regression analysis was performed to adjust for confounding variables. RESULTS: Of 2479 patients, 1807 had a spontaneous labor, 417 had labor induced by amniotomy with or without oxytocin, and 255 had labor induced by using transcervical Foley catheter. The rate of successful vaginal birth after cesarean delivery was significantly different among the groups (78.0% versus 77.9% versus 55.7%, P <.001), but not the rate of uterine rupture (1.1% versus 1.2% versus 1.6%, P =.81). After adjusting for confounding variables, the odds ratio (OR) for successful vaginal birth after cesarean delivery was 0.68 (95% confidence interval [CI] 0.41, 1.15), and the OR for uterine rupture was 0.47 (95% CI 0.06, 3.59) in patients who underwent an induction of labor using a transcervical Foley catheter when compared with patients with spontaneous labor. CONCLUSION: Labor induction using a transcervical Foley catheter was not associated with an increased risk of uterine rupture.     

Randomised trial of intravaginal misoprostol and intracervical Foley catheter for cervical ripening and induction of labour.

Induction of labour may be indicated despite an unripe cervix. The purpose of this study was to compare the safety and efficacy of intravaginal misoprostol and an intracervical Foley's balloon catheter for preinduction cervical ripening and labour induction. A total of 120 patients requiring indicated induction of labour with an unfavourable cervix (Bishop's score < or =4) were randomised prospectively to receive either 50 mug intravaginal misoprostol every 6 h for a maximum of two doses, or an intracervical Foley balloon catheter for 12 h followed by an intravenous oxytocin infusion. The two arms of the study were comparable with respect to maternal age, parity, gestational age, indication for induction, and initial Bishop's scores. There were significant change in the Bishop's score in the two groups (5.9 +/- 0.2 and 4.0 +/- 0.2, respectively, p < 0.001) but no inter group differences. Oxytocin induction or augmentation of labour occurred more in the catheter group (95%) than in the misoprostol group (43.3%) (p < 0.0001). Induction to delivery interval was significantly shorter in the misoprostol group than in the catheter group (8.7 +/- 2.4 vs 11.9 +/- 2.7 h p < 0.0001). There was no significant difference noted in the caesarean or other operative delivery rates among patients in the two treatment groups. There was a higher incidence of tachysystole and hyperstimulation in the misoprostol group than in the catheter group (p < 0.03). No differences were observed between groups for meconium passage, 1- or 5-min Apgar scores < 7 and admission into the neonatal intensive care unit. In conclusion, the maternal and perinatal outcomes in this study have shown no difference confirming the efficacy and safety of both methods, however we observe a decrease in the induction-to-delivery interval when misoprostol is used for this purpose.     

Induction of labour: which method to use?

Induction of labour is a common obstetric instrument to employ when the potential risk to continue a pregnancy is higher than to terminate it. The methods of induction can be pharmacological or mechanical; the choice of the method mainly depends by the cervical ripening, as it is significantly able to influence, according to the type of induction, its final issue. The mechanical methods are: stripping and sweeping of the membranes, hand dilatation of cervix, intrauterine pressure catheters, Laminaria Japonicum, transcervical Foley catheter and amniotomy. To pharmacological methods include some agents such as the prostaglandins (PG), the most common approach to induce a labour, and used above all by vaginal way in patients with unripe cervix. They simulate the natural PG effects at the beginning of delivery and show a great efficiency. There are a lot of PG on the market, but except some of them, as Dinoprostone for PGE2 and Misoprostol for PGE1, no one of them shows the same safety in management of labour. Oxytocin, another inductive method, administered by diluted intravenous infusion, is utilized alone or mainly with other methods when the labour is started or with rupture of the membranes, because it begins or maintains the myometrial contraction.     

A prospective randomized controlled trial that compared misoprostol, Foley catheter, and combination misoprostol-Foley catheter for labor induction

OBJECTIVE: The purpose of this study was to determine the efficacy of combination intravaginal misoprostol and intracervical Foley catheter for prelabor cervical ripening. STUDY DESIGN: A prospective, randomized controlled trial was conducted. Women who were undergoing labor induction, with a singleton gestation >or=28 weeks and an unfavorable cervix (Bishop score 相似文献   

Efficacy and Patient Satisfaction with Outpatient Prostaglandin E2 versus Foley Catheter for Cervical Ripening—A Randomized Trial

Introduction: an important factor in the success of labour induction is the presence of a ripe cervix. The safety and efficacy of outpatient prostaglandin E₂ (PGE₂) administered intracervically compared to extra-amniotic cervical Foley catheter placement to ripen the cervix were studied. Patient satisfaction and overall cost with both methods were reported for the first time.Methods: pregnant women with uncomplicated term pregnancies having an indication for induction of labour were enrolled. Singleton pregnancies with intact membranes and cervical Bishop scores < 5 were randomized blindly to receive .5 mg intracervical PGE2 (n=67) every six to eight hours or intracervical Foley catheter (extra-amniotic) (n=62) insertion overnight. Cervical assessments were carried out prior to treatment and again before induction of labour. Patients filled out a post-treatment Likert questionnaire.Results: overall change in Bishop score did not differ between the two groups. The Foley treatment group were more likely to have Mated to three to four cm (χ²=5.48 DF=1 p=.02). Intrapartum variables, mode of delivery and post-partum complications were similar. For patients completing the questionnaire, pain experienced during insertion was similar, however, fewer patients would recommend the Foley catheter treatment to a pregnant friend (F[1,64]=5.53 p=.02). The price of the Foley catheter is much less than the PGE₂.Conclusion: both methods lead to similar changes in overall Bishop score although the intracervical Foley catheter was more likely to lead to cervical dilatation of three centimetres or more—a dilatation which facilitates amniotomy. There were no differences in the mode of delivery, maternal or neonatal outcomes. Patients reported the same amount of pain with both treatments but patients seem to prefer the more expensive PGE₂.     

Cervical Ripening: An Evaluation of Current Methods

EDITORIAL COMMENT: The state of the cervix is an important factor in determining the outcome of induction of labour. Arulkumaran and colleagues reported (Aust NZ J Obstet Gynaecol 1985; 25: 190–193) that 65% of nulliparas with an unfavourable cervix, who had induction of labour performed by amniotomy and simultaneous oxytocin infusion, came to Caesarean section, two-thirds because of failed induction. The numerous reports on induction of labour do not dispel confusion since no one method is clearly superior. Problems are the size of the series, the proportion of porous to nulliparous patients, and whether or not the control group assists in evaluation of results obtained, since amniotomy and oxytocin infusion are usually employed in addition to the method being evaluated to ripen the cervix. This journal recently published a comprehensive account of the physiology of the initiation of human reproduction (Roy AC, Kottegoda SR, Ratnam RR. 1985; 25: 94–100). This paper reviews recent reports on cervical ripening and includes a summary of a number of studies with details of results obtained according to the method used and the patients' parity.     

Intracervical Foley catheter balloon vs. prostaglandin in preinduction cervical ripening.

OBJECTIVES: The aim of this study is to compare the effectiveness of the intracervical Foley balloon catheter and 3 mg prostaglandin E(2) tablet(s) in preinduction cervical ripening. METHODS: Ninety women referred to the maternity clinic for induction of labor with a Bishop score of less than or equal to 5 were randomized to receive an intracervical Foley catheter or prostaglandin E(2) tablets. The primary measured outcome was ripening of the cervix as measured with the Bishop score. RESULTS: There were no differences in mean Bishop scores between the prostaglandin and the Foley catheter groups. Bishop scores (mean+/-S.D.) after ripening were 6.6+/-0.80 and 6.7+/-0.86 for the Foley catheter and prostaglandin groups, respectively (P=0.54). The Foley catheter group showed a statistically shorter time to ripening compared with the prostaglandin group (3.4+/-2.1 and 6.5+/-3.2 h, respectively (P=0.001). There was no statistically significant difference in induction time (4.8+/-1.8 h and 5.3+/-2.4 h, respectively (P=0.36). CONCLUSIONS: There are no differences in preinduction cervical ripening efficacy between prostaglandin E(2) and the Foley catheter, but the Foley catheter has the advantage of ripening an unfavorable cervix in a shorter time.     

Efficacy and safety of labour induction in patients with a single previous Caesarean section: a proposal for a clinical protocol

Purpose

To evaluate the efficacy and safety of induction in women with a single prior Caesarean section.

Methods

This was a cohort study in which we included all singleton pregnancies in patients with a single prior Caesarean who delivered between 2007 and 2012. Methods of induction were ocytocic infusion plus amniotomy (if Bishop score ≥6) or insertion of a Foley catheter (Bishop <6).

Results

Of the 2,075 patients included, 806 (38.8 %) had an elective repeat Caesarean, 1,045 (50.4 %) went into spontaneous labour, 89 (4.3 %) were induced by artificial rupture of the membranes and infusion of ocytocics and 135 (6.5 %) were induced using a Foley catheter. Rates of vaginal delivery were 79.2, 79.8 and 43.7 %, respectively. Six cases of uterine rupture were reported in the group of patients who went into spontaneous labour. There was no difference between groups with regard to neonatal morbidity. On multivariate analysis, risk factors for Caesarean delivery were macrosomia (OR 2.04, 95 % CI 1.31–3.18) and induction by Foley catheter (OR 3.73, 95 % CI 2.47–5.62); protective factors were previous vaginal delivery (OR 0.41, 95 % CI 0.29–0.57) and cervical dilatation (OR 0.84, 95 % CI 0.78–0.91).

Conclusions

Uterine induction after a single Caesarean section with ocytocic infusion and amniotomy where the cervix is favourable does not appear to entail any significant added risk in terms of maternal or foetal morbidity. Foley catheter induction is a reasonable option if the cervix is not ripe.     

Comparison of extraamniotic Foley catheter and intracervical prostaglandin E gel for preinduction cervical ripening

BACKGROUND: The success of induced labor depends on the degree of ripening of cervix. Pharmacological preparations are in widespread use for cervical ripening but are not free from side-effects and complications. Mechanical methods, i.e. the use of Foley catheter balloon, though effective have not gained much popularity because of the fear of infection. Therefore, this study has been conducted to prove the efficacy and safety of extraamniotic Foley catheter balloon and to compare it with intracervical prostaglandin E2 (PGE2) gel. METHODS: The randomized prospective study was conducted in the Department of Obstetrics and Gynecology and Medical Microbiology of Nehru Hospital. Hundred women attending the labor ward for induction of labor were divided into two groups: Group A--Foley catheter, Group B--PGE2 gel. Cervical swabs before and after the insertion of ripening agents were taken for culture studies. Placental membranes were also sent for culture. Labor outcome, side-effects, and complications were compared in both the groups. The statistical methods used were Student's compared t-test, Chi-square test, and Wilcoxon-Mann-Whitney test. RESULTS: Foley catheter proved to be a very effective preinduction ripening agent for unfavorable cervix compared with PGE2 gel, as is evident by the mean Bishop score at 12 h (P<0.001). Preparation delivery interval was significantly shorter (P<0.05) in women who underwent cervical ripening with Foley catheter balloon than with the PGE2 gel. No clinical evidence of chorioamnionitis was present in both the groups. CONCLUSION: This study concludes that extraamniotic Foley catheter balloon is an effective, safe, simple, low-cost, reversible, non-pharmacological mechanical method of preinduction cervical ripening.     

Does Cervical Ripening at Term Using a High Volume Foley Catheter Result in a Lower Caesarean Section Rate Than a Low Volume Foley Catheter? A Systematic Review and Meta-Analysis

Cervical ripening with a Foley catheter before induction of labour is a common obstetrical intervention. In this study we aimed to evaluate primarily the relationship between high or low volume Foley catheters used for cervical ripening and Caesarean section, and secondarily the relationship between Foley catheter volume, cervical ripeness, and time to delivery. We searched Medline and Embase from their inceptions with the assistance of an experienced librarian. All abstracts and complete articles were independently reviewed by two reviewers, according to predefined inclusion criteria. Six hundred forty-eight abstracts were identified, and 30 complete articles were read in full. Three articles with a total of 575 participating women met the inclusion criteria. The rate of Caesarean section with use of 80 mL Foley catheters was not significantly different from the rate using 30 mL Foley catheters (RR 0.82; 95% CI 0.48 to 1.41). A favourable cervix (which was defined heterogeneously) was more common with high volume catheters (RR 1.72; 95% CI 1.46 to 2.04), and failure to deliver in 24 hours was lower (RR 0.70; 95% CI 0.54 to 0.90). High volume Foley catheters improve the likelihood of a favourable cervix and chance of delivery in 24 hours more than low volume Foley catheters. As a more favourable cervix before induction of labour is associated with a lower rate of Caesarean section, a randomized controlled trial comparing high and low volume Foley catheters for cervical ripening using Caesarean section as the primary outcome is warranted.     

Unsucessful labour induction in women with unfavourable cervical scores: predictors and management

BACKGROUND: Misoprostol fails to induce labour in 5-20% of women at term. AIM: To analyse possible predictors of unsuccessful induction with 50 microg vaginal misoprostol and effectiveness and the safety of intracervical Foley catheter application in induction failures. METHODS: An observational study was conducted on 1030 women with singleton, live fetuses, vertex presentation, > 34 weeks of gestation and Bishop score < 5. Induction of labour with 50 microg vaginal misoprostol repeated every 6 h was attempted. Women without regular uterine contractions and cervical changes at the end of 24 h were considered to be unsuccessful, and a transcervical Foley balloon catheter was placed and inflated with 50 mL saline. Possible predictors of induction failures were analysed via logistic regression analysis. Neonatal outcomes and vaginal delivery achieved after Foley catheter were also determined. RESULTS: Induction was successful in 918 cases (89.1%) and Foley catheter was placed in 112 (10.8%) women. Increasing gestational age in weeks (odds ratio [OR] 0.77, 95% confidence interval [CI] 0.68-0.88) and increasing Bishop score (OR 0.73, 95% CI 0.60-0.90) decreased the risk of failed induction. Failure rates were 16% (27/169) in post-term nulliparous women with Bishop score 相似文献   

Transcervical Foley catheter with and without extraamniotic saline infusion for labor induction: a randomized controlled trial

OBJECTIVE: To compare the efficacy of transcervical Foley catheter alone (Foley) to transcervical Foley catheter with extraamniotic saline infusion for labor induction and cervical ripening in women with an unfavorable cervix. METHODS: This was a multicenter, randomized, controlled trial of women presenting for labor induction with a singleton, cephalic fetus, intact membranes, and unfavorable cervix (Bishop score 6 or less). Eligible women were randomly assigned to receive either Foley catheter alone or Foley catheter with extraamniotic saline infusion. All women received concurrent oxytocin administration. The primary study outcome was the induction-to-delivery interval. Secondary outcomes included cesarean delivery, maternal infectious outcomes, and immediate neonatal outcomes. Analysis was by intent to treat. RESULTS: One hundred eighty-eight women met eligibility criteria and were randomly assigned (Foley plus extraamniotic saline infusion, n=97; Foley, n=91). Baseline demographic characteristics, including parity, gestational age, and Bishop score were similar between the study groups. The median induction-to-delivery interval in the extraamniotic saline infusion arm (12.6 hours, interquartile range 9.3-18.8 hours) was similar to that in the Foley arm (13.4 hours, interquartile range 9.6-17.5 hours) (P=. 70). The proportion of women delivered by 24 hours was comparable between groups (delivery 24 hours, extraamniotic saline infusion 89.7%, Foley 87.9%, P=.70), as was the rate of cesarean delivery (Foley 18.7%, extraamniotic saline infusion 27.8%, P=.14). No significant differences were noted between the study groups with respect to rate of chorioamnionitis, endometritis, or immediate birth outcomes. CONCLUSION: In women with an unfavorable cervix, the addition of extraamniotic saline infusion to a transcervical Foley catheter does not improve efficacy for labor induction. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00442663 LEVEL OF EVIDENCE: I.     

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.     

Ripening of the uterine cervix and induction of labour at term with prostaglandin E2 in viscous gel.

In order to achieve ripening of the uterine cervix or induce labour in patients at term with an unfavourable cervical state, 1 mg of prostaglandin E2 (PGE2), suspended in a viscous gel, was instilled into the cervical canal. In a pilot study, 41 patients received the PGE2-gel. Twenty-three of these, (56%), went into labour, and delivery occurred without further stimulation within 15 hours. In the remaining 18 patients, there was a marked improvement of the cervical state, which changed from an average (modified) Bishop score of 2.5 to 6.1 within 24 hours. In a double-blind study comprising 20 nulliparae, 10 received gel containing PGE2 and 10 gel without prostaglandin. Cervical state did not change significantly (Bishop score 3.6 and 4.0) after 24 hours in patients receiving placebo gel. In those receiving PGE2 gel, 8 went into labour and were delivered without further induction within 13 hours. Two patients showed an increase in Bishop score from 3 to 6 and 7, respectively, after 24 hours. They were then induced by oxytocin and delivery occurred after 8 and 10 hours. The results suggest that administration of PGE2 intracervically can induce ripening of the cervix in patients at term with an unfavourable cervical state, and thus facilitate delivery.     

30 mL和60 mL容量宫颈扩张球囊对足月妊娠促宫颈成熟效果比较

目的：探讨两种不同容量的宫颈扩张球囊用于足月妊娠促宫颈成熟的临床疗效观察,为提高引产成功率,降低产后不良影响提供临床依据。方法：随机抽取2017年6月-2017年12月同济大学附属第一妇婴保健院收治的具有引产指征且宫颈评分＜6分的足月单胎孕妇400例作为观察对象,根据不同的球囊注水容量随机分为2组,Foley单球囊注水30 mL促宫颈成熟组（F30组）200例,Foley单球囊注水60 mL促宫颈成熟组（F60组）200例,比较2组患者的促宫颈成熟效果、引产效果以及孕产妇和新生儿转归情况。结果：2组患者治疗前Bishop评分比较,差异无统计学意义（χ2=1.280,P=0.201）,治疗后2组患者Bishop评分均上升,治疗后Bishop评分比较,差异有统计学意义（χ2=-4.137,P=0.000）。2组初产妇的引产-分娩时间比较差异有统计学意义（t=4.204,P=0.000）。多因素分析显示球囊容量是初产妇24 h内成功阴道分娩的影响因素（OR=1.990,95%CI：1.444～2.742,P=0.000）。研究中20例瘢痕子宫孕妇用宫颈扩张球囊促宫颈成熟,其中18例顺利阴道分娩,无相关并发症。2组孕产妇和新生儿结局比较,差异均无统计学意义（均P＞0.05）。结论：对足月宫颈条件不成熟的孕妇（包括剖宫产术后再次妊娠者）采用宫颈扩张球囊引产,安全有效,Foley 60 mL球囊在促宫颈成熟方面效果更好,且适当缩短引产-分娩时间。