阴道内放置PGE2用于足月妊娠引产351例疗效观察

目的比较PGE\-2阴道栓剂及催产素静滴引产的效果。方法将585例同样条件孕妇，随机分两组，分别给PGE\-2阴道栓剂和催产素静脉滴注引产。结果前列腺素组及催产素组引产成功率分别为96.3%和79.92%；临产发动时间及总产程分别为(2.70±0.63)h,(3.01±3.41)h和(3.91±0.71)h,(6.03±3.50)h；剖宫产率分别为6.8%和18.18%(P<0.01)，有显著差异。结论PGE\-2栓剂用于足月妊娠引产效果显著、安全、方便，对促宫颈成熟意义重要，可缩短住院天数，减少住院费用。     

口服米索前列醇用于足月妊娠胎膜早破引产

目的　对足月妊娠发生胎膜早破的产妇予口服米索前列醇 (米索 )与静滴催产素引产的效果进行比较研究。方法　选择 10 0例尚未临产的胎膜早破初产妇 ,随机分为米索组和催产素组。米索组予米索 5 0μg口服 ,若有效宫缩尚未发动 ,6小时后重复给药一次。催产素按常规使用方法静滴。结果　米索组与催产素组引产成功率分别为 6 7.3%、 6 4.5 % ,从引产至阴道分娩时间分别为 (12 .2 2± 3.5 1) h、 (18.10± 3.2 4) h,米索组有 2例需加用催产素。分娩方式、新生儿 Apgar评分两组比较 ,差异均无显著性 (P >0 .0 5 ) ,但宫缩过强及胎粪污染的发生率米索组较高。结论　口服米索可替代催产素静滴用于胎膜早破初产妇的引产     

米索前列醇直肠置药用于晚期妊娠引产32例效果观察

选择有引产指征、无引产及使用米索前列醇禁忌证的单胎晚期妊娠产妇 6 2例 ,随机分为米索组 32例(每次 2 5 μg ,直肠置药 ,间隔 3h可重复 ,2 4h最大剂量 2 0 0 μg) ,催产素组 30例。结果 :米索组与催产素组引产成功率分别为 81.3 %、76 .7% ,两组比较 ,差异无显著性 (P >0 .0 5 ) ,首次用药至临产时间分别为 6 .4± 1.5h、14.3± 2 .6h ,两组差异有显著性 (P <0 .0 5 ) ;分娩方式、新生儿 1minApgar评分 ,两组差异无显著性 (P >0 .0 5 )。表明 2 5 μg米索前列醇直肠置药用于晚期妊娠引产安全而有效     

足月妊娠60例米索前列醇引产效果观察

目的 :探讨米索前列醇足月妊娠引产效果。方法 :对足月妊娠 60例应用米索前列醇引产与静脉点滴催产素 60例对比分析。结果 :总有效 :米索组 5 6例 (93 .3 % ) ,催产素组 3 9例 (65 .0 % ) ,宫缩至分娩 ,米索组 7.5 8± 3 .90 h,催产素组 12 .5 0± 7.48h(P<0 .0 1) ,剖宫产米索组 4例 ,催产素组 2 1例。结论 :米索前列醇用于足月妊娠引产效果优于催产素。     

米索前列醇用于晚期妊娠引产的临床观察

目的 :探讨米索前列醇 ( MP)阴道放药对晚期妊娠引产的效果和安全性。方法 :89名晚期妊娠妇女随机分成两组在阴道放药途径下 ,一组给予MP1 0 0μg;另一组给予前列腺素 E2 凝胶 ( PGE2 　 gel) 1 mg;6h后如未临产给予静点催产素。结果 :6h后两组宫颈评分增加 ;引产至分娩时间 ,催产素使用率 MP组显著短于 PGE2 ( P<0 .0 5) ;2 4 h分娩率 MP组显著高于 PGE2 ( P<0 .0 5)组 ;子宫过度刺激综合症发生率两组之间差别无统计意义。结论 :阴道内放置 MP片用于晚期妊娠宫颈成熟和引产效果优于 PGE2 　gel,其副作用不增加     

米非司酮配伍米索前列醇用于9～24周妊娠引产的效果与孕周的关系

目的　探讨米非司酮配伍米索前列醇用于 9～ 2 4周妊娠引产的效果。　方法　 16 8例 9～ 2 4周妊娠妇女 ,口服米非司酮 75 m g,每 12 h 1次 ,共 2次。末次服药后 1h,阴道后穹窿置米索前列醇 2 0 0μg,间隔 4h重复给药。按孕周分四组观察。　结果　引产成功率 (% )分别为 95 .12 ,10 0 ,96 .6 7,97.96 ,四组比较差异无显著性 (P>0 .0 5 )。产后出血量 (ml)分别为 6 8.2 1± 14.2 1,89.2 5± 2 6 .47,117.18± 18.73,12 6 .2 4± 2 5 .16 ,与孕周呈正相关 (P<0 .0 1)。引产时间(h)分别为 8.0 5± 2 .0 2 ,11.2 7± 4.2 9,15 .35± 1.17,2 1.2 3± 3.32 ,与孕周呈正相关 (P<0 .0 1)。米索前列醇用量 (μg)分别为 5 0 0 .14± 82 .13,490 .0 6± 10 4.2 5 ,5 74.82± 93.0 6 ,482 .5 1± 12 1.34 ,各组米索前列醇用量无显著差异且与孕周无相关 (P>0 .0 5 )。　结论　米非司酮配伍米索前列醇用于 9～ 2 4周妊娠引产有效而且安全。引产时间和出血量与孕周有关。     

米索前列醇预防剖宫产术中术后出血效果的临床对照研究

目的　对米索前列醇和催产素预防剖宫产出血的效果进行比较。方法　 96例剖宫产患者半随机分为A组 :米索前列醇 4 0 0 μg口服 ;B组 :米索前列醇 4 0 0 μg口服加催产素 1 0 U肌注 ;C组 :催产素静脉及肌肉各注射1 0 U;D组 :催产素静脉及肌肉各注射 2 0 U加术后肌注 1 0 U q1 2 h× 2次。观察各组术中、术后 2 h、术后 2～ 2 4 h出血量 ,手术前后 Hb及 HCT、血压的变化。结果　四组术中出血量分别为 (4 2 6 .0± 1 91 .3) ml,(2 71 .1± 1 1 5 .4 )ml,(2 5 6 .5± 1 34.0 ) m l,(2 5 1 .7± 6 5 .2 ) m l。 A组术中出血量及出血总量与其余三组相比 ,差异均有显著性 (P值分别 <0 .0 0 1和 <0 .0 5 ) ,而其余三组间差异无显著性。术中失血≥ 5 0 0 ml者四组分别为 33.3% ,4 .2 % ,8.3% ,0 % ,有显著性差异。产前产后 Hb、HCT变化 :四组间无明显差异。结论　单纯口服米索前列醇 4 0 0 μg预防剖宫产出血的效果不及米索前列醇加催产素组和单独使用催产素组     

口服米索前列醇用于足月妊娠胎膜早破引产

目的对足月妊娠发生胎膜早破的产妇予口服米索前列醇(米索)与静滴催产素引产的效果进行比较研究.方法选择100例尚未临产的胎膜早破初产妇,随机分为米索组和催产素组.米索组予米索50μg口服,若有效宫缩尚未发动,6小时后重复给药一次.催产素按常规使用方法静滴.结果米索组与催产素组引产成功率分别为67.3%、64.5%,从引产至阴道分娩时间分别为(12.22±3.51)h、(18.10±3.24)h,米索组有2例需加用催产素.分娩方式、新生儿Apgar评分两组比较,差异均无显著性(P>0.05),但宫缩过强及胎粪污染的发生率米索组较高.结论口服米索可替代催产素静滴用于胎膜早破初产妇的引产.     

阴道内放置小剂量米索用于足月胎膜早破的引产

目的　观察足月胎膜早破孕妇阴道内放置小剂量米索前列醇 (米索 )引产的有效性和安全性。方法　 72例足月胎膜早破的孕妇随机分成二组 ,米索组 (n =30 )在孕妇的后穹窿单次放置 5 0 μg米索 ,对照组 (n =42 )用催产素静滴引产。结果　米索组用药后 5小时内正规宫缩发动者 2 4例 (占 80 % ) ,较催产素组 ( 7例 )差异有显著性 (P <0 .0 1) ;米索组阴道分娩总产程 ( 482± 199min)较催产素组 ( 6 2 9±2 34min)短 (t=2 .44 ,P <0 .0 5 ) ;剖宫产率 ( 2 0 % )较催产素组 ( 48% )低 (P <0 .0 5 ) ;子宫强直性收缩的发生率 ( 6 .7% )较催产素组 ( 16 .7% ) (P <0 .0 5 )。结论　阴道后穹窿放置小剂量米索对于足月胎膜早破病人的引产是有效和安全的     

米索前列醇阴道给药用于足月妊娠引产的临床分析

目的 :探讨小剂量米索前列醇 (米索 )用于足月妊娠促宫颈成熟、引产的有效性和安全性。方法 :将 96例单胎头位有引产指征的孕妇 ,宫颈Bishop评分 <4分 ;随机分为A组 4 8例阴道后穹窿置米索首次剂量 5 0 μg ;观察宫缩情况 ,若无规律宫缩则每 3～ 5h重复给药 1次 (2 5 μg) ,直至出现规律宫缩 ,总量不超过 15 0 μg ;B组 4 8例静脉点滴催产素。结果 :用药 2 4h内临产发生率A组 91 7% ,B组 6 6 7% ,有显著性意义 (P <0 .0 5 )。总产程A组 (8 6± 3 1)h ,显著短于B组 (12 3± 2 5 )h。用药 12h后宫颈Bishop评为提高A组 5 .7分 ,显著高于B组 3 3分 (P <0 .0 5 )。结论 :小剂量重复阴道后弯窿给米索用于足月妊娠引产 ,是一种简便、有效、安全的方法。     

控释地诺前列酮用于足月妊娠引产的临床观察

目的 探讨控释地诺前列酮用于足月妊娠引产的有效性及安全性。方法采用对照观察的方法,选择单胎头位足月妊娠无引产禁忌症的孕妇120例,随机分为两组：控释地诺前列酮组60例,于孕妇阴道后穹窿放置地诺前列酮阴道栓剂引产;缩宫素组60例,予静脉点滴小剂量缩宫素引产。比较两组的宫颈评分、引产成功率、分娩情况以及对胎儿和新生儿的影响。结果控释地诺前列酮组用药12h后促宫颈成熟总有效率93．3％、24h内临产率73．33％、阴道分娩率71．67％,均优于缩宫素组（分别为13．33％、8．33％、35．0％）,两组比较差异有显著统计学意义（P〈0．01）;而两组总产程、产后出血量、新生儿Apgar评分差异无统计学意义（P〉0．05）。结论控释地诺前列酮用于足月妊娠引产方便、省时,引产成功率高,剖宫产率低,不良反应少,为安全有效的引产药物。     

Prostaglandin E2 gel for cervical ripening and labour induction: a multicentre placebo-controlled trial.

OBJECTIVE: To determine the effect of a single intracervical dose of prostaglandin E2 (PGE2) gel on cervical ripening and the need for subsequent labour induction with oxytocin. DESIGN: Multicentre randomized, double-blind, placebo-controlled study. SETTING: Tertiary care hospitals. PATIENTS: A total of 397 women met the inclusion criteria: gestational age of at least 36 weeks, parity of 3 or less, a Bishop score of 4 or less, intact membranes, an indication for induction, no contraindication to vaginal delivery, no history of cesarean section or major uterine surgery, no hypersensitivity to prostaglandins, no previous attempt at cervical ripening or induction, no vaginal bleeding and no fetal abnormalities. INTERVENTION: The experimental group (203 women) received a low dose (0.5 mg) of PGE2 in 2.5 mL of gel and the control group (194) 2.5 mL of a placebo gel intracervically. The observation period was 12 hours before further induction (with oxytocin) was attempted. OUTCOME MEASURES: Ripening effect of gel, need for induction with oxytocin, rate of labour induction, time from gel administration to delivery. RESULTS: Seventeen women could not be evaluated because induction was not attempted after the first 12 hours (in nine cases) or the induction attempt was delayed for 24 hours (in six); in the other two cases the gel was in place for only 2 1/2 and 4 hours respectively before cesarean section was required. The Bishop score 12 hours after the gel administration and the difference in the score from the time of admission to the end of the 12-hour observation period were significantly higher in the experimental group than in the control group (p less than 0.001). In all, 91 (46%) of the 196 patients in the experimental group went into labour within the 12-hour observation period, as compared with 21 (11%) of the 184 in the control group (p less than 0.001). When the women who required further induction were included the rate of successful induction was 85% (166 women) and 72% (132) respectively (p less than 0.004). The mean interval from the time of gel administration to delivery was smaller in the experimental group than in the control group (19.8 v. 24.1 hours respectively) (p less than 0.001). CONCLUSIONS: A single, low dose of PGE2 gel administered intracervically is a safe and reliable method of dealing with indicated but potentially difficult inductions.     

INDUCTION OF LABOUR WITH MISOPROSTOL – A PROSTAGLANDIN E1 ANALOGUE

The purpose of our study was to compare the safety and efficacy of intravaginal misoprostol versus existing hospital protocol of intracervical dinoprostone and oxytocin for cervical ripening and induction of labour. 200 patients with indication for induction of labour were randomly assigned to receive either intravaginal misoprostol or dinoprostone/oxytocin combination. In first group twenty five micrograms of misoprostol was placed intravaginally every 6 hours till the patient reached active stage of labour. In second group dinoprostone gel 0.5 mg was placed in the endocervix at night and oxytocin induction was started in the early morning. The average interval from start to induction of vaginal delivery was shorter in misoprostol group (1315±811 minutes) compared to dinoprostone/oxytocin group (1512±712 minutes) (p < 0.01). There was no significant difference in route of delivery. 18% of misoprostol treated patients and 23% of dinoprostone/oxytocin treated patients required Caesarean section. Complications such as uterine tachysystole were significantly higher in misoprostol group (p < 0.01) but it was not associated with increased incidence of uterine hyperstimulation. Perinatal outcome was similar in both groups.KEY WORDS: Induction of labour, Misoprostol     

COMPARISON OF INTRACERVICAL PROSTAGLANDIN E2 AND INTRAVENOUS OXYTOCIN IN INDUCTION OF LABOUR

154 patients requiring induction with unfavourable cervix at varying period of gestation were studied. Patients were distributed into two groups. 76 patients were induced with 0.5 mgm single dose intracervical application of Prostaglandin E2 gel and remaining 78 patients with Oxytocin and efficacy of the two methods of induction was compared. Labour was established within 24 hours in 71.4% of primigravidas and 91.7% of multigravidas in the prostaglandin treated group compared to 65.6% of primigravidas and 89.1% of multigravidas in the oxytocin group. The study found substantial improvement in cervical score 12 hours after application of intracervical prostaglandin E2 gel and decrease in Caesarean section rate with no major adverse effect to mother or neonate.KEY WORDS: Induction, Intracervical Prostaglandin E2 gel, Oxytocin     

米索前列醇预防产后出血的临床及护理分析

目的:探讨临床应用米索前列醇预防产后出血的效果。方法:选取我科2009年7月～2010年12月间住院并经阴道正常分娩的产妇400例,随机分为米索组132例、米索+缩宫素组142例及缩宫素组126例,三组患者临床资料比较无明显统计学差异。3组给药时间均为胎儿娩出后,米索组胎儿娩出后立即口服米索前列醇400μg;米索+缩宫素组胎儿娩出后立即静脉滴注缩宫素20U并口服米索前列醇400μg,缩宫素组胎儿娩出后立即静脉滴注缩宫素20U。临床观察3组分娩后2h内阴道出血量。结果:观察3组患者产后2h内阴道平均出血量,米索组为(280±46)mL;米索+缩宫素组为(216±45)mL;缩宫素组为(360±49)mL;组间比较差异显著,以米索+缩宫素组最优,米索组次之,缩宫素产后出血发生率最高。比较差异具有统计学意义(P<0.01)。结论:米索前列醇可促进子宫收缩,作用强于缩宫素,能较好的预防产后出血,且用药方便、安全,值得临床推广应用。     

缩宫素在产程中合理应用的临床研究

目的:研究缩宫素用于足月妊娠引产的有效性与安全性.方法:106例初产、足月妊娠而未临产者,分为缩宫素静脉滴注组52例,缩宫素鼻黏膜给药组54例,观察两组给药前和给药后4、8、12 h的宫颈Bishop评分、引产成功率、剖宫产手术指证和引产并发症发生情况.结果:两组孕妇在用药后8h和12 h的宫颈Bishop评分比较,静脉滴注组均优于鼻黏膜给药组(P＜0.01);孕妇24 h临产率和经阴道分娩率,静脉滴注组为90.4％(47/52)和76.9％(40/52),鼻黏膜给药组为57.4％(31/54)和51.9％ (28/54),静脉滴注组高于鼻黏膜给药组(P＜0.01)；两组因引产失败而行剖宫产的比例,静脉滴注组低于鼻黏膜给药组(P＜0.05);两组因医学手术指征而剖宫产及分娩并发症发生比例比较,差异无统计学意义.结论:缩宫素静脉滴注用于足月妊娠引产与缩宫素鼻黏膜给药比较,促宫颈成熟效果好,引产成功率高,失败率低,不增加剖宫产手术率及引产并发症发生率,是一种安全、有效的引产药物.     

普贝生用于足月妊娠引产与降低剖宫产率的临床观察

目的评估普贝生对于足月妊娠引产和降低剖宫产率的影响。方法选取足月妊娠孕妇180例,随机分为观察组和对照组,对照组使用缩宫素引产,观察组使用普贝生引产。结果用药后,观察组的宫颈Bishop评分明显高于对照组（P〈0．05）;观察组的有效率92．22％,对照组仅45．56％,观察组的有效率明显高于对照组（χ^2=45．7258,P〈0．01）;观察组阴道分娩率56．67％,明显高于对照组（χ^2=17．9908,P〈0．01）;观察组出现不良反应11例,对照组8例,两组比较差异无统计学意义（χ^2=0．5296,P〉0．05）。结论普贝生是一种有效的引产药物,能够降低剖宫产率,不良反应少。     

米索前列醇配伍催产素预防剖宫产术后出血的临床观察

目的观察催产素配伍直肠放置米索前列醇预防剖宫产术后出血的临床效果。方法将住院分娩有手术指征、无米索前列醇使用禁忌证的产妇120例分为A、B 2组,2组均于胎儿娩出后立即宫体肌内注射缩宫素20 U,A组术毕立即直肠放置米索前列醇400μg并10%GS加缩宫素20 U静脉滴注;B组术后仅使用10%GS加缩宫素20 U静脉滴注。观察2组预防剖宫产术后出血的临床效果。结果 A组产后2 h出血量、产后24 h出血量明显少于B组,2组比较差异有统计学意义（P〈0.05）。结论米索前列醇配伍催产素用于预防剖宫产术后出血临床效果显著,值得推广应用。     

COOK双球囊联合缩宫素在宫颈不成熟足月引产中的应用

目的 探讨COOK双球囊联合缩宫素在宫颈不成熟足月引产中的应用效果.方法 选择2015年3月至2016年12月期间我院妇产科收治的足月引产者60例为研究对象,根据随机数表法将患者随机分为观察组(n=30)和对照组(n=30),对照组患者给予静脉滴注缩宫素法,观察组给予COOK双球囊联合静脉滴注缩宫素法,比较两组患者促宫颈成熟及妊娠结局情况.结果 观察组患者促宫颈成熟有效率为86.87%,明显高于对照组的50.00%,差异有统计学意义(P<0.05);治疗后,对照组患者的宫颈Bishop评分与治疗前比较差异无统计学意义(P>0.05);观察组患者的宫颈Bishop评分为(8.12±3.49)分,较治疗前的(4.28±1.51)分明显提高,且高于对照组的(5.83±2.01)分,差异均有统计学意义(P<0.05);观察组患者的总产程为(10.25±1.52)h,明显短于对照组的(14.91±2.53)h,阴道分娩率为76.67%,明显高于对照组的46.67%,差异均有统计学意义(P<0.05).结论 COOK双球囊联合缩宫素应用于宫颈不成熟足月引产可以有效起到促宫颈成熟的作用,进而缩短产程,提高引产成功率.     

Extra-amniotic prostaglandin induction of labour supplemented with intravenous oxytocin following fetal death in utero

A Ave year retrospective study (1984–1989) was undertaken on 24 consecutive patients with fetal death to ascertain the efficacy, side effects and complications associated with a combination of extra-amniotic prostaglandin E₂ and intravenous oxytocin to induce labour. Six patients were primigravidae and eighteen multigravidae with inductions carried out at gestations ranging from 16 to 37 weeks (mean 26 weeks and 3 days). The estimated time from fetal death to induction ranged from 1 day to 3 weeks (mean 8 days). Induction was successful in all cases with a mean induction to delivery time of 9 hours and 30 minutes. The mean dose of prostaglandin required was 0.914 gms and of oxotocin 12.78 I.U.s. Minor side effects were experienced by 16% of patients though none were serious. This series confirms the combination of extra-amniotic prostaglandin and intravenous oxytocin as an effective means of inducing labour where fetal death has occurred.