宫颈成熟度与三种方法引产效果

目的研究分析不同宫颈Bishop评分、不同引产方法的时效及对母儿的影响.方法将431例孕足月单胎头位初产妇、按不同宫颈评分随机分成 A、B、C 3组,每组分别采用米索、催产素、蓖麻油引产餐3种方法引产.统计学分析不同宫颈评分、不同药物引产方法对宫颈评分改善度、引产时效及母儿并发症影响.结果 A组和B组用米索引产可显著改善宫颈评分(A组P<0.01,B组P<0.05),提高引产成功率及阴道分娩率(P<0.005).C组用米索和催产素引产效果差异无显著性(P>0.05),而引产餐引产效果低于其他两种方法(P<0.025).催产素引产时各不同宫颈评分组剖宫产率高于其他两种方法(A、B组(P<0.005),C组P<0.025).米索引产时,A组羊水污染率及新生儿窒息率高于催产素组和蓖麻油引产餐组(P值<0.005).结论宫颈Bishop评分≤5分时不宜用催产素引产.低宫颈评分用米索引产效果佳,但需严密监护.宫颈条件成熟时(宫颈评分≥6分)用米索和催产素引产效果佳,但用各种引产方法均需加强监护,及时发现异常情况及时处理.

The relationship between Bishop score and three different methods of labor induction

Objective To compare the effects of different Bishop scores and methods of labor induction on maternal and infant complications.Methods A total of 431 pregnant women with singleton vertex fetus pregnancies were randomly distributed into three Groups ( Group A, Group B and Group C ) scored less than or equal to 4,5,or equal to or more than 6(6 or 7) respectively. Three methods were used in different groups:50 ug misoprostol was placed in the posterior vaginal fornix every 4 hours, Oxytocin at 5% was intravenously dripped or castor oil-diet was offered.Results In Group A and Group B, misoprostol raised Bishop scores(In Group A P<0.01,In Group B P<0.05) and the success rate of labor induction and parturition through vagina(P<0.005). In Group C no significant difference was found between misoprostol and Oxytocin groups(P>0.05). Castor oil-diet was less effective than misoprostol and Oxytocin(P<0.025). The incidence of meconium in Oxytocin method was much higher than in misoprostol method and castor oil-diet method(In Group A or B P<0.005,In Group C P<0.025). In Group A, the incidence of stained amniotic fluid and neonatal asphyxia in misoprostol was much higher than in Oxytocin method and in castor oil-diet method(P<0.05).Conclusion Oxytocin should not be recommended when the Bishop score is less than or equal to 5. Misoprostol is an efficient agent for labor induction at low Bishop scores ,but the use of this and other agents in patients with high Bishop scores all require careful monitoring.