摘要
目的通过回顾性分析妊娠晚期引产和自然临产的临床资料,探讨引产指征的掌握和引产方式对分娩过程和结局的影响。方法将2008年1月1日至4月15日在北京大学第一医院非选择性剖宫产分娩的587例单胎孕足月初产妇作为研究对象,引产组258例,自然临产组329例。比较两组的年龄、体重指数、分娩孕周,总产程时间,分娩方式和剖宫产指征。比较引产组的引产指征及单纯因孕龄超过预产期引产的64例与自然临产组的剖宫产率。比较不同宫颈条件和新生儿体重对分娩方式的影响以及两种促宫颈成熟的方法即缩宫素静脉点滴和阴道内放置普贝生对宫颈条件的改善情况。统计方法:计数资料采用卡方检验和Fisher′s精确概率法,计量资料采用t检验。结果引产组和自然临产组孕妇比较年龄、体重指数、分娩孕周和总产程时间均无统计学差异。引产指征包括妊娠合并症、胎膜早破、孕41周及其他。引产组剖宫产率明显高于自然临产组(48.1%vs17.0%,P<0.05)。引产组剖宫产指征第一位为引产失败,自然临产组剖宫产指征主要为胎儿窘迫和产程停滞。引产组宫颈评分越低,剖宫产率越高。两种促宫颈成熟的方法比较,采用普贝生对宫颈条件改善程度明显高于缩宫素。结论在临床密切监测下,应严格掌握引产指征,减少引产,降低剖宫产率。勿因当前医疗环境影响而扩大引产范围。对于宫颈条件差的引产患者应首先选择有效的促宫颈成熟剂即前列腺醇制剂改善宫颈条件,可降低引产失败率。
Objective To investigate the indications of induced labor and the effect of induction methods on delivery process and outcome. Methods Retrospective analysis was performed in 587 cases of term pregnancies who were single birth primipara in Peking University First Hospital from January 2008 to April 2008. All patients were divided into two groups： induction group （n=258） and non- induction group （n=329）. The indications and methods of induction, the effect of induction on cervical ripening while delivery were analyzed. General clinical data, total stage of labor and indication of cesarean section of the two groups were compared. Results The indications of induction included pregnancy complications, prelabor rupture of fetal membranes, beyond term and others. Cesarean section （cs） rate of induction group was significantly higher than non- induction group. Primary indication of cs in induction group was induction failure, but in non - induction group, that were fetal distress and arrested labor. The lower of Bishop score, the high of cs rate. The methods of improving cervical maturity were oxytocin drip and prostaglandinE2 （PGE2）. The effect of PGE2 was significantly better than oxytocin. Conclusions We should choose induction indications strictly and decrease unnecessary induction of labor at term which was caused by present medical circumstances. The use of PGE2 can improve cervical Bishop score and decrease induction failure.
出处
《中国妇产科临床杂志》
2009年第4期248-251,共4页
Chinese Journal of Clinical Obstetrics and Gynecology
基金
北京大学“985工程”二期项目(985-2-015-24)资助
关键词
引产
剖宫产
宫颈成熟
induction of labor
cesarean section
cervical ripening
