球囊引产+破膜+缩宫素引产在足月妊娠生产中作用观察

目的:探究球囊引产联合人工破膜及缩宫素在足月妊娠中的引产效果。方法:选择2019年1月至2019年12月于我院接受治疗的82例足月产妇,按照随机数字表法将其均分为研究组与对照组(每组各41例),对照组产妇实施人工破膜,2 h后如未见有效宫缩则静脉滴注缩宫素,研究组首先于宫颈处放置COOK球囊,取出球囊后进行人工破膜,30 min后静脉滴注缩宫素,对比两组产妇静滴缩宫素至分娩时间、第1产程、第2产程、总产程时间,对比两组产妇不同时间段分娩率,对比两组产妇自然分娩率、胎儿Apgar评分、产后24 h出血量及副作用情况。结果:(1)研究组产妇缩宫素静滴至分娩时间、第1产程、第2产程、总产程均明显短于对照组(P0.05);(2)12 h内研究组分娩率明显高于对照组(P0.05);(3)研究组产妇自然分娩率高于对照组(P0.05),胎儿Apgar评分差异不明显(P0.05),产后24 h出血量研究组低于对照组产妇(P0.05);(4)两组产妇羊水浑浊、宫缩过强等副作用发生率对比差异不具有统计学意义(P0.05)。结论:应用球囊引产联合人工破膜及静滴缩宫素的方式,能够显著缩短产妇产程,提高自然分娩率,同时还能够降低分娩后产妇阴道出血量,且安全性较高。     

普贝生用于足月妊娠促宫颈成熟的疗效观察

目的:探讨普贝生促进宫颈成熟,提高足月妊娠经阴道分娩的有效性和安全性。方法:120例足月妊娠的未临产孕妇随机分为试验组与对照组,其中试验组50例给予阴道后穹隆置入普贝生1～2次,对照组50例给予小剂量催产素静脉滴注,比较两组宫颈成熟度,分娩情况及对于产妇、新生儿的影响。结果:①试验组宫颈Bishop评分增加3.81±1.04,对照组增加3.09±1.15,两组间差异有统计学意义(P<0.05)②试验组促宫颈成熟的显效率为78.33%,总有效率为91.67%,高于对照组35.00%显效率和63.33%总有效率(P<0.01)。③试验组阴道分娩率73.33%,进入产程时间(34.19±13.20)h,产程(8.47±2.68)h,对照组阴道分娩率41.67%,进入产程时间(52.14±16.05)h,产程(12.25±3.73)h,两组间比较差异有显著性(P<0.01或0.05)。④试验组产后出血量(225.31±67.80)ml,新生儿体重(3369.48±311.65)g,Apgar评分9.52±0.39,对照组产后出血量(232.44±75.76)ml,新生儿体重(3417.63±359.68)g,Apgar评分9.48±0.47,两组间差异无统计学意义(P>0.05)。结论:普贝生可有效促进足月妊娠产妇的宫颈成熟,提高经阴道引产成功率,降低剖宫产率,且安全性好,对母儿影响小。     

不同容量水囊引产在足月妊娠促宫颈成熟中的效果分析

目的分析不同容量水囊引产在足月妊娠促宫颈成熟中的临床效果。方法将2014年2月~2017年2月在我院进行引产的180例足月妊娠产妇为研究对象,根据随机法分为A、B、C三组,每组60例。其中A组选择30ml小水囊,B组选择80ml小水囊,C组选择150ml小水囊,并观察统计三组产妇引产后的宫颈成熟疗效、宫颈评分和新生儿Apgar评分情况。结果A组产妇的促宫颈成熟有效率低于B组和C组,组间差异均有统计学意义(P0.05);A组产妇的Bishop评分低于B组和C组,组间比较差异有显著统计学意义(P0.05)。三组新生儿的Apgar评分比较,差异无统计学意义(P0.05)。结论大容量水囊引产在足月妊娠促宫颈成熟的效果较好,有较高临床应用价值。     

情志护理干预联合缩宫素用于妊娠晚期引产效果评价

目的观察情志护理干预联合缩宫素用于妊娠晚期引产的临床疗效。方法选择妊娠晚期引产产妇82例,随机分为观察组和对照组各41例,对照组应用常规护理联合缩宫素,观察组在对照组的基础上实施情志护理干预,比较两组患者的临床效果。结果观察组产妇临产时间、总产程时间均短于对照组,产后出血量少于对照组,差异均有统计学意义(均P0.01);观察组产妇的阴道分娩率(85.4%)明显高于对照组(65.9%),差异有统计学意义(P0.05)。结论情志护理干预联合缩宫素应用于妊娠晚期引产过程中,能减少临产时间、缩短产程,降低产后出血量,提高阴道分娩率。     

乳酸依沙吖啶联合子宫颈扩张单球囊对瘢痕子宫中期妊娠引产的应用效果

目的:研究乳酸依沙吖啶联合子宫颈扩张单球囊对瘢痕子宫中期妊娠引产的应用效果。方法:选择2014年4月~2016年12月在我院进行诊治的由于社会因素或者医学因素自愿要求终止妊娠并无任何引产禁忌证的110例健康中期妊娠(孕周14~27周)孕妇为研究对象,随机分为观察组与对照组,每组各55例。对照组采用常规方案进行引产,即口服米非司酮150 mg,并在B超引导下经腹壁行羊膜腔内注射100 mg乳酸依沙吖啶;观察组采用乳酸依沙吖啶联合子宫颈扩张单球囊进行引产。比较两组孕妇的引产成功率、产程时间、宫缩发动时间、胎儿娩出时间、产后2 h出血量、住院时间、引产并发症的发生情况以及多次剖宫产患者的引产成功率。结果:观察组孕妇的引产成功率为96.36%(53/55),明显高于对照组[83.64%(46/55)](P0.05),且观察组的产程时间、宫缩发动时间、产后2 h出血量以及住院时间均明显低于对照组(P0.05)。对照组多次剖宫产孕妇引产成功率为33.33%(2/6),观察组多次剖宫产孕妇引产成功率为100.00%(7/7),观察组明显高于对照组(P0.05)。对照组发生宫颈裂伤1例,会阴裂伤1例,两组孕妇均未出现羊水栓塞、子宫破裂以及感染等并发症。结论:乳酸依沙吖啶联合子宫颈扩张单球囊用于瘢痕子宫中期妊娠引产的应用效果明显优于口服米非司酮并在B超引导下经腹壁行羊膜腔内注射乳酸依沙吖啶,且安全性高。     

双腔水囊联合腹主动脉介入阻隔术对比催产素联合常规剖宫产在晚期妊娠糖尿病引产中的应用分析

摘要 目的：探讨双腔水囊联合腹主动脉介入阻隔术对比催产素联合常规剖宫产对于晚期妊娠糖尿病引产的临床疗效。方法：收集2019年9月至2020年4月在我院待产的146例晚期妊娠糖尿病患者,随机分为研究组（73例）和对照组（73例）。研究组首先采用双腔水囊置于宫颈引产,对于双腔水囊引产失败的患者则采用腹主动脉介入阻隔术情况下剖宫产;对照组采用单纯静脉滴注小剂量催产素引产,对于催产素引产失败的患者则行常规剖宫产。通过询问病史、体征检查、实验室检查等收集孕妇一般情况、引产前后宫颈Bishop评分、各产程情况、不良反应等数据;引产失败的部分患者收集手术时间、输血量、出血量、子宫切除率、新生儿Apgar评分。对比分析两组患者促宫颈成熟度、各产程情况、妊娠结局、不良反应等结果。结果：研究组孕妇宫颈Bishop评分治疗后高于对照组（P＜0.05）;研究组与对照组在宫颈Bishop评分提高上比较差异有统计学意义（P＜0.05）。研究组引产成功率高于对照组,对照组剖宫产率高于研究组,两组分娩结局比较差异有统计学意义（P＜0.05）。研究组引产开始至临产时间、第一产程、第二产程、总产程时间上短于对照组（P＜0.05）。研究组术中出血量、输血量、子宫切除率及新生儿Apgar评分均少于对照组（P＜0.05）。研究组不良反应发生例数低于对照组（P＜0.05）。结论：双腔水囊、催产素均可促宫颈成熟,但前者优于后者且可提高引产成功率;腹主动脉介入阻隔术的应用较常规剖宫产优势更为明显,对于晚期妊娠糖尿病孕妇采用双腔水囊联合腹主动脉介入阻隔术引产具有更高安全性,值得临床借鉴。     

普贝生用于足月妊娠促宫颈成熟的疗效观察

目的：探讨普贝生促进宫颈成熟,提高足月妊娠经阴道分娩的有效性和安全性。方法：120例足月妊娠的未临产孕妇随机分为试验组与对照组,其中试验组50例给予阴道后穹隆置入普贝生1～2次,对照组50例给予小剂量催产素静脉滴注,比较两组宫颈成熟度,分娩情况及对于产妇、新生儿的影响。结果：①试验组宫颈Bishop评分增加3．81±1．04,对照组增加3．09±1．15,两组间差异有统计学意义（P〈0．05）②试验组促宫颈成熟的显效率为78．33％,总有效率为91．67％,高于对照组35．00％显效率和63．33％总有效率（P〈0．01）。③试验组阴道分娩率73．33％,进入产程时间（34．19±13．20）h,产程（8．47±2．68）h,对照组阴道分娩率41．67％,进入产程时间（52．14±16．05）h,产程（12．25±3．73）h,两组间比较差异有显著性（P〈0．01或0．05）。④试验组产后出血量（225．31±67．80）ml,新生儿体重（3369．48±311．65）g,Apgar评分9．52±0．39,对照组产后出血量（232．44±75．76）ml,新生儿体重（3417．63±359．68）g,Apgar评分9．48±0．47,两组间差异无统计学意义（P〉0．05）。结论：普贝生可有效促进足月妊娠产妇的宫颈成熟．提高经阴道引产成功率,降低剖宫产率,且安全性好,对母儿影响小。     

控释前列腺素E2-普贝生用于足月妊娠引产的疗效观察

目的:探讨控释前列腺素E2栓剂普贝生用于足月妊娠引产的有效性及安全可行性.方法:将本院2008年12月2009年4月有引产指征的足月妊娠孕妇140例随机分成两组,研究组以普贝生用药,对照组行催产素静滴引产,比较两组产妇Bishop评分、引产费用、临产时间、破膜时间、分娩时间、总产程时间、分娩情况和结局以及新生儿体重及评分.结果:普贝生组用于足月妊娠引产效果明显优于对照组(P＜0.01),研究组用药至临产时间显著短于对照组(P＜0.01),引产成功率高于对照组,对母婴影响无显著差别.结论:普贝生是一种安全有效方便实惠的新型引产药物,对母婴没有明显不良影响,可在,临床上应用.     

12例宫颈锥切术后患者妊娠分娩的护理

目的探讨宫颈锥切术后患者妊娠分娩的护理方法。方法选取2014年11月~2015年11月在我院行宫颈锥切术的患者12例为研究对象,随机分为对照组和观察组各6例。对照组给予妇科常规护理方法,观察组采取有针对性的护理干预措施,观察比较两组的分娩情况、并发症发生率及护理满意度。结果两组分娩情况比较,观察组均优于对照组,差异具有统计学意义(P0.05)。观察组的护理满意率为100%,对照组为33.33%,两组比较差异有统计学意义(P0.05)。观察组无1例并发症发生,对照组并发症发生率达33.33%,组间差异有统计学意义(P0.05)。结论宫颈锥切术后患者妊娠分娩存在较多的危险因素,临床上给予系统有效的护理措施,是保证母婴健康的前提。     

拉玛泽式分娩法提高初次产妇经阴道分娩的作用及对妊娠结局的影响

目的探讨拉玛泽式分娩法提高初次产妇经阴道分娩的作用及对妊娠结局的影响。方法将我院2016年8月~2017年7月收治的152例初产妇按随机数字表法分为两组,每组76例。对照组给予常规分娩指导,观察组予以拉玛泽式分娩法,观察比较两组产妇的阴道分娩率、产程用时、分娩疼痛及分娩结局。结果观察组产妇经阴道分娩率为94.7%,高于对照组的72.4%,差异有统计学意义(P0.05)。观察组的第一产程、第二产程、总产程用时均短于对照组(P0.05),分娩疼痛分级、产后出血量、血性恶露持续时间均少于对照组(P0.05)。结论拉玛泽式分娩法能提高初产妇经阴道分娩率,缩短产程用时,减少分娩疼痛,改善分娩结局。     

Preinduction cervical priming with PGE2 vaginal film in primigravidae--a randomised, double blind, placebo controlled study

Previous reports with an 850 micrograms prostaglandin E2 film for cervical ripening before induction of labour in term pregnancy have been favourable. These studies however had no controls. The present study compares this PGE2 vaginal film with a nonmedicated similar vaginal film (placebo) for preinduction cervical ripening in primigravid women at term. A total of 69 women with modified Bishop's cervical scores 1-5 were assigned randomly to either the PGE2 group (33 women) or placebo group (36 women). Cervical score assessments were made at 12 and 24 hours after which labour was induced by amniotomy and oxytocin infusion. Although the cervical scores between placebo and PGE2 groups at 12 and 24 hours were not significantly different, the scores were marginally better with the prostaglandin film. Pregnancy outcome was satisfactory in both groups with no perinatal or maternal mortality and morbidity. The caesarean rate was 30.6% in the placebo group and 24.2% in the PGE2 group. This study emphasizes the need for a control group when studying the success of agents used for ripening the pregnant cervix at term.     

Induction of human labor at term: uterine activity, inducibility, duration and neonatal jaundice

A total of 821 patients, 39-40 weeks pregnant, was obstetrically normal at admission. In 212 of them intra-uterine pressure (IUP) was monitored before and during inducing labor by oxytocin, in 212 patients delivery was also induced by oxytocin but not monitored, in 197 by combining oxytocin and amniotomy, and 200 had spontaneous delivery. Inducibility could be predicted by uterine baseline activity and a 50 mu i.v. shot of oxytocin, together with determination of cervical status and placental location. The duration of labour induction was affected by parity, placental location and cervical status, but was predicted only to a minor degree by baseline activity and uterine oxytocin sensitivity. Amniotomy did not affect caesarean, section rate. The newborn child benefited from IUP monitoring: fewer transfers to pediatrics were necessary, there was less neonatal jaundice and fewer blood exchanges. It is assumed that if labor is not monitored through IUP, oxytocin may cause neonatal hyperbilirubinaemia through episodes of increased uterine resting pressure.     

Foley Catheter for Induction of Labor at Term: An Open-Label,Randomized Controlled Trial

Objective

This study aimed to determine the optimal Foley catheter balloon volume (30-mL vs. 80-mL) and the maximum time for cervical ripening (12 hours vs. 24 hours) to improve vaginal delivery rate within 24 hours of induction.

Methods

We conducted an open-label, randomized controlled trial in a teaching hospital in China. Women with a term singleton pregnancy, cephalic presentation, intact membrane and an unfavorable cervix (Bishop score <6) were randomly allocated, in 1:1:1:1 ratio, to receive either one of the four treatments: (1) 30-mL balloon for a maximum of 12 hours, (2) 30-mL balloon for a maximum of 24 hours, (3) 80-mL balloon for a maximum of 12 hours, and (4) 80-mL balloon for a maximum of 24 hours. The primary outcome was vaginal delivery within 24 hours. Secondary outcomes included cesarean section rate and maternal/neonatal morbidity. Data were analyzed on a per-protocol basis.

Results

Five hundred and four women were recruited and randomized (126 women in each group); nine women did not receive the assigned intervention. More women achieved vaginal delivery within 24 hours in 12-hour Foley catheter groups than in the 24-hour Foley catheter groups (30-mL/12 hours: 54.5%, 30-mL/24 hours: 33.1%, 80-mL/12 hours: 46.4%, 80-mL/24 hours: 24.0%, p < 0.001). Cesarean section rates and the incidence of chorioaminonitis were comparable among four groups. After adjustment for confounding factors, both ripening time and balloon size did not affect the proportion of women delivered vaginally within 24 hours of induction.

Conclusion

For women with an unfavorable cervix at term, induction of labor with a Foley catheter is safe and effective. Higher balloon volume (80-mL vs. 30-mL) and longer ripening time (24 hours vs. 12 hours) would not shorten induction to delivery interval or reduce cesarean section rate.

Trial Registration

Chinese Clinical trial registry (ChiCTR-TRC-13003044)     

Prospective study of different methods and routes of administration of prostaglandin E2 to improve the unripe cervix.

Methods of vaginal and extra-amniotic prostaglandin administration to achieve ripening of the cervix as a preliminary to induction of labour are described. Three groups of twenty patients with unfavourable induction features were studied, each receiving prostaglandin E2 the evening prior to planned induction. One group received PGE2 500 micrograms suspended in a viscous medium extra-amniotically. One group received PGE2 3 mg suspended in a viscous medium into the vaginal vault. A third group received a 3 mg PGE2 vaginal pessary to the posterior fornix. Improvement in cervical status at time of induction occurred in all groups but no single group had a significant advantage when regarding mean improvement, the induction-delivery interval or the number of patients in whom labour began before formal induction. However, with regard to relative cost, ease of preparation and storage, as well as patient and medical staff convenience, Prostaglandin E2 in pessary form is a superior form of administration.     

Use of prostaglandin E2 to ripen the cervix of the mare prior to induction of parturition

Eleven light-breed pregnant mares (335 to 347 d gestaton) were used to evaluate the use of prostaglandin E2 as a cervical ripening agent prior to induction of parturition during the months of April and May. Six hours prior to induction, each mare's cervix was examined per vagina for softness and dilation. Each mare was then assigned to 1 of 2 treatment groups: Group PGE mares (n = 7) received 2.0 to 2.5 mg prostaglandin E2 deposited intracervically; Group SAL mares (n = 4) received 0.5 mL of sterile NaCl deposited intracervically. Six hours later, the mares were readied for parturition by wrapping the tail, scrubbing and rinsing the perineum and udder, and examining the cervix as previously described. Each mare was then administered 15 U, i.v. oxytocin at 15-min intervals until the chorioallantois ruptured. Intervals from initial oxytocin injection until rupture of the chorioallantois, from initial oxytocin injection until delivery of the foal, from delivery of the foal until the foal stood unassisted, and from delivery of the foal until the foal suckled were recorded. Mean cervical dilation immediately prior to induction of parturition tended to be greater in Group PGE mares (3.9 +/- 1.7 cm) than in Group SAL mares (1.9 +/- 1.9 cm; P = 0.10). Mean change in cervical dilation over the 6-h period prior to induction (3.4 +/- 1.9 cm vs 1.5 +/- 2.1 cm), mean number of injections of oxytocin required until the chorioallantois ruptured (1.9 +/- 0.7 vs 2.5 +/- 1.0), and mean intervals from initial injection of oxytocin to rupture of the chorioallantois (20 +/- 10 min vs 28 +/- 19 min) and delivery of the foal (28 +/- 7 min vs 34 +/- 22 min) were not different between Group PGE and SAL mares, respectively (P > 0.10). The proportion of foals that stood within 1 h of birth also did not differ between Group PGE foals (6/7; 86%) and Group SAL foals (3/4; 75%; Chi-square = 0.17; P > 0.10). The proportion of foals that nursed within 2 h of birth was higher in Group PGE foals (6/7; 86%) than in Group SAL foals (1/4; 25%; Chi-square = 4.02; P < 0.05). Premature separation requiring manual rupture of the chorioallantois at the vulvar labia occurred in 1 Group PGE mare (cervical dilation of 1.5 cm at time of induction) and 1 Group SAL mare (cervix closed and firm at time of induction). Foals born from the 2 mares with premature placental separation had the longest intervals from initial oxytocin injection to delivery, delivery to ability to stand unassisted, and delivery to suckling within their respective treatment groups. In summary, it appears that cervical ripening prior to induction of parturition favors shorter deliveries and foal vigor. Intracervical administration of prostaglandin E2 may prove useful for ripening the cervix of the mare prior to induction of parturition. Further studies are indicated to determine optimal dosage and method of administration of prostaglandin E2.     

Comparative study of a two dose schedule of PGE2 3 mg pessary and 1700 micrograms film for induction of labour in nulliparae with poor cervical score

Efficacy of a two dose schedule of 3 mg pessary or 1700 micrograms film of PGE2 for induction of labour was compared in nulliparae with poor cervical score. Patient characteristics in the two groups (43 in 3 mg and 40 in 1700 micrograms group) were comparable in age, period of gestation, indications for induction of labour and in their initial cervical score. The number of patients who started labour with a two dose schedule 4 hours apart were similar in each group. The improvement of cervical score, length of labour, mode of delivery and the neonatal outcome were not different in the two groups. There was no advantage of using a film preparation over that in the form of a pessary and the use of 3 mg dose did not give significantly better results compared with the 1700 micrograms dose, in terms of obstetric or neonatal outcome.     

Prospective study of different methods and routes of administration of prostaglandin E2 to improve the unripe cervix

Methods of vaginal and extra-amniotic prostaglandin administration to achieve ripening of the cervix as a preliminary to induction of labour are described. Three groups of twenty patients with unfavourable induction features were studied, each receiving prostaglandin E₂ the evening prior to planned induction. One group received PGE₂ 500 μg suspended in a viscous medium extra-amniotically. One group received PGE₂ 3 mg suspended in a viscous medium into the vaginal vault. A third group received a 3 mg PGE₂ vaginal pessary to the posterior fornix. Improvement in cervical status at time of induction occurred in all groups but no single group had a significant advantage when regarding mean improvement, the induction-delivery interval or the number of patients in whom labour began before formal induction. However, with regard to relative cost, ease of preparation and storage, as well as patient and medical staff convenience, Prostaglandin E₂ in pessary form is a superior form of administration.