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Obstet Gynecol:宫颈管放置导尿管诱导引产中是否需要使用催产素!

2017-05-24 xing.T MedSci原创

与催产素之后再使用导尿管引产相比,同时使用导尿管与催产素引产可以提高初产妇和经产妇24小时内分娩率。

近日,妇产科权威杂志Obstetrics and Gynecology上发表了一研究文章,研究人员旨在评估在导尿管诱导宫颈成熟中是否需要使用额外的催产素,以提高24小时内分娩率。

这是一项随机、多中心的平行试验,受试者为妊娠24周或孕周更大的接受引产的单胎妊娠妇女。妇女被随机分配到使用催产素后进行宫颈导尿管组或进行宫颈导尿管同时使用催产素组。研究人员将初产妇和经产妇随机分组,并根据平行设计分别进行分析。该研究的主要结果是在24小时或更短时间内发生分娩。每组需要100名初产妇和75名经产妇的样本量,以检测基础的24小时分娩率20%的增长,每个组的效能为80%.

从2015年1月至2016年7月期间,共纳入323名患者:184名初产妇和139名经产妇。进行宫颈导尿管同时使用催产素组的初产妇比先使用催产素后使用导尿管组的孕妇24小时内分娩更频繁(64% vs. 43%,P=0.003,相对风险为1.51,95%[CI]为1.14-2.00)。进行宫颈导尿管同时使用催产素组的经产妇比先使用催产素后使用导尿管组的孕妇24小时内分娩也更频繁(87% vs. 72%,相对危险度为1.22,95%CI为1.02-1.45)。与催产素之后在使用导尿管引产的孕妇相比,同时使用导尿管与催产素的初产妇(20.9 vs. 26.1小时,P<0.001)和经产妇(14.9 vs. 18.6小时,P=0.01)发生分娩的中位时间更短。而组间剖宫产率、产后出血、绒毛膜羊膜炎或新生儿重症监护室入院率的差异无统计学意义。

与催产素之后再使用导尿管引产相比,同时使用导尿管与催产素引产可以提高初产妇和经产妇24小时内分娩率。

原始出处:

Schoen, Corina N, et al. Intracervical Foley Catheter With and Without Oxytocin for Labor Induction: A Randomized Controlled Trial.Obstetrics & Gynecology.2017. http://journals.lww.com/greenjournal/Fulltext/2017/06000/Intracervical_Foley_Catheter_With_and_Without.14.aspx

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    2017-07-02 suibian2007bbb

    学习

    0

  4. 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08:32:27 CST 2017, time=2017-05-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=202264, encodeId=bab220226493, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Thu May 25 06:27:10 CST 2017, time=2017-05-25, status=1, ipAttribution=)]
    2017-05-26 daiyaozu

    学习了,不错

    0

  5. 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08:32:27 CST 2017, time=2017-05-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=202264, encodeId=bab220226493, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Thu May 25 06:27:10 CST 2017, time=2017-05-25, status=1, ipAttribution=)]
    2017-05-26 cmsvly
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08:32:27 CST 2017, time=2017-05-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=202264, encodeId=bab220226493, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Thu May 25 06:27:10 CST 2017, time=2017-05-25, status=1, ipAttribution=)]
    2017-05-26 zhanfl
  8. 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08:32:27 CST 2017, time=2017-05-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=202264, encodeId=bab220226493, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Thu May 25 06:27:10 CST 2017, time=2017-05-25, status=1, ipAttribution=)]
    2017-05-26 一闲
  9. [GetPortalCommentsPageByObjectIdResponse(id=2011303, encodeId=324a201130377, content=<a href='/topic/show?id=840d1e300e5' target=_blank style='color:#2F92EE;'>#TET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17300, encryptionId=840d1e300e5, topicName=TET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cc52251, createdName=yhy100200, createdTime=Sat Oct 21 06:47:00 CST 2017, time=2017-10-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2043966, encodeId=b23b2043966e9, content=<a href='/topic/show?id=8513126129d' target=_blank style='color:#2F92EE;'>#NEC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12612, encryptionId=8513126129d, topicName=NEC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, 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08:32:27 CST 2017, time=2017-05-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=202264, encodeId=bab220226493, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Thu May 25 06:27:10 CST 2017, time=2017-05-25, status=1, ipAttribution=)]
    2017-05-25 大爰

    学习了分享了谢谢!!

    0

  10. 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08:32:27 CST 2017, time=2017-05-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=202264, encodeId=bab220226493, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Thu May 25 06:27:10 CST 2017, time=2017-05-25, status=1, ipAttribution=)]
    2017-05-25 龙胆草

    学习了,谢谢分享

    0

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休斯顿贝勒医学院的Jason L. Salemi博士和同事对2005-2009年间的675,302名单胎妊娠孕妇进行了一项基于人群的研究,孕妇在妊娠37-44周分娩。根据孕妇的分娩时间和方式进行分组,包括妊娠37-38周分娩的四个亚组,还有选择期待治疗,于妊娠39-40周分娩的对照组。研究人员发现,与期待治疗,妊娠39-40周分娩的新生儿相比,妊娠37-38周选择性引产不会增加新生儿呼吸系统疾病、

Obstet Gynecol:妊娠39周初产妇,宫颈条件不好,选择引产还是期待?

研究者进行了一项研究,探究对宫颈条件不好的初产妇实施引产,会对剖宫产率产生什么影响。该研究纳入了≥18岁,妊娠38-38+6周的单胎初产妇,Bishop评分≤5分,将其随机分为引产组和期待组。引产组在纳入研究的1周内,39周孕以上时实施引产,对照组则期待,继续产前日常监测。初始结局指标为剖宫产发生情况。估计对照组剖宫产率为20%,引产组剖宫产率翻倍则为40%,需要162名患者。该研究纳入了2010

世卫组织引产指南7大原则

本指南的主要目的是,改善资源不足情况下孕妇引产的保健质量和结局。本指南的目标读者包括产科医生、助产士、全科医师、卫生保健管理者和公共卫生政策制定者。原文链接本指南建立在循证医学基础之上,涵盖了一些与引产相关的主题,这些主题被一个由卫生保健工作者、服务对象及其他利益相关者组成的多学科小组认为是关键性的、需优先考虑的问题。

贺晶教授:宫颈成熟指南解读、管理、监测

【编者按】 妊娠晚期促宫颈成熟与引产是为了使胎儿及早脱离不良的宫内环境,解除与缓解孕妇合并症或并发症所采取的一种措施。引产前的基本准备是宫颈成熟。促宫颈成熟是采用药物或者其他手段促进宫颈变软、变薄并扩张,增加阴道分娩的成功率。为此,我国专门制定了《妊娠晚期促宫颈成熟与引产指南(2014)》。2016年4月7日,浙江大学医学院附属妇产科医院贺晶教授在“华夏国际产科大会”会前会上讲授了《宫颈成熟—

NEJM:35岁以上高领产妇接受引产的安全性研究

35岁以上的女性足月产前死胎的长期风险大于较年轻女性。引产可能降低死胎的风险,但也可能会增加剖宫产,这已是这个年龄组常见的危险现象。

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