【摘要】 目的探讨米索前列醇用于改良法宫颈Bishop评分≤3分伴宫颈分泌物胰岛素样生长因子结合蛋白-1(IGF- BP-1)阴性的延期妊娠孕妇促宫颈成熟的效果与风险。方法观察组阴道后穹隆放置米索前列醇25μg,对照组按照催产素点滴促宫颈成熟常规。使用米索前列醇或催产素后24 h无效重复应用,不超过3次。宫颈Bishop评分、胎心监护 1次／24h,用药后24、48h检测宫颈分泌物IGFBP-1。结果观察组促宫颈成熟效果优于对照组(P<0．001);观察组用药 24、48 h后宫颈分泌物IGFBP-1阳性率明显高于对照组(P<0．01和0．001);对照组以宫颈不成熟作为剖宫产指征者明显高于观察组(P<0．001);两组产后出血、过强子宫收缩、羊水粪染发生率和新生儿Apgar评分比较,差异无显著性 (P>0．05)。结论米索前列醇用于延期妊娠宫颈Bishop评分≤3分伴宫颈分泌物IGFBP-1阴性孕妇促宫颈成熟安全、有效;宫颈Bishop评分≤3分伴宫颈分泌物IGFBP-1阴性的延期妊娠孕妇不宜使用催产素促宫颈成熟;宫颈分泌物 IGFBP-1可作为评估宫颈成熟度的生物学指标之一。更多还原

【Abstract】 Objective To evaluate the effect and risk of misoprostol for stimulating cervical maturity in women with post-term pregnancy negative for insulin-like growth factor binding protein-1 (IGFBP-1) in cervical secretion with modified Bishop score less than 3. Methods Seventy-one women with post-term pregnancy randomized into misoprostol group (n=37) and control group (n=34) received misoprostol placement at the posterior vaginal fornix and routine intravenous oxytocin infusion, respectively, to stimulate cervical maturity. Failure to respond to the treatment within the initial 24 h necessitated a repeated administration for no more than 3 times in all. Modified Bishop score was recorded and fetal heart monitored once every 24 h, and IGFBP-1 in the cervical secretion was detected at 24 and 48 h after drug administration. Results The misoprostol group showed better effect of cervical maturity stimulation than the control group (P<0.001), and the positivity rates of IGFBP-1 24 and 48 h after drug administration were significantly higher than that of the control group (P<0.01 and 0.001). The number of cases with indication for cesarean section was significant higher in the control group (P<0.001). There were no significant differences in postpartum hemorrhage, excessive uterine contraction, incidence of fecal contamination of the amniotic fluid or Apgar score of the newborn between the two groups (P>0.05). Conclusions Misoprostol is safe and effective for stimulating cervical maturity in women with post-term pregnancy who have modified Bishop score lower than 3 and are negative for IGPBF-1 in cervical secretion. Oxytocin is not advised for use in such gravida for stimulating cervical maturity. IGFBP-1 in cervical secretion may serve as an important index for evaluating the cervical maturity.更多还原