米索前列醇在晚期妊娠引产中的应用

米索前列醇在晚期妊娠引产中的应用王宇刘英熊丁韩仕碧李继美近年来国外陆续报道使用前列腺素类似物“米索前列醇”引产，其疗效已得到肯定［１～３］。本研究通过随机对照，观察米索前列醇用于晚期妊娠和病理妊娠引产的临床效果，以及对胎儿的安全性。一、材料与方法１．...     

足月妊娠阴道米索前列醇引产77例分析

我院于１９９６年１０～１２月对７７例足月或过期妊娠孕妇,采用阴道置米索前列醇（简称米索）引产,对其有效性和安全性进行临床观察研究,并抽取６０例同等条件接受催产素引产者临床资料,进行比较分析。１资料与方法１１对象及分组１９９６年１～１２月本院住院分娩...     

米索前列醇用于足月妊娠引产1828例疗效观察

综合报道国内１６所医院分娩的初产妇１８２８例，随机分为两组，分别给予米索前列醇和催产素进行足月妊娠引产的病例对照研究。结果：米索前列醇用于足月妊娠的有效率为９３．５６％，显著高于催产素组７９．４９％（Ｐ＜０．０１），其临产发动时间及总产程分别为（２．９５±０．５３）ｈ和（６．３５±２．２１）ｈ，短于催产素组的（３．７５±０．６１）ｈ及（９．０９±２．４１）ｈ（Ｐ＜０．０１）；剖宫产率为８．８９％亦显著低于催产素组１７．０５％（Ｐ＜０．０１）；两组新生儿体重及新生儿窒息发生率均无显著差异（Ｐ＞０．０５）。因此认为：米索前列醇用于足月妊娠引产能缩短产程，降低剖宫产率，有利于计划分娩，是一种安全有效的引产方法。     

米索前列醇用于足月妊娠引产剂量分析

近年来 ,有不少报道米索前列醇用于足月妊娠引产的临床分析 ,而剂量各家报道不一。为了探讨米索前列醇用于足月妊娠引产最适宜剂量 ,我们对 68例足月妊娠孕妇采用阴道置米索前列醇引产 ,剂量分别为 2 5 μｇ或 5 0 μｇ ,观察其临床效果 ,现总结如下。1　资料与方法1 1　一般资料　我院于 1998年 10月至 1999年 8月间 ,对因各种原因需行引产的单胎头位的足月孕妇共 68例 ,经阴道检查排除产道异常 ,无明显头盆不称 ,无米索前列醇禁忌证者随机分两组 :Ⅰ组 3 3例 (初产妇 3 0例 ,经产妇 3例 )阴道置米索前列醇 2 5 μｇ ;Ⅱ组 3 5例 (初产妇 3…     

不同剂量米索前列醇用于足月妊娠引产的临床观察

米索前列醇 (ＭＰ)用于足月妊娠引产 ,已取得了满意效果 ,在国内外已报道较多。但对其副作用 (宫缩过频、胎儿窘迫、子宫破裂、羊水栓塞等 ) ,仍存在顾虑。我们想选用最佳剂量 ,以减少副作用的发生 ,提高阴道分娩的成功率。为此 ,我科对妊娠足月需要引产的孕妇 141例给予阴道后穹窿放置米索前列醇 ,分两组采用不同剂量进行临床观察 ,现报道如下。1　资料与方法1.1　一般资料　选择 1998年 10月至 1999年 4月符合引产指征 (如过期妊娠、羊水过少、妊高征等 )在我科实行计划分娩的孕妇 141例随机分成两组 ,年龄 2 2～ 38岁 ,平均2 6 7岁 ,孕…     

口服米索前列醇混悬液用于足月妊娠引产70例分析

目的 探讨小剂量口服米索前列醇混悬液用于足月妊娠引产的有效性和安全性。方法 １４０例有引产指征的足月孕妇分为两组。Ａ组７０例口服米索混悬液,每２ｈ１次,初起每次２０ｍｌ,连续３次后若无规律宫缩出现,第４次起改为每次４０ｍｌ,若出现有效宫缩即停药,否则直至服守２００ｍｌ;Ｂ组７０例静滴催产素引产作为对照组。结果 两组引产成功率分别为８８．５７％和８２．８６％（Ｐ〉０．０５）。Ａ组从开始用药至监产的平     

米索前列醇后穹窿给药用于足月妊娠引产

目的探讨足月妊娠应用米索前列醇引产的安全性和效果.方法选择正常单胎头位足月妊娠具有引产指征,而无禁忌症100例,随机分成两组,米索组用米索前列醇50μg放置阴道后穹窿,每3h服1次,共3次,缩宫素组用缩宫素2.5IU加入5%葡萄糖500ml内.结果米索组引产的有效率为95.46%,缩宫素组为80.85%,P＜0.05,有显著差异,低宫颈评分引产成功率,米索组84.09%,缩宫素组48.94%,P＜0.05,有显著差异,总产程时间米索组短于缩宫素组,二组分娩方式、产后出血、以及新生儿情况比较无显著差异.结论米索前列醇应用于足月妊娠引产既能促宫颈成熟,又能于短时间内发动规律宫缩,两者同步化,是一种使用方便、安全有效、价格便宜的引产方法,但需严密监护.     

米索前列醇在晚期妊娠引产中的减量研究

目的 :探讨初产妇晚期妊娠引产时将米索前列醇的剂量降至 2 5μg能否有效 ,及能否降低副反应的发生。方法 :将妊娠 38～ 4 2周的健康初产妇 93例随机分为A组(2 5μg)和B组 (50 μg) ,将药物放入阴道后穹窿 ,每日 2次 ,间隔 6h ,最多应用 4次。 结果 :引产成功率A组为 80 % ,B组为 81.2 5% ,差异无显著性 (P >0 .0 5)。两组产妇的产程进展、分娩方式及新生儿结局均无显著性差异。但是 ,A组自用药到发动规律宫缩的时间长于B组 ,产程中需用催产素加强宫缩的例数多于B组。副反应的发生率A组低于B组。结论 :将米索前列醇的剂量降至 2 5μg ,对晚期妊娠促宫颈成熟和引产有效 ,副反应发生减少 ,但是 ,孕妇对于米索前列醇的敏感性存在差异     

米索前列醇联合间苯三酚在足月妊娠引产的应用

目的比较米索前列醇联合间苯三酚与单用普贝生在足月妊娠引产中的应用效果差异。方法 120例自2017年1月~2019年5月足月妊娠需引产的初产妇按抽签法随机分成两组:实验组孕妇引产前联合使用间苯三酚、米索前列醇与缩宫素(60例),对照组使用普贝生。对比两种不同引产方案的使用效果。结果实验组促宫颈成熟有效率83.3%与对照组促宫颈成熟有效率85%比较并无统计学意义(P>0.05)。结论联合使用米索前列醇、间苯三酚,能保证孕妇宫颈成熟度,有效且更经济的完成足月妊娠引产,适用于在基层医院推广使用。     

米非司酮配伍米索前列醇在12～20周妊娠引产中的应用

目的 探讨米非司酮配伍米索前列醇用于中期妊娠引产的可行性。方法 对56例中期妊娠要求引产的孕妇，用口服米非司酮然后阴道上米索前列醇的方法进行引产，以23例同样条件的孕妇用利凡诺引产为对照。结果 米非司酮组较利凡诺组引产所需时间缩短，胎盘娩出更完整，产后出血减少，两者差异有显著性。结论 米非司酮配伍米索前列醇用于中孕引产安全、方便、可靠。     

Misoprostol for labor induction in term pregnancy

Misoprostol has been used off-label for labor induction for many years. A large number of randomized controlled studies have assessed the efficacy and safety of misoprostol in different dose ranges between 10 and 100 mcg, with different dose intervals and different administration routes including oral, intravaginal, rectal, sublingual, and buccal administration. Currently, registration trials are underway, and misoprostol for registered indication of labor induction might be available in several European countries in the near future. Meanwhile, guidelines for off-label use should be provided by authorities or OB/GYN associations.     

Prediction of adverse outcome associated with vaginal misoprostol for labor induction

Objective: To identify predictors of adverse outcome in pregnant women at term receiving 50 μg of intravaginal misoprostol for labor induction. Study design: A prospective observational study was conducted of 720 pregnant women at term with an unfavorable cervix and a medical or obstetric indication for labor induction. All patients received 50 μg of intravaginal misoprostol every 4 h up to three doses. The primary outcome measure was “adverse outcome” defined as: neonatal death, fetal acidemia and emergent cesarean delivery performed for non-reassuring fetal heart rate tracings. A stepwise logistic regression analysis was used to identify predictors of adverse outcome. Results: Tachysystole (frequent uterine contractions) (odds ratio (OR), 3.7; 95% confidence interval (CI), 1.2–10.8) and fetal tachycardia (OR, 4.8; 95% CI, 1.4–16.2) were determined as significant predictors of adverse outcome. The specificity of the model was 94.2%, whereas the sensitivity was 20.4%. Conclusion: In the absence of tachysystole and fetal tachycardia, an uneventful delivery might be expected for women receiving 50 μg of intravaginal misoprostol.     

Off-label use of misoprostol for labor induction: a nation-wide survey in Switzerland

Objective

Off-label use of drugs is frequent in obstetrical practice. No data however are available about nation-wide off-label use in obstetrics regarding frequency and patient information. The objective of our study was to assess the clinical practice of off-label use of misoprostol for labor induction.

Study design

We performed a prospective nation-wide survey study by means of a validated questionnaire in three languages in Switzerland. All registered obstetricians/gynaecologists in Switzerland were included. Of 1100 subjects, 725 (66%) answered the questionnaire; 69 subjects were excluded because they were not actively practicing OB/GYN, resulting in a total of 656 questionnaires included in the analysis.

Results

A total of 512 out of 656 obstetricians/gynaecologists (78%) use misoprostol for labor induction. The most frequent administration route of misoprostol is intravaginal (86%), in a single dose of 50 μg (94%), at a dose interval range from 4 to 6 h (85%). Among the users of misoprostol, 314 (61%) answered that they do not inform their patients about the off-label use of the medication. Among the non-users of misoprostol, the main reason for non-use is absent license for obstetric indications (48%) and non-availability (14%). If misoprostol were to be licensed for this indication, and commercially available, 69% of current non-users would use it. Non-users of misoprotol use prostaglandin E2 vaginal gel, ovules or slow-release vaginal insert, and oxytocin for labor induction.

Conclusion

Misoprostol is the single most commonly used drug for labor induction in Switzerland, although it is not licensed and although there are effective, licensed alternative drugs available. A minority of practitioners inform the patients about the off-label use.     

Misoprostol vs. oxytocin for induction of labor at term.

Efficacy of misoprostol was studied for induction of labor at term. Seventy patients were randomized to Group A (n = 36, oral misoprostol 50 microg four hourly to maximum of 5 doses) and B (n = 34, continuous oxytocin infusion). Induction-delivery interval was shorter with misoprostol (7.7 +/- 2.8 h against 14.3 +/- 4.8 h with oxytocin) but the rates of vaginal delivery, cesarean, neonatal outcome variables were similar. Hence, misoprostol is an effective agent for induction of labor at term.     

Oral, vaginal and sublingual misoprostol for induction of labor.

OBJECTIVE: To evaluate the effectiveness and safety of different administration routes of misoprostol for induction of labor. METHOD: PubMed, Cochrane Library and EMBASE searches were carried out using the keywords oral, vaginal, sublingual, buccal, misoprostol, labor induction, identifying randomized case-controlled trials comparing different routes for giving misoprostol to induce labor, published in English between 1994 and 2004. RESULTS: Seventeen studies (3549 participants) were included. Compared to vaginal administration, oral misoprostol was associated with higher failure rates for achieving vaginal delivery within 24 h (odds ratio (OR) 1.61, 95% confidence interval (CI) 1.23-2.10), higher rates of uterine hyperstimulation without fetal heart rate (FHR) changes (OR 2.21, 95% CI 1.12-4.34) and lower cesarean section rates (OR 0.74, 95% CI 0.56-0.97). A lower dose of oral misoprostol (50 microg) compared to the 25-50 microg administered vaginally was associated with a higher rate of vaginal delivery not being achieved within 24 h (OR 3.60, 95% CI 2.10-6.18), more need for oxytocin augmentation (OR 2.19, 95% CI 1.65-2.92), less uterine hyperstimulation both without FHR changes (OR 0.58, 95% CI 0.42-0.80) and with FHR changes (OR 0.34, 95% CI 0.17-0.67) and fewer cesarean sections (OR 0.69, 95% CI 0.51-0.91). Compared to vaginal administration, buccal misoprostol resulted in a higher rate of failure to achieve vaginal delivery after 24 h, more frequent uterine hyperstimulation and lower rates of cesarean section, but these differences were not significant. When 50 mug of misoprostol used sublingually was compared to oral administration, the sublingual misoprostol was associated with less failure to achieve vaginal delivery after 24 h, less oxytocin augmentation and reduced cesarean section, but none of the differences were statistically significant. CONCLUSIONS: Vaginal misoprostol appears more effective than the equivalent dosage administered orally. However, the vaginal route appears to be associated with a higher risk of uterine hyperstimulation. Sublingual misoprostol seems an effective route of administration, but a lack of data necessitates more clinical trials to establish the effectiveness and safety of the buccal/sublingual route.     

Induction of labor with intravaginal administration of misoprostol

Objective: The purpose of this study was to evaluate the efficacy and safety of intravaginal misoprostol for labor induction. Methods: 110 singleton term pregnancies with or without rupture of membranes were enrolled. Fractionated doses of misoprostol were applied (50–100 μg), every 6 h until a maximum of three doses or beginning of labor. Results: The average interval (±S.D.) from vaginal application to the beginning of active labor and to delivery were, respectively, 9.5±5.7 h and 14.8±9.5 h. Failed labor induction was observed in two cases (2%). Cesarean section rate was 14%. The incidence of tachysystole was 18% and hypersystole 4%, but these situations were associated with abnormal fetal heart rate pattern (hyperstimulation) in only 3%. No maternal side effects and neonatal adverse effects were noted. Conclusions: Intravaginal misoprostol administration with low doses is an effective and safe method for labor induction in term pregnancies, with or without rupture of membranes.     

Randomized controlled trial of 50 and 100 mcg of misoprostol for induction of labor at term

To compare the safety and efficacy of two different regimens of misoprostol for labor induction at term, we conducted a randomized controlled trial on women presenting for induction of labor at >37 weeks’ gestation. Eligible women were randomized to receive intra-vaginal misoprostol 50 μg every 4 h or 100 μg every 6 h until any of the following: 1) adequate contraction pattern (3 contractions/10 min); 2) dilatation >3 cm; 3) artificial rupture of membranes; or 4) signs of uterine hyperstimulation. Use of oxytocin during labor was at the discretion of the managing clinician. The main outcome variable considered for analysis was cesarean section rate. Secondary outcome measures were induction to delivery interval and neonatal outcome (Apgar scores, meconium staining, and umbilical artery pH). A total of 58 women were randomized to receive either misoprostol 100 μg (n=26) or 50 μg (n=32). The 100 and 50 μg groups had similar mean Bishop’s scores at induction (4.0±2.3 vs 4.1±2.2, p=0.87), rates of nulliparity, use of epidural anesthesia, and oxytocin augmentation. The number of doses of misoprostol used was similar in the two groups (1.4±0.6 vs 1.8±1.2). The mean±standard deviation time to delivery (hours) (11.9± 7.3 vs 14.3±9.6 h, p=0.30) and cesarean section rate (35% vs 19%, p=0.30, relative risk: 1.8, 95% confidence interval 0.7–5.4) were not different in the 100 vs 50 μg group. Power analysis demonstrated that 132 women would be required in each group to achieve statistical significance in the primary outcome measure (α=0.05, β=0.80). Similarly, rates of 5-minute Apgar scores <7 (4% vs 3%, p=1.0), and of meconium passage (17% vs 25%, p=0.73) were not significantly different between the two groups. Received: 20 January 2001 / Accepted: 7 March 2001