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的临床观察

目的：探讨米索前列醇用于足月妊娠引产的安全性及效果。方法：将６０例有引产指征的孕足月单胎头位、无宫缩的初产妇，随机分成两组，研究组（３０例）用米索前列醇５０μｇ阴道用药，每３小时１次至正式临产；对照组（３０例）用蓖麻油鸡蛋餐口服。结果：两组引产总有效率无显著差异，研究组引产时间显著少于对照组（Ｐ＜０．０５），研究组需静脉滴注催产素人数为１０．０％，显著少于对照组的４０．０％，（Ｐ＜０．０５），用药６小时后研究组宫颈评分提高５．５分，对照组提高３．１分，评分结果比较，差异有显著性（Ｐ＜０．０５），研究组子宫收缩过频的发生率为１６．７％，对照组为３．０％。结论：阴道放置米索前列醇用于足月妊娠引产能促宫颈成熟及发动子宫收缩，是安全、有效的引产方法     

米索前列醇用于晚期妊娠引产效果观察

目的：探讨米索前列醇用于晚期妊娠引产的安全性及效果。方法：对９０ 例妊娠３３ ～４３ 周有引产指征的初产妇,随机分成两组,米索前列醇组（４６ 例） 、对照组（４４ 例） , 分别用米索前列醇５０ μｇ 阴道后穹窿用药引产及用催产素引产。结果：米索前列醇组晚期妊娠引产的有效率为９５ ．６５ ％ ,显著高于对照组的８１ ．８２ ％ （ Ｐ＜ ０ ．０５） , 两组宫颈评分提高程度比较差异有非常显著性意义（ Ｐ＜ ０ ．０１） 。米索前列醇组引产时间、总产程显著短于对照组（ Ｐ ＜ ０ ．０５） 。两组新生儿情况比较无显著性差异（ Ｐ ＞ ０ ．０５） 。结论：阴道后穹窿放置米索前列醇用于晚期妊娠引产能促宫颈成熟及发动子宫收缩,是一种方便、有效、较安全的引产方法。     

米索前列醇预防剖宫产术后出血的临床研究

目的观察米索前列醇用于剖宫产预防产后出血的效果。方法选择１８２例剖宫产者,随机分为米索前列醇组、米索前列醇＋催产素组及催产素组。米索前列醇组６０例,术中打开腹膜时口服米索前列醇６００μｇ。米索前列醇＋催产素组６４例,术中打开腹膜时口服米索前列醇６００μｇ,胎儿娩出后宫体肌内注射催产素２０ＩＵ。催产素组５８例,胎儿娩出后宫体肌内注射催产素２０ＩＵ,再静脉滴注催产素２０ＵＩ。以上各组观察术中及术后２小时内出血量。结果术中及术后２小时平均出血量,米索前列醇组为２１２±５６０ｍｌ;米索前列醇＋催产素组为２０８±５５４ｍｌ;催产素组为３４５±６４７ｍｌ。米索前列醇组与催产素组比较,差异有极显著性（Ｐ＜００１）。米索前列醇组与米索前列醇＋催产素组比较,差异无显著性（Ｐ＞００５）。结论米索前列醇促进子宫收缩作用强于催产素,能较好地预防剖宫产术后出血,且用药方便、安全。     

小剂量米索前列醇用于晚期妊娠引产的效果观察

目的观察２５μｇ米索前列醇对晚期妊娠引产的有效性和安全性。方法选择有引产指征、无引产及米索前列醇使用禁忌证的单胎、头位、胎膜完整的晚期妊娠妇女４８例,随机分为Ａ组（２７例,米索前列醇２５μｇ）和Ｂ组（２１例,米索前列醇５０μｇ）。间隔４～６小时重复给药,２４小时内最大剂量为２００μｇ。胎膜破裂或临产则停止用药。结果Ａ组与Ｂ组引产成功率分别为７７．８％、８１．０％。首次用药至临产时间分别为７６９．９±３５９．９分钟、８０７．４±４０５．２分钟,首次用药至阴道分娩时间分别为９７８．６±４６４．４分钟、９７７．５±４２１．４分钟,加用催产素引产者Ａ组４例、Ｂ组２例;分娩方式、新生儿体重,两组比较,差异均无显著性（Ｐ＞０．０５）,但宫缩过强伴发胎心监护异常的发生率Ａ组低于Ｂ组。结论２５μｇ米索前列醇用于晚期妊娠引产有效而且安全     

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     

米非司酮配伍米索前列醇用于终止14—33周妊娠的临床研究

采用２００ｍｇ米非司酮一次顿服，２４ｈ后每隔３ｈ服用米索前列醇０．２ｍｇ的方法，对７０例１４～３３周妊娠进行了引产临床观察（Ａ组），并以６５例常规利凡诺引产作为对照组（Ｂ组）。结果：Ａ组引产成功６３例，失败７例，成功率为９０．００％，Ｂ组引产成功６２例，失败３例，成功率为９５．３８％。４８ｈ内Ａ组有９６．８３％孕妇引产成功，Ｂ组仅５９．６８％（Ｐ＜０．０１）；平均引产时间Ａ组显著短于Ｂ组，分别为３７．１９±７．１０ｈ与４５．１９±１３．５９ｈ（Ｐ＜０，０１）；Ａ组中经产妇或≤１６孕周的孕妇引产时间显著短于初产妇或＞１６孕周者（Ｐ均＜０．０１），而Ｂ组引产时间在产次、孕周方面差异无显著性。米非司酮配伍米索前列醇的服药方案用于中、晚孕引产效果与利凡诺相似，且具有引产时间短，服药方便、安全等优点，为≤１６孕周的引产提供了良好的安全引产方法。     

米索前列醇舌下含服用于足月妊娠引产的安全性分析

目的探讨米索前列醇用于足月妊娠引产的安全性.方法回顾性分析了216例使用米索前列醇引产和200例使用缩宫素引产的足月妊娠产妇的临床资料.结果米索组产程中出现不协调宫缩63例,占29.2%,过频宫缩43例,占19.9%,而缩宫素未出现异常宫缩.两组羊水混浊发生率分别为21.8%和14.5%,P＜0.01,差异有显著性.两组CST(+)发生率分别为12.0%和6.0%,P＜0.05,差异有显著性.剖宫产原因中,胎儿宫内窘迫均为两组主要手术指征,米索组30例,占78.9%,缩宫素17例,占54.8%,P＜0.05,差异有显著性,提示米索前列醇用于足月妊娠引产,对母亲和胎儿有潜在的不安全因素存在.     

硫酸普拉酮钠用于中期妊娠引产的疗效观察

对５０例利凡诺引产的中期妊娠妇女应用硫酶普拉酮钠（硫酸去氢表雄酮，ＤＨＡＳ）促宫颈成熟（用药组），并与同期５０例单纯利凡诺引产的中期妊娠妇女（对照组）进行比较。结果表明：用药组５０例宫颈Ｂｉｓｈｏｐ评分均有升高，显效率为８６％；总有效率为９８％；与对照组比较差异有显著性（分别为Ｐ＜０．００１及Ｐ＜０．０１）；用药组平均引产时间比对照组缩短１３．４小时，差异有显著性（Ｐ＜０．０１）。     

米索前列醇阴道后穹窿给药用于足月妊娠引产90例临床分析

目的：探讨小剂量米索前列醇（米索）用于足月妊娠引产的有效性和完全性。方法：A组90例根据宫颈Bishop评分阴道后穹窿首次置米索25－50μg,观察宫缩情况，若无规律宫缩则每3小时置药一次（25μg），直至出现规律宫缩，总量不超过200μg；B组90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87．78％和80．00％（P＞0．05）。A组从开始用药至临产时间较B组明显缩短（P＜0．05）。初产妇宫颈评分≤5分者，A组引产成功率高于B组（P＜0．05），两组剖宫产率，产时出血量及新生儿窒息的发生率均无显著性。结论：小剂量重复阴道后穹窿给米索用于足月妊娠引产，是一种安全、有效的方法。     

Oral misoprostol for premature rupture of membranes at term

OBJECTIVE: The study was undertaken to compare the efficacy, safety, and maternal satisfaction of oral misoprostol and intravenous oxytocin for labor induction in women with premature rupture of membranes at term. STUDY DESIGN: One hundred five women were stratified by parity and randomly assigned to oral misoprostol 75 microg every 4 hours as needed to establish labor or to intravenous oxytocin. RESULTS: The induction to vaginal delivery time with oral misoprostol was 737 (+/-426) minutes compared with 573 (+/-318) minutes with oxytocin (P=.04). The incidence of hyperstimulation was lower in the misoprostol group (6.0% vs 27.1%, P=.005). Women were more likely to be very satisfied with their care in the misoprostol group (86.0% vs 63.4%, P=.02). CONCLUSION: In women at term with premature rupture of membranes, oral misoprostol resulted in a longer induction to vaginal delivery interval but increased maternal satisfaction and less hyperstimulation compared with intravenous oxytocin. Further research is needed to assess uncommon neonatal and maternal outcomes.     

A comparison of oral and vaginal misoprostol for induction of labor

OBJECTIVE: The aim of the study is to compare the efficacy and safety of oral (100 microg) and vaginal (50 microg) misoprostol for labor induction. STUDY DESIGN: Ninety-nine patients with indications for labor induction randomly received 100 microg oral misoprostol every 4 h or 50 microg vaginal misoprostol every 4 h, using maximum six doses. Mean induction to delivery interval, mode of delivery, rates of tachysystole, hypertonus and hyperstimulation syndrome, oxytocin use, number of doses used, failed induction rate and neonatal outcomes were compared for the two groups. RESULTS: Mean dose of misoprostol used for oral and vaginal misoprostol groups were 2.17+/-1.35 and 1.91+/-0.94, respectively (p=0.65). There were two failed inductions in the oral (4%) and one failed induction (2.5%) in the vaginal group after a total of six doses of misoprostol (p=0.58). There was no significant difference for the mean induction to delivery interval, to the beginning of active phase interval, active phase duration, second stage duration and the number of women who received oxytocin for induction or augmentation between the two groups (p>0.05). There were also no significant differences for intrapartum complications and neonatal outcomes between the oral and vaginal misoprostol groups (p>0.05). CONCLUSION: Our findings indicate that, in a closely supervised hospital setting with adequate monitoring, 100 microg oral misoprostol has the potential to induce labor as safely and effectively as its 50 microg vaginal analogue. As oral use of the drug is easier for both the patient and the doctor, oral misoprostol will probably be more preferable than the vaginal route.     

A comparison of orally administered misoprostol to intravenous oxytocin for labor induction in women with favorable cervical examinations

OBJECTIVE: The purpose of this study was to compare orally administered misoprostol with intravenous oxytocin infusion for labor induction in women with favorable cervical examinations (defined as a Bishop score of 6 or more). STUDY DESIGN: One hundred ninety-eight women with indications for labor induction and favorable cervical examinations were assigned randomly to receive oral misoprostol or oxytocin induction. Misoprostol, 100 mg, was administered every 4 hours up to 6 doses, or intravenous oxytocin was administered by standardized protocol. RESULTS: One hundred ten (55.6%) women received misoprostol; 88 (44.4%) received intravenous oxytocin. There was no statistically significant difference in the average interval from start of induction to vaginal delivery, being longer in the misoprostol group (789.4 +/- 510.2 minutes) than in the oxytocin group (654.0 +/- 338.2 minutes, P=.19, log-transformed data). Two women had tachysystole develop in each treatment group. More women in the misoprostol group experienced hyperstimulation (7/110, 6.4%) than in the oxytocin group (0/88, P=.02, Fisher exact test). Nine (8.1%) misoprostol-treated women and 8 (9.1%) oxytocin-treated women underwent cesarean deliveries (P=.82). There was a presumed uterine rupture in a misoprostol-treated multipara women. There were no statistically significant differences in neonatal outcomes between the groups. CONCLUSION: Oral misoprostol offers no benefit over intravenous oxytocin for labor induction in women with favorable cervical examinations. It is associated with a higher likelihood of uterine hyperstimulation and may increase the risk of uterine rupture.     

Oral versus vaginal misoprostol for induction of labor: a double-blind randomized controlled trial

OBJECTIVE: To determine the efficacy of oral misoprostol (50 microg) administered every 3 hours compared to vaginal misoprostol (50 microg) administered every 6 hours for induction of labor. STUDY DESIGN: In this double-blind randomized trial, 126 women received misoprostol (50 microg) either orally every 3 hours or vaginally every 6 hours for induction of labor. Outcomes included time from induction to delivery, oxytocin augmentation, incidence of hyperstimulation and tachysystole, mode of delivery, and neonatal outcomes. RESULTS: Median time to delivery was shorter in those women who were receiving vaginal misoprostol (vaginal 14.3 hours vs oral 23.1 hours; P =.0004) and more women in the oral group required oxytocin augmentation of labor (73% vs 42%) (RR, 1.98; 95% CI, 1.29 to 3.06). The incidence of hyperstimulation was similar between the groups, but there was an increased incidence of tachysystole in the vaginal group (26.5% vs 9.7%)(RR, 2.74; 95% CI, 1.16 to 6.51). There was no difference between the groups with respect to mode of delivery or neonatal outcome. CONCLUSION: Vaginal misoprostol administered every 6 hours is more effective for induction of labor than oral misoprostol administered every 3 hours. The higher rates of tachysystole with use of vaginal misoprostol in the current study warrant further investigation.     

A prospective randomized study comparing misoprostol and oxytocin for premature rupture of membranes at term.

OBJECTIVE: The aim of this randomized trial was to compare the efficacy and safety of vaginal misoprostol and oxytocin for cervical ripening and labor induction in patients with premature rupture of membrane (PROM) at term. METHODS: Ninety-seven women with PROM at term were assigned randomly to receive intravaginal misoprostol or oxytocin. The primary outcome measure was the induction-delivery interval. Secondary outcomes included the number of women who delivered vaginally within 12 hours of the start of the induction in the two groups, the cesarean, hyperstimulation, and failed induction rates, the mode of delivery, and the neonatal outcome. RESULTS: Forty-eight women were assigned to intravaginal misoprostol and 49 to oxytocin administration. The mean interval from induction to delivery was 10.61 +/- 2.45 hours in the misoprostol group and 11.57 +/- 1.91 hours in the oxytocin group (p = 0.063). The rates of vaginal delivery were 83.3% and 87.7% and cesarean delivery were 16.7% and 8.2% in the misoprostol and oxytocin groups, respectively. Neonatal outcomes were not significantly different. Of the cases, 8.3% in the misoprostol group and 8.2% in the oxytocin group revealed uterine contraction abnormalities. CONCLUSION: Our study demonstrates that, intravaginally, misoprostol results in a similar interval from induction of labor to delivery when compared to oxytocin.     

Excessive uterine activity accompanying induced labor

OBJECTIVE: To estimate the incidence and timing of excessive uterine activity accompanying induction of labor with misoprostol using different routes (oral or vaginal) and forms (intact tablet or crushed) and to compare these with dinoprostone gel, oxytocin, and spontaneous labor. METHODS: This retrospective cohort study included 519 women at term who had labor induced and 86 women at term in spontaneous labor. Induction agents included misoprostol, dinoprostone, or oxytocin. Fetal heart rate and uterine activity tracings were analyzed independently by three maternal-fetal medicine physicians. The diagnosis of tachysystole or hyperstimulation required the agreement of two or more reviewers. RESULTS: The incidence of tachysystole was highest with misoprostol administered by vaginal tablet (misoprostol vaginal tablet 50 microg every 4 hours, 48.6%; vaginal tablet crushed 50 microg and suspended in hydroxyethyl gel every 4 hours, 30.7%, P =.009; oral tablet 50 microg every 4 hours, 22.2%, P =.001; oral tablet crushed 50 microg every 4 hours, 15.5%, P <.001; dinoprostone gel, 33.0%, P =.022; intravenous oxytocin, 30.2%, P =.027; and spontaneous onset of labor, 23.3%, P <.001). Hyperstimulation occurred more often with dinoprostone gel (16.5%) than with other forms of induction or spontaneous labor. Hyperstimulation occurred significantly more often with vaginal misoprostol crushed tablet (7.9%) and vaginal misoprostol intact tablet (7.6%) than with crushed oral misoprostol (1.0%) (P =.016 and.018, respectively). There was a shorter time to tachysystole with increasing doses of vaginal misoprostol tablet (P =.01). CONCLUSION: The incidence of tachysystole and hyperstimulation, and time to tachysystole, varied depending on the route and form of misoprostol given.     

Randomized comparison of oral misoprostol and oxytocin for labor induction in term prelabor membrane rupture

OBJECTIVES: To compare labor induction intervals between oral misoprostol and intravenous oxytocin in women who present at term with premature rupture of membranes. METHODS: One hundred eight women were randomly assigned to misoprostol 50 microg orally every 4 hours as needed or intravenous oxytocin. The primary outcome measure was time from induction to vaginal delivery. Sample size was calculated using a two-tailed alpha of 0.05 and power of 80%. RESULTS: Baseline demographic data, including maternal age, gestation, parity, Bishop score, birth weight, and group B streptococcal status, were similar. The mean time +/-standard deviation to vaginal birth with oral misoprostol was 720+/-382 minutes compared with 501+/-389 minutes with oxytocin (P = .007). The durations of the first, second, and third stages of labor were similar. There were no differences in maternal secondary outcomes, including cesarean birth (eight and seven, respectively), infection, maternal satisfaction with labor, epidural use, perineal trauma, manual placental removal, or gastrointestinal side effects. Neonatal outcomes including cord pH, Apgar scores, infection, and admission to neonatal intensive care unit were not different. CONCLUSION: Although labor induction with oral misoprostol was effective, oxytocin resulted in a shorter induction-to-delivery interval. Active labor intervals and other maternal and neonatal outcomes were similar.     

Induction of labor with oral misoprostol for premature rupture of membranes at term in women with unfavorable cervix: a randomized, double-blind, placebo-controlled trial

AIM: To evaluate the efficacy and safety of oral misoprostol for labor induction in women with term premature rupture of membranes (PROM) and an unfavorable cervix. METHODS: We randomized 130 women with PROM of < or =4 h to either oral misoprostol, 50 microg, or a placebo given every 4 h for up to three doses. Intravenous oxytocin was initiated if active labor did not begin within 12 h. RESULTS: Sixty-four women received oral misoprostol and 66 received placebo. The PROM-to-delivery interval was shorter with misoprostol than with placebo (13.7+/-5.8 vs. 20.3+/-6.8 h, respectively, P<0.05). Misoprostol significantly reduced the need for oxytocin (28.1 vs. 72.7%, P<0.001) and antibiotics (25 vs. 69.7%, P<0.001). No significant differences in cesarean section or hyperstimulation rate were noted. CONCLUSION: Oral misoprostol given to women with unfavorable cervix soon after term PROM significantly reduces the induction-to-delivery time and the need for oxytocin and antibiotics.     

Comparison of oral and vaginal misoprostol for induction of labor at term: a randomized controlled trial

OBJECTIVE: To compare the efficacy of oral with vaginal misoprostol for induction of labor at term. METHODS: One hundred and fifty-three pregnant women at term with indications for induction of labor and Bishop score < or = 6 were randomly assigned to receive misoprostol either 100 microg orally or 50 microg vaginally every 6 h for 48 h. Repeated doses were given until Bishop score > or = 8 was achieved or spontaneous rupture of membranes occurred. Those who were not in labor after 48 h had labor induced with amniotomy and oxytocin. The main outcome measure was induction to delivery time. RESULTS: The median induction to vaginal delivery time in the oral group (14.3 h) was not significantly different from that of the vaginal group (15.8 h). The median number of doses was also not significantly different in the oral group compared with the vaginal group. There was a significant higher incidence of uterine tachysystole in the vaginal group compared to the oral group (17.1% vs 5.3%, P = 0.032). There was no hyperstimulation in either group. There were no significant differences between the groups with respect to oxytocin augmentation, cesarean section rate, analgesic requirement, and neonatal outcomes. CONCLUSION: Oral administration of 100 microg misoprostol has similar efficacy to intravaginal administration of 50 microg misoprostol for labor induction with less frequent abnormal uterine contractility. 100 microg of misoprostol orally can be used as an alternative to the vaginal route for labor induction.