关键词：米索前列醇；催产素；延期妊娠；宫颈成熟

    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(IGFBP-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25 μg，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∕24 h，用药后24、48 h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。

    Effect and risk analysis of misoprostol in stimulating cervical maturity for post-term pregnancy

    YIN Chun-yan, ZHOU Jing-zhen, WANG Bao-ping, Lv Xiao-yan

    Department of Obstetrics, Second People’s Hospital of Guangdong Province, Guangzhou 510317, China

    Abstract: Objective To evaluate the effect and risk of misoprostol for stimulating cervical maturity in women with postterm 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 (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 hours, 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. ......