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Abstract：
Background: Induction of labor (IOL) in nulliparas with premature rupture of membranes (PROM) and an unfavorable cervix at term poses challenges. Our study sought to investigate the impact of prostaglandin E2 (PGE2) compared to oxytocin on the duration of IOL in this specific group of parturients. Methods: This was retrospective matched-case study. All nulliparas with term PROM who underwent induction between January 2006 to April 2023 at Shaare Zedek Medical Center were identified. Cases induced by either PGE2 or oxytocin were matched by the following criteria: (1) time from PROM to IOL; (2) modified Bishop score prior to IOL ≤ 5; (3) newborn birthweight; and (4) vertex position. The primary outcome was time from IOL to delivery. Results: Ninety-five matched cases were identified. All had a modified Bishop score ≤ 5. Maternal age (26 ± 4.7 years old, p = 0.203) and gestational age at delivery (38.6 ± 0.6, p = 0.701) were similar between the groups. Matched factors including time from PROM to IOL (23.5 ± 19.2 versus 24.3 ± 21.4 p = 0.780), birth weight of the newborn (3111 g versus 3101 g, p = 0.842), and occiput anterior position (present on 98% in both groups p = 0.687) were similar. Time from IOL to delivery was significantly shorter by 3 h and 36 min in the group induced with oxytocin than in the group induced with PGE2 (p = 0.025). Within 24 h, 55 (58%) of those induced with PGE2 delivered, compared to 72 (76%) of those induced with oxytocin, (p = 0.033). The cesarean delivery rates [18 (19%) versus 17 (18%)], blood transfusion rates [2 (2%) versus 3 (3%)], and Apgar scores (8.8 versus 8.9) were similar between the groups (PGE2 versus oxytocin, respectively), p ≥ 0.387. Conclusions: Induction with oxytocin, among nulliparas with term PROM and an unfavorable cervix, was associated with a shorter time from IOL to delivery and a higher rate of vaginal delivery within 24 h, with no difference in short-term maternal or neonatal adverse outcomes.
摘要：
背景：足月胎膜早破（PROM）和子宫颈不良的未产妇引产（IOL）构成挑战。我们的研究旨在调查前列腺素E2（PGE2）与催产素相比对该特定产妇组IOL持续时间的影响。方法：回顾性配对病例研究。所有在2006年1月至2023年4月期间在ShaareZedek医疗中心接受引产的足月PROM无效者均被确定。PGE2或催产素诱导的病例符合以下标准：（1）从PROM到IOL的时间；（2）IOL≤5之前的Bishop评分；（3）新生儿出生体重；（4）顶点位置。主要结果是从IOL到分娩的时间。结果：共发现95例匹配病例。所有人的Bishop评分均修改为≤5。产妇年龄(26±4.7岁,p=0.203）和分娩时的胎龄（38.6±0.6，p=0.701）在两组之间相似。匹配因素包括从PROM到IOL的时间（23.5±19.2对24.3±21.4p=0.780），新生儿出生体重(3111克与3101克，p=0.842),和枕骨前位（两组均为98％，p=0.687）相似。与PGE2诱导组相比，催产素诱导组从IOL到分娩的时间明显缩短了3小时和36分钟（p=0.025）。24小时内,PGE2诱导的患者中有55例（58%）交付，与催产素诱导的72（76％）相比，（p=0.033）。剖宫产率[18（19%）对17（18%）]，输血率[2（2%）对3（3%）]，两组之间的Apgar评分（8.8对8.9）相似（PGE2与催产素，分别)，p≥0.387。结论：催产素诱导，在患有足月胎膜早破和子宫颈不利的无效房中，从人工晶状体到分娩的时间较短，24小时内阴道分娩率较高，短期孕产妇或新生儿不良结局无差异。
