这篇综述评估了药物(前列腺素,催产素,米非司酮,透明质酸酶,和一氧化氮供体)和机械方法(单球囊和双球囊导管,海带,膜剥离,和羊膜切开术)以及通常在补充医学的标题下考虑的那些(蓖麻油,乳头刺激,性交,草药,和针灸)。大量已发表的报告,包括2个大型网络荟萃分析,支持米索前列醇(PGE1)用于宫颈成熟和引产时的安全性和有效性。以50μg的剂量阴道给药的米索前列醇在24小时内实现阴道分娩的可能性最高。不管给药,路线,和管理时间表,当用于宫颈成熟和引产时,前列腺素E2在降低剖宫产率方面似乎具有相似的疗效.全球范围内,尽管催产素代表了最广泛使用的引产药物,其有效性高度依赖于胎次和宫颈状态。催产素在引产方面比期待管理更有效,与羊膜切开术联合使用时,催产素的疗效得到增强。然而,经阴道或子宫内给药的前列腺素在引产方面比催产素更有效。口服200毫克米非司酮片似乎是促宫颈成熟的最低有效剂量。评估松弛素的大量文献表明,当用于该适应症时,该药物的益处有限。尽管宫颈内注射透明质酸酶可能会导致宫颈成熟,对宫颈内给药的需要限制了这种药物的使用。关于一氧化氮供体的阴道给药,包括单硝酸异山梨酯,异山梨醇,硝酸甘油,和硝普钠,这些药物的副作用发生率较高,限制了它们的使用。已发现合成的吸湿性宫颈扩张器可有效用于预诱导宫颈成熟。尽管可以在使用合成吸湿性扩张器后施用药理学药物,为了减少阴道分娩的间隔,正在探索同时使用机械和药理学方法。将单球囊导管与地诺前列酮结合使用,米索前列醇,或催产素增强这些药物在宫颈成熟和引产中的功效。单球囊导管和双球囊导管在宫颈成熟和引产中的功效相似。迄今为止,在平衡分娩时间和安全性时,米索前列醇与宫颈导管联合使用似乎是最佳方法.尽管患者偶尔会使用补充方法,鉴于缺乏记录其有效性和安全性的数据,这些方法很少在医院使用.
This review assessed the efficacy and safety of
pharmacologic agents (prostaglandins, oxytocin, mifepristone, hyaluronidase, and nitric oxide donors) and mechanical methods (single- and double-balloon catheters, laminaria, membrane stripping, and amniotomy) and those generally considered under the rubric of complementary medicine (castor oil, nipple stimulation, sexual intercourse, herbal medicine, and acupuncture). A substantial body of published reports, including 2 large network meta-analyses, support the safety and efficacy of misoprostol (PGE1) when used for cervical ripening and labor induction. Misoprostol administered vaginally at doses of 50 μg has the highest probability of achieving vaginal delivery within 24 hours. Regardless of dosing, route, and schedule of administration, when used for cervical ripening and labor induction, prostaglandin E2 seems to have similar efficacy in decreasing cesarean delivery rates. Globally, although oxytocin represents the most widely used
pharmacologic agent for labor induction, its effectiveness is highly dependent on parity and cervical status. Oxytocin is more effective than expectant management in inducing labor, and the efficacy of oxytocin is enhanced when combined with amniotomy. However, prostaglandins administered vaginally or intracervically are more effective in inducing labor than oxytocin. A single 200-mg oral tablet of mifepristone seems to represent the lowest effective dose for cervical ripening. The bulk of the literature assessing relaxin suggests this agent has limited benefit when used for this indication. Although intracervical injection of hyaluronidase may cause cervical ripening, the need for intracervical administration has limited the use of this agent. Concerning the vaginal administration of nitric oxide donors, including isosorbide mononitrate, isosorbide, nitroglycerin, and sodium nitroprusside, the higher incidence of side effects with these agents has limited their use. A synthetic hygroscopic cervical dilator has been found to be effective for preinduction cervical ripening. Although a
pharmacologic agent may be administered after the use of the synthetic hygroscopic dilator, in an attempt to reduce the interval to vaginal delivery, concomitant use of mechanical and
pharmacologic methods is being explored. Combining the use of a single-balloon catheter with dinoprostone, misoprostol, or oxytocin enhances the efficacy of these
pharmacologic agents in cervical ripening and labor induction. The efficacy of single- and double-balloon catheters in cervical ripening and labor induction seems similar. To date, the combination of misoprostol with an intracervical catheter seems to be the best approach when balancing delivery times with safety. Although complementary methods are occasionally used by patients, given the lack of data documenting their efficacy and safety, these methods are rarely used in hospital settings.