催产素治疗方案用于诱导分娩和怀孕结果
Uma M Reddy1, Grecio J Sandoval2, Alan T N Tita3
1Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (Reddy).
American journal of obstetrics & gynecology MFM
|October 2, 2024
概括
在无产期患者中,中高剂量的催产素治疗方案并没有降低剖腹产率,并且与新生儿呼吸支的增加有关. 需要进一步的研究来澄清不同剂量的催产素的益处和风险.
科学领域:
- 产科和妇科 产科和妇科
- 孕产妇和胎儿医学 孕产妇和胎儿医学
- 新生儿护理 新生儿护理
背景情况:
- 在低风险的无胎儿患者中,在39周选择性诱导分娩增加了,因为有证据表明剖腹产产率降低.
- 目前的证据不足以推更高剂量的催产素方案,而不是较低剂量的方案,用于例行劳动诱导.
研究的目的:
- 为了评估催产素治疗方案剂量与剖腹产率之间的关联,在低风险的无产期患者中,在怀孕39周以上进行分娩诱导.
- 评估催产素治疗方案剂量与综合不良产周结局之间的关系,包括产周死亡或严重的新生儿并发症.
主要方法:
- 诱导与预期管理的随机试验的二次分析 (诱导与预期管理的随机试验).
- 在2933名患者中,中高剂量催产素治疗方案 (>2mU/min) 与低剂量治疗方案 (≤2mU/min) 的比较.
- 共同初级结局:剖腹产和围产死亡或重症新生儿并发症的复合,使用多变量回归模型进行分析.
主要成果:
- 中高剂量催产素治疗方案与显着较低的剖腹产分娩率没有关联 (调整后的RR,0.90;97.5%CI,0.76-1.07).
- 综合不良周产期结局在中高剂量疗法中更为频繁 (调整后RR,1.61;97.5%CI,1.11-2.35),主要是由于对新生儿呼吸支的需求增加.
- 中高剂量疗法与更高的手术性阴道分娩率和更短的分娩时间有关,但没有改善新生儿结果.
结论:
- 与低剂量方案相比,中高剂量的催产素治疗方案在39周或更早的孕期无产妇患者的产业诱导中并没有降低剖腹产率.
- 较高剂量的催产素疗法与新生儿呼吸支的风险增加有关,尽管通常是自我限制的,并且不会改善新生儿的结果.
- 需要进一步的证据来确定最佳的催产素治疗方案,平衡孕产妇和新生儿的风险和益处.
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