COOK宫颈扩张球囊放置时间对低宫颈评分足月妊娠孕妇促宫颈成熟效果及妊娠结局的影响

Influence of placement time of COOK cervical dilation balloon on cervical ripening effect and pregnancy outcomes of low cervical score full-term pregnant women

摘要

目的 探讨COOK宫颈扩张球囊放置时间对低宫颈评分足月妊娠孕妇促宫颈成熟效果及妊娠结局的影响。方法 选取2022年1月至2023年12月遂宁市中心医院132例低宫颈评分足月妊娠孕妇作为研究对象,按照不同球囊放置时间分为三组,各44例.A组COOK宫颈扩张球囊放置10h,B组放置12h,C组放置14h.比较三组促宫颈成熟效果、放置前后Bishop评分、宫颈长度、宫颈弹性参数[弹性对比指数(ECI)、硬度比(HR)、宫颈内口应变值(IOS)与外口应变值(EOS)比值(IOS/EOS比值)]、阴道分娩率、剖宫产率、阴道分娩产妇球囊取出至临产时间、产程时间及妊娠结局。结果 三组促宫颈成熟总有效率差异无统计学意义(P>0.05);三组放置后Bishop评分均较放置前提高,宫颈长度较放置前缩短,HR较放置前下降,ECI、IOS/EOS比值较放置前升高,差异均有统计学意义(t值介于4.497~50.525之间,P<0.05),但组间差异无统计学意义(P>0.05);A组、B组阴道分娩率高于C组,剖宫产率低于C组(χ²=7.076,P<0.05);三组阴道分娩产妇球囊取出至临产时间、产程时间差异无统计学意义(P>0.05);A组产妇不良结局发生率、胎儿不良结局发生率均低于B组及C组(χ²值分别为10.155、8.658,P<0.05)。结论 COOK宫颈扩张球囊放置10h、12h、14h对低宫颈评分足月妊娠孕妇的促宫颈成熟效果相当,其中球囊放置10h能提高阴道分娩率,减少剖宫产及母婴不良结局.

Abstract

Objective To investigate influence of placement time of COOK cervical dilation balloon on cervical ripening effect and pregnancy outcomes of low cervical score full-term pregnant women. Methods A total of 132 pregnant women with low cervical scores full-term pregnancy in Department of Obstetrics, Suining Municipal Central Hospital of Sichuan province from January 2022 to December 2023 were selected. They were divided into three groups according to placement time of COOK dilation balloon: group A for 10h, group B for 12h and group C for 14h. (44 cases in each group). The effect of cervical ripening, Bishop scores before and after placement, cervical length, cervical elasticity parameters [elasticity contrast index (ECI), hardness ratio (HR), ratio of internal opening strain (IOS) to external opening strain (EOS) (IOS/EOS)], vaginal delivery rate, cesarean section rate, time from balloon extraction to vaginal delivery, labor duration and adverse maternal and infantile outcomes were compared among the three groups. Results There was no significant difference in total effective rate of cervical maturation promotion among the three groups (P>0.05). After placement of COOK dilation balloon, in the three groups, the Bishop score was higher than that before placement, the cervical length was shorter than that before placement, the HR was lower than that before placement, the ECI and IOS/EOS ratio were higher than those before placement, the differences were all statistically significant (t=4.497-50.525, all P<0.05), but there were no statistically significant differences in all indexes mentioned above among the three groups (all P>0.05). The vaginal delivery rates in group A and group B were higher than that in group C, while the cesarean section rate was lower than that in group C (χ²=7.076, P<0.05). There were no significant differences in the time from balloon extraction to vaginal delivery and the labor duration among the three groups (both P>0.05). The incidences of adverse maternal outcomes and adverse fetal outcomes in group A were lower than those in group B and group C (χ²=10.155 and 8.658 respectively, both P<0.05). Conclusion The effects of COOK cervical dilation balloon placement for 10 hours, 12 hours and 14 hours on promoting cervical ripening of the low cervical score full-term pregnant women are comparable. Among them, balloon placement for 10 hours can improve vaginal delivery rate and reduce cesarean section rate and incidences of adverse maternal and fetal outcomes.

关键词

孕妇 / 足月妊娠 / 低宫颈评分 / COOK宫颈扩张球囊 / 放置时间 / 促宫颈成熟 / 妊娠结局

Key words

pregnant women / full-term pregnancy / low cervical score / COOK cervical dilating balloon / placement time / promotion of cervical maturation / pregnancy outcome

参考文献

[1] 朱进璐, 朱鸣萍, 杨方纬, 等. 单腔球囊和COOK球囊在足月妊娠引产的效果[J]. 中国妇幼健康研究, 2019, 30(10): 1302-1305.

[2] Yamanokuchi E, Kitahara G, Kanemaru K, et al. Inflammatory Changes and Composition of Collagen during Cervical Ripening in Cows[J]. Animals (Basel), 2022, 12(19): 2646.

[3] Abu-Zaid A, Khadawardi K, Al-Matary A, et al. Isosorbide Mononitrate Versus Dinoprostone for Cervical Ripening During Labor Induction: a Systematic Review and Meta-analysis of Randomized Controlled Trials[J]. Reprod Sci, 2023, 30(2): 380-389.

[4] Abuzaid M, Baradwan S, Alkhamis W H, et al. Misoprostol plus isosorbide mononitrate versus misoprostol alone for cervical ripening during labor induction: A systematic review and meta-analysis of randomized controlled trials[J]. J Gynecol Obstet Hum Reprod, 2022, 51(1): 102235.

[5] Gu Y Z, Zhou Y, Li L, et al. Cook Cervical Ripening Balloon for placenta accreta spectrum disorders with placenta previa: a novel approach to uterus preserving[J]. Arch Gynecol Obstet, 2022, 306(6): 1979-1987.

[6] Wen C Y, Liu X M, Wang Y, et al. Conventional versus modified application of COOK Cervical Ripening Balloon for induction of labor at term: a randomized controlled trial[J]. BMC Pregnancy Childbirth, 2022, 22(1): 739.

[7] Qu S Y, Zhou P. Post-hysteroscopy Duration of the Cook Balloon Uterine Stent Effect on the Re-adhesion Formation[J]. J Coll Physicians Surg Pak, 2021, 31(10): 1163-1167.

[8] 卢艳峰, 洪招娣, 艾素贞. 宫颈双球囊在延期妊娠引产促宫颈成熟中的效果及对妊娠结局的影响[J]. 海南医学, 2022, 33(9): 1170-1172.

[9] Peel M D, Croll D M R, Kessler J, et al. Double-vs single-balloon catheter for induction of labor: Systematic review and individual participant data meta-analysis[J]. Acta Obstet Gynecol Scand, 2023, 102(11): 1440-1449.

[10] Imai K, Nozaki Y, Ushida T, et al. Comparison of the efficacy between controlled-release dinoprostone delivery system (PROPESS) and Cook's double balloon catheter plus oxytocin: A retrospective single-center study in Japan[J]. J Obstet Gynaecol Res, 2023, 49(9): 2317-2323.

[11] Druenne J, Semay T, Giraud A, et al. Pain and satisfaction in women induced by vaginal dinoprostone, double balloon catheter and oral misoprostol[J]. J Gynecol Obstet Hum Reprod, 2022, 51(10): 102484.

[12] 王妮, 张青松, 马锦琪, 等. 子宫颈双球囊引产时球囊不同放置时间对引产结局的影响[J]. 重庆医学, 2023, 52(3): 383-387, 392.

[13] 孙利华, 宁佩佩, 王璐, 等. 延长COOK宫颈扩张球囊放置时间对足月妊娠分娩结局的影响[J]. 临床医学, 2022, 42(1): 1-4.

[14] Roth L A, Kreiger-Benson E, Friedman S, et al. Time from insertion to expulsion of cervical ripening balloon in preterm versus term inductions of labor[J]. Arch Gynecol Obstet, 2024, 309(2): 515-521.

[15] 林玉治. 子宫颈双球囊联合缩宫素引产时球囊不同放置时间对引产效果与母婴结局的影响[J]. 中外医学研究, 2023, 21(33): 159-162.

[16] Lee D S, Tandel M D, Kwan L, et al. Favorable Simplified Bishop Score after cervical ripening associated with decreased cesarean birth rate[J]. Am J Obstet Gynecol MFM, 2022, 4(2): 100534.

[17] Ducarme G, Berthommier L, Planche L. Predictors of efficacy for cervical ripening among the Bishop score criteria in nulliparous women at term[J]. Int J Gynaecol Obstet, 2023, 161(3): 934-941.

[18] Muniz Rodriguez A, Naert M, Colatosti Catanho A, et al. The association between sonographic cervical length components and preterm birth in women with ultrasound-or exam-indicated cerclage[J]. J Matern Fetal Neonatal Med, 2022, 35(25): 5703-5708.

[19] 舒扬, 王志刚, 罗小东. E-cervix弹性成像评估足月妊娠宫颈成熟度预测阴道分娩的临床价值[J]. 临床超声医学杂志, 2022, 24(1): 44-47.

[20] Nazzaro G, Saccone G, Miranda M, et al. Cervical elastography using E-cervix for prediction of preterm birth in singleton pregnancies with threatened preterm labor[J]. J Matern Fetal Neonatal Med, 2022, 35(2): 330-335.

[21] Maheshwari A, Jha N, Chaturveduli L. Comparison of digital and speculum-guided methods of transcervical Foley catheter insertion in primigravida undergoing cervical ripening at term gestation: a noninferiority randomized clinical trial[J]. Am J Obstet Gynecol MFM, 2024, 6(4): 101349.

[22] Lassey S C, Haber H R, Kanbergs A, et al. Six versus twelve hours of single-balloon catheter placement with oxytocin administration for labor induction: a randomized controlled trial[J]. Am J Obstet Gynecol, 2021, 224(6): 611.e1-611.e8.

[23] Yi J, Chen L, Meng X L, et al. The infection, cervical and perineal lacerations in relation to postpartum hemorrhage following vaginal delivery induced by Cook balloon catheter[J]. Arch Gynecol Obstet, 2024, 309(1): 159-166.

[24] Strößner L, Heimann Y, Schleußner E, et al. Induction of Labour with a Double Balloon Catheter-Comparison of Effectiveness of Six Versus Twelve Hours Insertion Time: a Prospective Case Control Study[J]. Geburtshilfe Frauenheilkd, 2023, 83(12): 1500-1507.

[25] Lusink V, Usher L, Day T. The effect of extending dinoprostone pessary placement from 12 to 24h on the need for further mechanical cervical ripening[J]. Aust N Z J Obstet Gynaecol, 2014, 54(6): 586-588.

[26] Peng J, Li R B, Du S G, et al. Induction of labour in mid-trimester pregnancy using double-balloon catheter placement within 12h versus within 12-24h[J]. BMC Pregnancy Childbirth, 2021, 21(1): 17.

基金资助

2021年四川省医学(青年创新)科研课题项目(Q21201)

2025年遂宁市卫生健康科技计划项目(指导性项目)课题(25GGWS02)