Induction of Labour
Induction of Labour
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DOI：
10.1016/s1701-2163(15)30842-2
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发表时间：
2013-09-01
影响因子：
1.8
通讯作者：
Senikas, Vyta
中科院分区：
文献类型：
--
作者：
Leduc, Dean;Biringer, Anne;Senikas, Vyta
目的：回顾最新的文献，以便为产科护理提供者提供关于引产的循证建议。选项：妊娠引产的干预。结局：合适的引产时机和方法，合适的分娩方式，以及最佳的孕产妇和围产期结局。证据：2010年，通过检索PubMed、CINAHL和科克伦图书馆，使用适当的受控词汇（例如：例如，在一个实施例中，分娩，引产，引产，子宫颈成熟）和关键词（如，例如，在一个实施例中，诱导、诱导、增强）。结果仅限于系统综述、随机对照试验/对照临床试验和观察性研究。没有日期或语言限制。这些准则定期更新，并在2010年底前纳入准则。灰色（未发表）文献通过搜索卫生技术评估和卫生技术相关机构的网站、临床实践指南集、临床试验注册处以及国家和国际医学专业society.Values：本文件中的证据使用加拿大预防性医疗保健工作组报告（表1）中描述的标准进行评级。前列腺素E-2（宫颈和阴道）是促进宫颈成熟和对不良宫颈进行引产的有效药物。（一）2.阴道内注射伊兰定E-2优于宫颈内注射伊兰定E-2，因为它们导致更及时的阴道分娩。（一）建议必须记录引产指征，讨论应包括引产原因、引产方法和风险，包括未能分娩和可能增加的剖腹产风险。（III-B）如果引产不成功，应重新评估引产的适应症和方法。（III-B）不应仅对疑似巨大胎儿进行引产。（III-D）诱导不应仅仅因为患者或护理提供者的偏好而进行。（III-D）医疗保健提供者应评估宫颈（使用Bishop评分）以确定成功的可能性并选择适当的引产方法。（II-2A）应记录Bishop评分。（III-B）护理提供者需要考虑到，子宫颈不利的妇女引产与未经产患者的较高失败率以及未经产和经产患者的较高剖腹产率相关。（II-2A）每个女性最好都做一次超声波检查，最好是在孕早期，以确认胎龄。（一-A）医疗机构应制定质量保证计划和入职政策，包括检查表等安全工具，以确保仅对可接受的适应症进行入职。（II-2B）应在41+0和42+0周之间为妇女提供引产，因为这种干预可以降低围产期死亡率和胎粪吸入综合征，而不会增加剖腹产率。（I-A）选择延迟引产>41+0周的妇女应每周两次进行胎儿健康评估。（I-A）颅内Foley导管是可接受的药物（II-2B），在剖腹产后阴道分娩（I-B）和门诊环境中均安全。（II-2B）双腔导管可视为二线替代方案。（II-2B）前列腺素E-2（宫颈和阴道）不应用于剖宫产后阴道分娩，因为子宫破裂的风险增加。（II-2D）15.阴道前列腺素E-2可能被认为是足月时膜破裂的情况，并且可以在这种情况下使用。（一-A）16.米索前列醇可以被认为是一种安全有效的药物，用于完整胎膜和住院患者的引产。（一-A）17.米索前列醇不应用于剖宫产后阴道分娩，因为它会增加子宫破裂的风险。（II-3D）18.催产素应在最后一剂米索前列醇后不早于4小时开始。（III-B）19.羊膜切开术应保留给宫颈良好的妇女。在未接合先露的情况下应特别小心，因为有脐带脱垂的危险。（III-B）20.剖腹产后，应尽早开始催产素以建立分娩。（III-B）21.在足月胎膜破裂的情况下，在期待治疗前应考虑使用催产素。（I-A）22. B组链球菌阳性的妇女应在破膜后尽早开始使用催产素，以便在24小时内分娩。（III-B）23.高剂量和低剂量的催产素都可以在医院方案中考虑。（III-B）24.由于不同的浓度，催产素输注速率应始终以mU/min而不是mL/hr记录。（III-L）25。剖宫产后阴道分娩的医院环境中可考虑催产素诱导。（II-3B）
Objective: To review the most current literature in order to provide evidence-based recommendations to obstetrical care providers on induction of labour.Options: Intervention in a pregnancy with induction of labour.Outcomes: Appropriate timing and method of induction, appropriate mode of delivery, and optimal maternal and perinatal outcomes.Evidence: Published literature was retrieved through searches of PubMed, CINAHL, and The Cochrane Library in 2010 using appropriate controlled vocabulary (e. g., labour, induced, labour induction, cervical ripening) and key words (e. g., induce, induction, augmentation). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to the end of 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.Values: The evidence in this document was rated using criteria described in the Report of the Canadian Task Force on Preventative Health Care (Table 1).Summary Statements1. Prostaglandins E-2 (cervical and vaginal) are effective agents of cervical ripening and induction of labour for an unfavourable cervix. (I)2. Intravaginal prostaglandins E-2 are preferred to intracervical prostaglandins E-2 because they results in more timely vaginal deliveries. (I)Recommendations1. The indication for induction must be documented, and discussion should include reason for induction, method of induction, and risks, including failure to achieve labour and possible increased risk of Caesarean section. (III-B)2. If induction of labour is unsuccessful, the indication and method of induction should be re-evaluated. (III-B)3. Inductions should not be performed solely for suspected fetal macrosomia. (III-D)4. Inductions should not be performed solely because of patient or care provider preference. (III-D)5. Health care providers should assess the cervix (using the Bishop score) to determine the likelihood of success and to select the appropriate method of induction. (II-2A)6. The Bishop score should be documented. (III-B)7. Care providers need to consider that induction of women with an unfavourable cervix is associated with a higher failure rate in nulliparous patients and a higher Caesarean section rate in nulliparous and parous patients. (II-2A)8. Every woman should ideally have an ultrasound, preferably in the first trimester, to confirm gestational age. (I-A)9. Institutions should have quality assurance programs and induction policies, including safety tools such as checklists, to ensure that inductions are performed only for acceptable indications. (II-2B)10. Women should be offered induction of labour between 41+0 and 42+0 weeks as this intervention may reduce perinatal mortality and meconium aspiration syndrome without increasing the Caesarean section rate. (I-A)11. Women who chose to delay induction >41+0 weeks should undergo twice-weekly assessment for fetal well-being. (I-A)12. Intracervical Foley catheters are acceptable agents (II-2B) that are safe both in the setting of a vaginal birth after Caesarean section (I-B) and in the outpatient setting. (II-2B)13. Double lumen catheters may be considered a second-line alternative. (II-2B)14. Prostaglandins E-2 (cervical and vaginal) should not be used in the setting of vaginal birth after Caesarean section due to the increased risk of uterine rupture. (II-2D)15. Vaginal prostaglandins E-2 may be considered with ruptured membranes at term and can be used in this setting. (I-A)16. Misoprostol can be considered a safe and effective agent for labour induction with intact membranes and on an inpatient basis. (I-A)17. Misoprostol should not be used in the setting of vaginal birth after Caesarean section due to the increased risk of uterine rupture. (II-3D)18. Oxytocin should be started no earlier than 4 hours after the last dose of misoprostol. (III-B)19. Amniotomy should be reserved for women with a favourable cervix. Particular care should be given in the case of unengaged presentation because there is a risk of cord prolapse. (III-B)20. After amniotomy, oxytocin should be commenced early in order to establish labour. (III-B)21. In the setting of ruptured membranes at term, oxytocin should be considered before expectant management. (I-A)22. Women positive for group B streptococcus should be started on oxytocin as early as possible after ruptured membranes in order to establish labour within 24 hours. (III-B)23. Both high-and low-dose oxytocin may be considered within a hospital protocol. (III-B)24. Because of the various concentrations, oxytocin infusion rates should always be recorded in mU/min rather than mL/hr. (III-L)25. Oxytocin induction maybe considered in the hospital setting of vaginal birth after Caesarean section. (II-3B)