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引产前不成熟宫颈的促成熟方法

Author
Deborah A Wing, MD, MBA
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Vanessa A Barss, MD, FACOG
Translators
李雪莲, 主任医师

引言

宫颈条件是引产时评估经阴道分娩可能性的一个良好指标。对于宫颈成熟的女性，任何引产方法都可能有效，反之，对于宫颈不成熟(即质硬、后位、不扩张且宫颈管未消退)的女性，任何方法成功的可能性均不高。因此，如果引产前宫颈不成熟，通常会实施促宫颈成熟的措施。

促宫颈成熟是一个使宫颈软化且具有可扩张性，最终实现宫颈管部分消退和宫口扩张的复杂过程[1-3]。宫颈的变化涉及酶催化的胶原原纤维溶解、水含量增加及各种化学变化(图 1)。这些变化是由激素(雌激素、孕激素、松弛素)以及细胞因子、前列腺素和一氧化氮合酶引起的。

医用促宫颈成熟主要有两种方法：(1)机械性(物理性)干预，如放置导管或宫口扩张器；(2)使用促宫颈成熟的药物，如前列腺素类制剂。这些方法将在下文介绍。关于引产和使用缩宫素的一般问题将单独讨论。 (参见“引产”)

BISHOP评分

Bishop评分是一种在引产前定量描述宫颈条件的方法(表 1)。虽然在不同研究中使用的阈值不同，但目前普遍认为评分大于8分表示宫颈成熟(即，无论是自然发动还是引产，经阴道分娩的概率相同)，而评分小于等于6分通常被定义为宫颈不成熟(即，如果引产，经阴道分娩的概率较低)[4]。

已有数据的局限性

几项因素限制了对已有的促宫颈成熟数据的解读，导致难以确定最有效的促宫颈成熟和引产的方法(无论是单独使用，还是联合使用)。这些因素包括：

                                  

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Literature review current through: 2017-06 . | This topic last updated: 2017-04-05.
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