مقایسه اثر تری نیتروگلیسیرین و میزوپروستول واژینال بر آمادگی سرویکس در حاملگی ترم

نوع مقاله: اصیل پژوهشی

نویسندگان

1 استادیار گروه زنان و مامایی، مرکز تحقیقات سلامت بارداری، دانشکده پزشکی، دانشگاه علوم پزشکی زاهدان، زاهدان، ایران.

2 دانشیار گروه زنان و مامایی، دانشکده پزشکی، دانشگاه علوم پزشکی زاهدان، زاهدان، ایران.

3 متخصص زنان، زاهدان، ایران.

چکیده

مقدمه: آمادگی سرویکس در زایمان واژینال ضروری است، لذا باید برای آمادگی سرویکس روشی ایمن و مناسب در نظر گرفته شود. امروزه جهت آمادگی سرویکس از روش­های مختلفی از جمله ژل­های استروژن، پروستاگلاندین‌ها و TNG استفاده می­شود که ارجحیت آنها بر دیگری، نا‌مشخص است. مطالعه حاضر با هدف مقایسه تأثیر میزوپروستول و TNG واژینال بر آمادگی سرویکس در حاملگی ترم انجام شد.
روش‌کار: این مطالعه کارآزمایی بالینی در سال 1390 بر روی 148 بیمار پرایمی گراوید باردار با حاملگی ترم که با سرویکس نامطلوب (امتیاز بیشاپ کمتر یا برابر 4) کاندید القای زایمان واژینال شده و به بیمارستان علی‌بن‌ابیطالب (ع) زاهدان مراجعه کرده بودند، انجام شد. بیماران در دو گروه A (400 میکرو‌گرم TNG واژینال) و B (25 میکرو‌گرم میزوپروستول) قرار گرفتند. داده‌ها در دو گروه در فرم­های مخصوص از طریق مشاهده ثبت شد. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزار آماری SPSS (نسخه 5/11) و آزمون‌های آماری تی تست و کای اسکوئر انجام شد. میزان p کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته‌ها: بعد از تجویز دارو، میزان آمادگی سرویکس (001/0>p) و امتیاز بیشاپ (001/0>p) در گروه میزوپروستول واژینال به‌طور معنی‌داری بیشتر از گروه TNG بود. همچنین مدت زمان طول کشیده از تجویز دارو تا زایمان در گروه میزوپروستول واژینال به‌طور معنی‌داری کوتاه‌تر از گروه TNG بود (001/0>p). آپگار دقایق 1 و 5 در دو گروه مشابه بود. میزان بروز عوارض جانبی دارو قبل از زایمان در گروه میزوپروستول 11 مورد (9/14%) و در گروه TNG، 29 مورد (2/39%) بود که میزان بروز این عوارض در دو گروه از نظر آماری معنی‌دار بود (001/0>p).
نتیجه‌گیری: میزوپروستول در مقایسه با TNG سبب آماده‌سازیسریع‌ترو مؤثرتر سرویکس می­شود و با عوارض جانبی کمتر همراه است.

کلیدواژه‌ها


عنوان مقاله [English]

Comparison of Vaginal Trinitroglycerin (TNG) and Vaginal Misoprostol in Cervical Ripening at term pregnancy

نویسندگان [English]

  • Batoul Teimouri 1
  • Marzieh Ghasemi 1
  • Nahid Sakhavar 2
  • Sima Khajeh Noori 3
1 Assistant Professor, Department of Obstetrics and Gynecology, Pregnancy Health Research Center, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.
2 Associate professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.
3 Gynecologist, Zahedan, Iran.
چکیده [English]

Introduction: Cervical ripening is essential in vaginal delivery; so, a safe and suitable method should be considered for cervical ripening. Nowadays, different methods are used for cervical ripening, including estrogen gels, prostaglandins and TNGs that their preference is unclear. This study was performed with aim to compare vaginal misoprostol and trinitroglycerin (TNG) on cervical ripening at term pregnancy.
Methods: This randomized clinical trial was performed in 2011 on 148 primigravida patients with term pregnancy and unfavorable cervix (Bishop score ≤ 4) who were candidate for induced vaginal delivery and referred to Zahedan Ali Ebne Abi Talib hospital. The patients were divided into two groups: group A (400 µg vaginal TNG) and group B (25 µg vaginal misoprostol). The outcomes in two groups were recorded in the forms by observation. Data was analyzed by SPSS software (version 11.5) and Chi-square and T-test. P<0.05 was considered significant.
Results: After administration of the drugs, cervical ripening (P<0.001) and Bishop score (P<0.001) were significantly higher in vaginal misoprostol group than TNG group. Also, time duration from drug administration to delivery was significantly shorter in vaginal misoprostol group than TNG group (P<0.001). 1 and 5 minutes Apgar Scores were similar in two groups. The side-effects of drugs before delivery in misoprostol group were 11 cases (14.9%) and in TNG group were 29 cases (39.2%); two groups were significantly different in terms of the incidence of these side-effects (P<0.001).
Conclusion: Misoprostol compared to TNG causes more effective and rapid cervical ripening and also has less side-effect.

کلیدواژه‌ها [English]

  • Cervical Ripening
  • Misoprostol
  • pregnancy
  • Trinitroglycerin
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