بررسی مقایسه اثر میزوپروستول و پروپرانولول با میزوپروستول به تنهایی در القای زایمان در مادران مراجعه کننده به بیمارستان کوثر قزوین: یک کارآزمایی بالینی تصادفی شده

نوع مقاله : اصیل پژوهشی

نویسندگان

1 متخصص زنان و زایمان، مرکز آموزشی درمانی کوثر، دانشکده پزشکی، دانشگاه علوم پزشکی قزوین، قزوین، ایران.

2 دانشیار گروه زنان و زایمان، دانشکده پزشکی، دانشگاه علوم پزشکی قزوین، قزوین، ایران.

3 استادیار گروه زنان و زایمان، دانشکده پزشکی، دانشگاه علوم پزشکی قزوین، قزوین، ایران.

4 دانشجوی پزشکی عمومی، دانشکده پزشکی، دانشگاه علوم پزشکی همدان، همدان، ایران.

5 دانشیار گروه اپیدمیولوژی، مرکز تحقیقات بیماری‌های غیرواگیر، پژوهشکده پیشگیری از بیماری‌های غیرواگیر، دانشگاه علوم پزشکی قزوین، قزوین، ایران.

10.22038/ijogi.2026.27613

چکیده

مقدمه: زایمان، یک پدیده فیزیولوژیک است که معمولاً به‌صورت طبیعی با شروع خودبه‌خودی دردها در هفته‌های 42-38 بارداری آغاز و با خروج محصولات بارداری خاتمه می‌یابد. شروع خودبه‌خودی لیبر و زایمان تحت تأثیر عوامل متعددی از جمله تغییر در سطح هورمون‌های استروژن، پروژسترون و پروستاگلاندین‌ها، تغییر حساسیت میومتر به اکسی‌توسین و پروستاگلاندین‌ها و اثرات متقابل این عوامل قرار دارد. مطالعه حاضر با هدف مقایسه اثر ترکیب میزوپروستول و پروپرانولول با میزوپروستول به‌تنهایی در القای زایمان مادران انجام شد.
روش‌کار: این مطالعه کارآزمایی بالینی تصادفی شده دوسوکور بر روی 240 زن باردار مراجعه کننده به بیمارستان کوثر در طی سال 1403 انجام شد. ابزار گردآوری داده‌ها، چک‌لیستی شامل مشخصات فردی بیمار و داده ­های بالینی بود. به گروه شاهد (120 نفر) 50 میکروگرم میزوپروستول زیرزبانی (حداکثر دو دوز) به همراه پلاسبو و به گروه مداخله (120 نفر) 50 میکروگرم میزوپروستول زیرزبانی (حداکثر دو دوز) و 20 میلی‌گرم پروپرانولول خوراکی هر 6 ساعت تا دو دوز داده شد و با شروع انقباضات رحمی، ادامه القاء با اکسی‌توسین انجام شد. تجزیه و تحلیل داده ­ها با نرم‌افزار آماری SPSS (نسخه 25) و آزمون‌های کای‌اسکوئر و تی مستقل انجام شد. میزان p کمتر از ۰۵/۰ معنی‌دار در نظر گرفته شد.
یافته ­ها: بر اساس نتایج، تفاوت آماری معنی‌داری بین دو گروه از نظر تعداد بارداری­ ها (676/0=p) و آپگار نوزادان (000/1=p) مشاهده نشد. همچنین متغیرهای هموگلوبین قبل (959/0=p) و بعد (852/0=p) و تغییرات آن (842/0=p)، فشارخون سیستولیک (334/0=p) و دیاستولیک (484/0=p) تفاوت آماری معنی‌داری بین دو گروه نداشت، در حالی که میانگین ضربان قلب گروه مداخله (76/3±18/85) به‌طور معنی‌داری کمتر از گروه کنترل (99/3±22/86) بود (040/0=p). در مقایسه طول مدت فازهای زایمان، تفاوت آماری معنی‌داری بین دو گروه از نظر فاز نهفته (570/0=p) و فاز 1 (660/0=p) و فاز 2 (704/0=p) وجود نداشت.
نتیجه ­گیری: افزودن پروپرانولول خوراکی به میزوپروسترول باعث تسریع فازهای زایمانی نمی‌شود. از بین متغیرهای بالینی، فقط میانگین ضربان قلب گروه مداخله (18/85) کمتر از گروه کنترل (22/86) گزارش شد.

کلیدواژه‌ها

موضوعات

عنوان مقاله [English]

Comparing the Effects of Misoprostol and Propranolol with Misoprostol Alone for Induction of Labor in Mothers Referred to Kausar Qazvin Hospital: A Randomized Clinical Trial

نویسندگان [English]

  • Somayeh Honarpisheh 1
  • Ezzatalsadat Haji Seyed Javadi 2
  • Masoumeh Dadashaliha 3
  • Farideh Movahed 2
  • Armina Haji Seid Javadi 4
  • Mehdi Ranjbaran 5
1 Obstetrician and Gynecologist, Kowsar Educational and Medical Center, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.
2 Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.
3 Assistant Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.
4 Medical Student, Faculty of Medicine, Hamedan University of Medical Sciences, Hamedan, Iran.
5 Associate Professor, Department of Epidemiology, Non-communicable Diseases Research Center, Research Institute for Prevention of Non-communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
چکیده [English]

Introduction: Childbirth is a physiological phenomenon that usually begins naturally with the spontaneous onset of pain in the 38-42 weeks of pregnancy and ends with the exit of pregnancy products. Spontaneous onset of labor and delivery is influenced by various factors such as changes in the level of estrogen, progesterone and prostaglandin hormones, changes in myometrial sensitivity to oxytocin and prostaglandins and the mutual effects of these factors. This study was conducted with aim to compare the effect of misoprostol and propranolol with misoprostol alone in induction of labor in mothers.
Methods: This double-blind randomized clinical trial was conducted on 240 pregnant women referred to Kowsar Hospital during 2024. The data collection tool was a checklist including the patient's personal characteristics and clinical data. The control group was given 50 micrograms of sublingual misoprostol up two doses along with placebo, and the intervention group was given 50 micrograms sublingual misoprostol up to two doses and 20 mg propranolol tablets every 6 hours up to two doses. Induction with oxytocin was continued with the onset of uterine contractions. Data analysis was performed with SPSS (version 25) and Chi-square test and independent t-test. P<0.05 was considered statistically significant.
Results: According to the results, there was no statistically significant difference between the two groups in terms of the number of pregnancies (p=0.676) and the Apgar score of the newborns (p=1.000). Moreover, the variables of hemoglobin before (p=0.959) and after (p=0.852) and its changes (p=0.842), systolic blood pressure (p=0.334) and diastolic blood pressure (p=0.484) did not have a statistically significant difference between the two groups. However, the mean of heart rate of the intervention group (85.18 ± 3.76) was significantly lower than that of the control group (86.22 ± 3.99) (P=0.040). In comparing the duration of labor phases, there was no statistically significant difference between the two groups in terms of latent phase (p=0.570), phase 1 (p=0.660), and phase 2 (p=0.704).
Conclusion: Adding oral propranolol to misoprostol did not accelerate the duration of labor phases. Among the clinical variables, only the mean heart rate of the intervention group (85.18) was lower than that of the control group (86.22).

کلیدواژه‌ها [English]

  • Labor Induction
  • Misoprostol
  • Oxytocin
  • Propranolol

مراجع

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مجله زنان، مامایی و نازایی ایران
دوره 28، شماره 12
اسفند 1404
صفحه 1-16

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