بررسی اثربخشی تزریق خارج آمنیونی دگزامتازون در آماده‌سازی سرویکس برای القای زایمان؛ یک کارآزمایی بالینی تصادفی‌سازی شده

نوع مقاله : اصیل پژوهشی

نویسندگان

1 استادیار گروه زنان و مامایی، مرکز تحقیقات خونریزی غیرطبیعی رحم، دانشکده پزشکی، دانشگاه علوم پزشکی سمنان، سمنان، ایران.

2 استادیار گروه پزشکی اجتماعی، مرکز تحقیقات عوامل اجتماعی مؤثر بر سلامت، دانشکده پزشکی، دانشگاه علوم پزشکی سمنان، سمنان، ایران.

چکیده

مقدمه: برای آماده‌سازی سرویکس جهت القای زایمان، روش ­های مکانیکی و دارویی وجود دارد که استفاده از ترکیب این روش‌ها، نتایج بهتری داشته است. مطالعه حاضر با هدف بررسی تأثیر تزریق خارج آمنیونی دگزامتازون بر آماده‌سازی سرویکس و بهبود نمره بیشاپ، اثر آن بر روند زایمان و عوارض مادری و نوزادی انجام شد.
روش‌کار: این مطالعه کارآزمایی بالینی تصادفی‌سازی شده طی سال­های 99-1398 بر روی 60 مادر باردار ترم با سرویکس نامناسب که کاندید ختم بارداری بودند، در زایشگاه بیمارستان امیرالمومنین سمنان انجام شد. افراد به‌طور تصادفی به گروه مداخله (تزریق خارج آمنیونی دگزامتازون از طریق سوند داخل سرویکس) و شاهد (تزریق خارج آمنیونی نرمال سالین) تقسیم شدند. هر دو گروه تحت القای زایمان قرار گرفتند و اطلاعات روند زایمان شامل مدت زمان فاز نهفته و فعال، مدت زمان خروج سوند، نمره بیشاپ پس از خروج سوند، میزان زایمان سزارین و آپگار دقیقه اول و پنجم نوزادان، در چک‌لیست وارد شد. تجزیه و تحلیل داده‌ها با استفاده از نرم­ افزار آماری SPSS (نسخه­ 23) و آزمون­ های تی تست، یو من‌ویتنی و کای اسکوئر انجام شد. میزان p کمتر از 05/0 معنی­دار در نظر گرفته­ شد.
یافته­ ها: پس از انجام مداخله، نمره بیشاپ اولیه و نمره بیشاپ بعد از خارج شدن سوند بین دو گروه تفاوت معنی ­داری داشت (028/0=p)، اما مدت زمان خروج سوند (45/0=p)، میانگین مدت شروع اینداکشن تا زایمان (14/0=p)، مدت فاز فعال (84/0=p) و نهفته (83/0=p)، نمره آپگار دقایق اول و پنجم (19/0=p) و میزان سزارین (76/0=p) بین دو گروه تفاوت معنی­ داری نداشت.
نتیجه­ گیری: تزریق خارج آمنیونی دگزامتازون، باعث بهبود و پیشرفت بیشتر نمره بیشاپ نسبت به گروه کنترل شد و آماده‌سازی سرویکس برای القای زایمان را تسهیل نمود.

کلیدواژه‌ها

عنوان مقاله [English]

The efficacy of Extra-amniotic dexamethasone infusion in cervical ripening for labor induction: A randomized clinical trial

نویسندگان [English]

  • Zahra Mahvi Khomami 1
  • Shahrzad Aghaamoo 1
  • Elham Saffarieh 1
  • Majid Mirmohammadkhani 2
1 Assistant Professor, Department of Obstetrics and Gynecology, Abnormal Uterine Bleeding Research Center, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran.
2 Assistant Professor, Department of Biostatistics, Social Determinants of Health Research Center, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran.
چکیده [English]

Introduction: There are mechanical and pharmacologic methods of cervical ripening that combination of these methods had better results. This study was performed aimed to investigate the effect of extra-amniotic dexamethasone infusion on cervical ripening and Bishop score, labor duration and maternal and neonatal complications.
Methods: This randomized clinical trial study was performed on 60 term pregnant women with unripe cervix who were candidates for induction of labor in Amiralmomenin hospital of Semnan in 2019-2020. The subjects were randomly assigned into intervention (extra-amniotic dexamethasone infusion through the intracervical catheter) and control groups (extra-amniotic normal saline infusion). Both groups underwent labor induction and the information about the delivery process including latent and active phase duration, time needed for catheter removal, bishop score after catheter removal, cesarean rate and first and fifth minutes Apgar score of neonates entered in a checklist. Data were analyzed by SPSS (version 23) and T-test, U-Man-Whitney and Chi-square tests. P<0.05 was considered statistically significant.
Results:  After the intervention, there was significant difference between the two groups in terms of initial Bishop score and the Bishop score after catheter removal (P=0.028), but duration of catheter removal (P=0.45), mean time of induction onset to delivery (P=0.14), duration of active phase (P=0.84) and latent phase (P=0.83), first and fifth minutes Apgar score (P=0.19) and cesarean rate (P=0.76) were not significantly different between the two groups. 
Conclusion: Extra-amniotic Dexamethasone infusion improves the Bishop score more than the control group, and facilitates cervical ripening for induction of labor.

کلیدواژه‌ها [English]

  • Bishop score
  • Dexamethasone
  • Induction of labor

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مجله زنان، مامایی و نازایی ایران
دوره 25، شماره 12
اسفند 1401
صفحه 33-42

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