유도분만에서 Misoprostol과 Prostaglandin E₂ 질정의 비교

Abstract

This study was performed to compare the safety and efficacy of intravaginal micoprostol versus prostaglandin(PG)E2 for labor induction in term pregnancies. One hundred seventy-two pregnant women opting for labor induction with randomly were allocated to two groups, receiving either 50 micro g misoprostol every four hours with maximum six times or 3 mg PGE2 vaginal tablet every eight hours with maxiumum three times, intravaginally in the posterior vaginal formix. No labor was initiated after maximum does of misoprostol or PGE2 vaginal tablet, or dystocia occurred during active phase of laobr, intravenous infusion of oxytocin was administrated. There were no differences in clinical characteristics between the misoprostol and the PGWE2 vaginal tablet group. Change of the Bishop score was more effetive in misoprostol group thean PGE2 vaginal tablet group at four hours(p<0.04) and eight hours(p<0.01) after induction of labor. No statistically significant differences were noted between the two groups in case of need for oxytocin and oxytocin total dosage. The mean time from insertion of the drug to delivery was statistically significant shorter in misoprostol group than the PGE2 vaginal tablet group(p<0.01). Nevertheless, no statistically significant differences in intrapartum complications, mode of delivery, and neonatal or maternal adverse outcomes between the two groups were noted. In conclusions, intravaginal administration of misoprostol is more effective and cheaper method than PGE2 vaginal tablet in induction of labor at term pregnancy and misoprostol 50ug every four hours is as safe as PGE2 vaginal tablet for induction of labor in term pregnancies.

임신말기 유도분만에 PGE2 질정과 위궤양 치료제인 PGE1 유도체 misoprostol의 유도분만 효과를 비교하기 위해 계명대학교 의과대학 분만장애 유도분만을 위해 입원한 임신부중 임의표본추출법을 이용해 PGE2 질정사용군 86명과 misoprostol 사용군 86명을 대상군으로 하여 연구를 진행하였다. 양 군간에 연령, 분만력, 임신주수에는 차이가 없었고, 유도분만 시작 4시간(p<0.04), 8시간(p.0.01)후 Bioshop 점수는 misoprostol 사용군이 PGE2 질정사용군에 비해 통계적으로 유의하게 높았고, 유도분만 중 oxytocin의 정맥주입이 필요한 예와 총 주입량은 양 군간에 차이가 없었다. 유도분만에 소요된 시간은 misoptostol 사용군에서 PGE2 질정사용군에 비해 통계적으로 유의하게(p<0.01) 짧았고, 태아곤란증이나 제왕절개분만에는 양 군간에 차이가 없었다. 신생아 체중 1분, 5분 Apgar점수 및 신생아 제대동맥형 pH, PaCO2 차이도 양군간에 없었다. 임신말기 유도분만에서 misoprostol은 PGE2 질정에 비해 효과가 좋으며, 태아곤란증이나 제왕절개분만 및 신생아 상태는 PGE2 질정에 비해 아주 저렴하고 사용하는데도 불편함이 없기에 널리 이용되기를 기대하며 용법은 50ug을 4시간 간격으로 사용하면 적당하리라 생각된다.