Objective To evaluate the efficacy and safty of misoprostol combined with COOK balloon in labor induction of term pregnancy.Methods From January 2013 to August 2016 altogether 257 primiparas in full term with indication for induced labor, cervical score equal to or greater than 6 and no contraindication were selected from Chengdu Fifth People's Hospital and Chengdu Second People's Hospital and randomly divided into four groups, misoprostol and COOK balloon group, misoprostol group, oxytocin group, and oxytocin and COOK balloon group.Bishop score of cervix before and after cervical ripening, rates of vaginal delivery and cesarean delivery, time from contractions to labor, duration of each stage, blood loss in vaginal delivery, postpartum hemorrhage rate, assisted vaginal delivery rate, cervical and vaginal laceration incidence, as well as neonatal 1 min Apgar score were compared among four groups.Results Cervical Bishop score had no significant difference before using COOK balloon or misoprostol among COOK group, misoprostol group and oxytocin group (F=0.85,P>0.05).After using COOK balloon or misoprostol, cervical Bishop score in COOK balloon group, misoprostol group and oxytocin group had significant difference (F=36.421,P<0.05).COOK balloon was more effective on promoting cervical ripening.There was significant difference in cesarean delivery rate in four groups (χ2 =87.26,P<0.05).Comparison among groups showed that no significant difference in cesarean rate was found between misoprostol group and oxytocin and cook balloon group (χ2 =9.17, P>0.05).Difference in contraction to delivery time among four groups was statistically significant (F=15.71, P<0.05) with COOK balloon and oxytocin group better than other groups (t value was 1.03, 6.61 and 2.78, respectively, all P<0.05).Difference in first stage, total stage of labor and blood loss in vaginal delivery among groups had statistical significance (F value was 44.55, 48.38 and 3.79, respectively, all P<0.05).Difference in second and third stage of labor among groups was not significant (F value was 1.66 and 2.14, respectively, both P>0.05).There was no significant difference in assisted vaginal delivery rate and episiotomy rate among four groups (χ2 value was 1.26 and 3.71, respectively, both P>0.05).Conclusion Application of misoprostol combined with COOK balloon in labor induction of term pregnancy is safe and effective, and can reduce cesarean delivery rate.%目的 评价米索前列醇联合COOK球囊用于足月妊娠引产的有效性及安全性.方法 选择成都市第五人民医院、成都市第二人民医院2013年1月至2016年8月住院具有引产指征,宫颈评分≤6分,无引产禁忌症的初产妇257例.随机分为4组:米索前列醇联合COOK球囊组、单用米索前列醇组、单用缩宫素组和缩宫素联合COOK球囊组.比较各组促宫颈成熟前后宫颈Bishop评分、阴道分娩率及剖宫产率、诱发宫缩至临产时间、各产程时间、阴道分娩出血量、产后出血率、阴道助产率、宫颈和阴道裂伤率、新生儿1min Apgar评分.结果 放置球囊或放置米索前列醇,COOK组与米索组、缩宫素组比较,宫颈Bishop评分差异无统计学意义(F=0.85,P>0.05).放置球囊或放置米索后,COOK组与米索组、缩宫素组比较,宫颈Bishop评分差异有统计学意义(F=36.42,P<0.05).COOK球囊促宫颈成熟效果更好.4组剖宫产率比较差异有统计学意义(χ2 =87.26,P<0.05),进一步组间比较发现米索组与COOK联合缩宫素组差异无统计学意义(χ2 =9.17,P>0.05).4组诱发宫缩至临产时间比较差异有统计学意义(F=15.71,P<0.05),COOK联合缩宫素组优于其他组(t值分别为1.03、6.61、2.78,均P<0.05).第一产程、总产程比较、阴道分娩出血量比较差异有统计学意义(F值分别为44.55、48.38、3.79,均P<0.05),第二产程、第三产程比较差异无统计学意义(F值分别为1.66、2.14,均P>0.05).阴道助产、会阴侧切率比较差异无统计学意义(χ2值分别为1.26、3.71,均P>0.05).结论 米索前列醇联合COOK球囊用于足月妊娠引产是安全、有效的,可降低剖宫产率.
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