目的：為避免misoprostol在引產中所造成的子宮過度刺激，我們採用一種多次少劑量的口服滴定用法，使用在妊娠合併子宮肌瘤的引產，並評估其有效性及安全度。病例報告：一位29歲懷孕的婦女在妊娠21週時，因下腹痛經超音波檢查發覺子宮前壁的下段處有8.4×7.3公分的子宮肌瘤。在所有的產前檢查中，除肌瘤及血壓正常偏高外，並無異常的發現，也無尿蛋白或水腫。在妊娠39週時，因三級胎盤鈣化及羊水較少而入產房引產。引產的原則是根據misoprostol的滴定口服用法。引產前的子宮頸成熟分數是3分，總共用了250微克的misoprostol。在整個待產過程中，沒有子宮過度刺激，沒有胎兒窘迫。從引產至活動期的時間為14小時45分鐘，而引產至陰道生產的時間為16小時20分鐘。新生兒為男性，重3050公克，1分鐘/5分鐘的Apgar’s score為9/10分。產後3小時25分鐘，由於發現惡露量較多，故給予3顆misoprostol共600微克，以防止產後出血。結論：根據藥物動力學與此位病人的實際反應，misoprostol的滴定口服用法是有效的，並且可避免子宮過度刺激所造成的急性胎兒窘迫，值得進一步再做大量的臨床評估。
Objective: To avoid uterine hyperstimulation of misoprostol during labor induction, we adopted a new method of repeated smaller doses titrated and used orally in one pregnancy with myoma. In addition, we assessed the effectiveness and safety of this regimen. Case Report(s): A 29-year-old pregnant woman complained of lower abdominal pain at 21 weeks of gestation. At that time, a leiomyoma approximately 8.4 × 7.3 cm in the anterior wall of uterine lower segment was found on a sonogram. There were no abnormal findings except for uterine myoma and high-normal blood pressure without proteinuria and edema in all prenatal examinations. She was admitted to the delivery room for labor induction at 39 weeks of gestation due to grade Ill calcified placenta and oligohydramnios. The principle of the labor induction with misoprostol was according to the titrated oral method. The Bishop score was 3 before labor induction and total dose of misoprostol used was 250μg. No hyperstimulation or no fetal distress was found during the whole labor course. The induction to active phase interval was 14 hours and 45 minutes, while the induction to vaginal delivery interval was 16 hours and 20 minutes. A male newborn that weighed 3050 g was delivered vaginally and the Apgar’s score of 1’/5’ was 9/10. Three tablets of oral misoprostol (600μg) were given 3 hours and 25 minutes after delivery to prevent postpartum hemorrhage due to heavy lochia. Conclusion(s): According to the pharmacokinetics of misoprostol and the patient’s responsiveness, the titrated oral use of misoprostol was effective. In the meantime, the uterine hyperstimulation resulting in acute fetal distress was also avoided. It is worthwhile to conduct a large trial to assess the effectiveness and safety of this regimen.
關聯:
Taiwanese Journal of Obstetrics & Gynecology 42(2):147~151
