近期，聚焦产科与妇科母胎医学领域的知名期刊《American Journal of Obstetrics & Gynecology MFM》发表了由应豪、程蔚蔚、刘小华等教授及其团队合作的研究论文《Vaginal dinoprostone vs Foley catheter for induction of labor at term with an unfavorable cervix: an open-label randomized controlled trial》。这一研究聚焦产科临床中极为关键的问题，为宫颈条件不成熟的足月孕妇引产提供了重要的决策依据。
在产科临床工作中，引产是常见的干预手段，大约20%-30%的孕妇会接受引产。对于足月但宫颈条件不理想（Bishop评分＜6）的孕妇来说，选择恰当的引产方法对保障母婴安全、优化分娩结局起着决定性作用。地诺前列酮阴道栓剂和Foley球囊，作为促宫颈成熟与引产的常用方法，其效果和安全性一直是产科医生关注的焦点。在实际临床操作中，如何做出正确选择成为了亟待解决的问题。
为了精准对比两种引产方法的优劣，研究团队开展了一项大规模研究。该研究在上海同济大学附属第一妇婴保健院和上海交通大学医学院附属国际和平妇幼保健院进行，从2019年10月至2022年7月，共纳入1860位符合条件的孕妇。这些孕妇均为足月单胎头位妊娠、胎膜完整，但宫颈条件不成熟。研究人员将她们随机分为两组，分别使用地诺前列酮阴道栓剂和Foley球囊进行引产，深入对比两组的引产效果与安全性。
研究结果显示，两种方法在总体引产效果上相近。地诺前列酮组的阴道分娩率为72.8% ，Foley球囊组为69.9%，阴道分娩时间差异无统计学意义。地诺前列酮组更容易引发子宫过度刺激，常伴随胎儿心率变化，胎盘早剥发生率相对较高，新生儿窒息风险也不容忽视。而Foley球囊组产妇出现疑似产时感染和产后感染的风险明显增加。
进一步的亚组分析发现，不同分娩次数的产妇适用的引产方法有所不同。对于初产妇，地诺前列酮可能更有助于提高阴道分娩率；对于经产妇，Foley球囊优势明显，它不仅能显著降低因胎儿窘迫而行剖宫产的风险，还能提高阴道分娩率，减少母婴不良事件的发生。
基于上述研究，临床医生在为足月宫颈条件不成熟的孕妇选择引产方法时，需要综合多方面因素进行考量。对于经产妇，Foley球囊在保障新生儿安全方面表现更优；但如果担心产妇的感染风险，就需要谨慎权衡，因为Foley球囊虽对新生儿有益，却会增加产妇感染的可能性。由于每位孕妇的身体状况都具有独特性，具体的引产方案应建立在医生与孕妇充分沟通的基础上，医生会根据孕妇的实际情况，制定最适宜的个性化方案。
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