BACKGROUND:Intravenous calcium administration has shown promise in enhancing uterine contractions and reducing blood loss during cesarean delivery, but this regimen has not been compared in vaginal labor induction. OBJECTIVE:This study aimed to determine the efficacy of oxytocin combined with calcium vs oxytocin alone for inducing labor in women with term premature rupture of membranes. STUDY DESIGN:This single-blind, randomized controlled trial was conducted between October 2022 and May 2023 at a tertiary university hospital. Patients diagnosed with premature rupture of membranes were randomly allocated into 2 groups. The intervention group received a bolus of 10 mL of calcium gluconate followed by a continuous infusion of oxytocin via a pump (n=210), whereas the control group received only oxytocin infusion (n=218). The primary outcome was successful vaginal deliveries within 24 hours after labor induction. The secondary outcomes included the interval from labor induction to delivery, vaginal delivery blood loss, and maternal and neonatal complications. RESULTS:Baseline characteristics, including maternal age, body mass index, and Bishop score before labor induction, were comparable between the groups. The rate of vaginal delivery within 24 hours after labor induction was statistically higher in the intervention group (79.52% vs 70.64%; P=.04). The participants in the intervention group experienced a shortened interval between labor induction and delivery (10.48 vs 11.25 hours; P=.037) and demonstrated a higher success rate in labor induction assessed by the onset of the active phase (93.80% vs 87.61%; P=.04) without increasing the cesarean delivery rate. Reduced hemorrhage was observed in the intervention group (242.5 vs 255.0 mL; P=.0015), and the maternal and neonatal outcomes were comparable between the groups. CONCLUSION:The coadministration of calcium and oxytocin in labor induction among pregnancies with premature rupture of membranes was more efficient and safer than the administration of oxytocin alone. Our research suggests that the combination therapy of calcium and oxytocin may offer significant advantages during the process of labor induction and result in better outcomes. VIDEO ABSTRACT.

目的 探讨孕妇BMI及血脂指标与妊娠期高血压、子痫前期的相关性,分析其对妊娠结局的影响.方法 选取2019年6月1日-2020年1月31日于某院分娩的妊娠期高血压疾病产妇115例作为研究组,其中妊娠期高血压63例,子痫前期52例;健康产妇115例,作为对照组.比较2组孕产妇BMI及血脂指标差异,并进行多因素分析.比较2组不良妊娠结局的发生率.结果 孕前、孕16周、孕37周BMI及孕16周TC、TG、HDL、LDL、孕37周TC、TG均是影响孕产妇妊娠期高血压及子痫前期发生的独立危险因素(P<0.05).研究组胎儿窘迫、低体重儿发生率分别为4.35％、6.96％,显著高于对照组(P<0.05).结论 BMI及血脂异常与妊娠期高血压及子痫前期发生具有相关性,可导致不良妊娠结局发生,应对其进行干预,改善母婴结局.

目的 研究apelin受体的内源性配体(APELA)基因cg02779075位点在6项胎盘全基因组甲基化中与子痫前期关联的甲基化改变.方法 系统回顾APELA基因cg02779075位点在6项胎盘全基因组甲基化中与子痫前期关联的甲基化改变.此外,回顾性采集医院2019年1-2019年12月采集获取的47例子痫前期以及50例正常妊娠孕妇胎盘组织样本.分析两组母婴基线资料以及CpG稳点甲基化水平的差异.结果 6项研究中cg02779075位点于子痫前期胎盘中DNA甲基化水平显著下调,其中4项研究结果存在明显差异(均为P＜0.05).异质性检验分析结果显示:各文献之间存在明显异质性(I2=0.64,P=0.016),通过随机效应模型计算合并SMD值为-1.16,较各单项文献更为明显,但尚未达到全基因组显著水平.子痫前期孕周、产妇收缩压、产妇舒张压均高于正常妊娠,且胎盘重量、新生儿出生体质量均低于正常妊娠(均为P＜0.05).子痫前期APELA基因 CpG1～CpG4位点甲基化水平分别为(0.12±0.05)、(0.07±0.02)、(0.22±0.07)、(0.43±0.12),均明显低于正常妊娠的(0.22±0.08)、(0.18±0.04)、(0.30±0.10)、(0.51±0.16),差异有统计学意义(均为P＜0.05).结论 子痫前期产妇胎盘中APELA基因cg02779075位点甲基化调控异常,值得临床重点关注.