妊娠早期阴道出血86例临床分析  

Clinical Analysis of the Characteristics about Vaginal Bleeding in Early Pregnancy

作　　者：李白鸾[1] 吕群英[1] 祁文瑾[1] 倪仁敏[1] 和华 

机构地区：[1]昆明医学院第一附属医院妇产科,云南昆明650032 [2]瑞丽县医院妇产科,云南瑞丽678400

出　　处：《昆明医学院学报》2007年第1期80-83,共4页Journal of Kunming Medical College

摘　　要：目的对妊娠早期阴道出血原因做出明确诊断并选择正确治疗方案.方法对86例妊娠早期阴道出血患者常规先行阴道检查,了解出血部位,取阴道及宫颈分泌物做多种病原体检测,再行B超检查了解胚胎及胎儿发育情况,同时做孕酮(P)及促甲状腺素(TSH)测定并与正常妊娠组相比较,进行t检验.结果(1)86例妊娠早期阴道出血原因分别为先兆流产61例,宫颈息肉15例,宫颈糜烂9例,阴道炎6例;(2)先兆流产及宫颈病变大多合并支原体或衣原体感染;(3)先兆流产组孕酮水平显著低于正常对照组,P<0.001;两组TSH无明显差异.结论(1)妊娠早期阴道出血大多为先兆流产的表现,但也有一部分为宫颈及阴道疾病所致,妇产科医生不应回避阴道检查而一概按先兆流产治疗,否则可致宫颈病变漏诊或误诊;(2)先兆流产原因可为孕卵本身异常、支原体/衣原体等感染或孕酮分泌不足等多种因素,故应明确诊断后再予相应治疗.Objective To explore the reasons about vaginal bleeding in early pregnancy and to choose right treatment way. Methods 86 patients with vaginal bleeding in early pregnancy underwent vaginal examination to find out the position of bleeding and vaginal discharges were picked out to detect the kinds of pathogen. Then B- ultrasound was performed to know the developmental condition of embryo and fetus. At the same time, P and TSH were tested and t - test followed hy comparing the results of these tests with those of the normal pregnancy. Results （ 1 ） The reasons of vaginal bleeding in the 86 cases were as follows： 61 cases with threatened abortion, 15 cases with cervix polyp, 9 cases with devastating cervix, and 6 cases with vaginal inflammation. （2） Most cases of threatened bleeding and cervix were complicated with the infection of Ureaplasma urealyticum or Chlamydia trachomatis. （3） Compared with the control group, progesterone （P） level was obvious lower in the group of threatened abortion （ P 〈 0. 001 ） and there was no significant difference between the two groups. Conclusion （1） Vaginal bleeding in early pregnancy not only can be a sign of threatened abortion but also can be caused by cervical or vaginal diseases. Therefore, vaginal examination should not be ignored and all the patients should not be treated as the ones who are threatened abortion, or missed diagnose or misdiagnose would appear. （2） Many factors may induce threatened abortion ： abnormal of zygote and embryo, infection of Ureaplasma urealyticum or Chlamydia trachomatis or P secretion insufficient and so on. Therefore correct diagnose should be given the priority over treatment.

关 键 词：妊娠 阴道出血 病因 诊断 治疗 

分 类 号：R714[医药卫生—妇产科学]