107例胎盘前置状态中期妊娠终止方法探讨  

Analysis of Methods of 107 Cases Mid-Trimester Pregnancy Termination with Lower Segmant of Placenta

作　　者：李晓翠[1] 徐蓓芬 方爱华[1] 

机构地区：[1]上海交通大学附属国际和平妇幼保健院计划生育科,上海200030 [2]上海市第五人民医院妇产科,上海200240

出　　处：《生殖与避孕》2011年第11期780-785,共6页Reproduction and Contraception

摘　　要：目的:探讨胎盘前置状态中期妊娠的最佳终止方法。方法:回顾性分析107例中期妊娠合并胎盘前置状态终止妊娠病例,按胎盘位置分为边缘型组(A组)、中央型组(B组),每组再按孕周大小分为<16周组、≥16周组,比较各组引产结局。结果:①采用依沙吖啶、天花粉及米非司酮配伍米索前列醇(药物)引产成功率A组分别为100%,80%,88.9%;B组分别为93.3%,100%,66.7%;孕周≥16周组分别为100%,94.1%,75%;孕周<16周组分别为90.9%,88.9%,92.4%。②采用天花粉引产时各组的出血量及总出血量均最少,引产与住院时间均最长(P<0.05)。③引产出血≥300 ml者共10例,分别为A组4例(药物组1例,依沙吖啶组3例);B组6例药物组1例,依沙吖啶组3例,天花粉组1例,小型剖宫产1例);引产失败6例,分别为A组4例(天花粉2例,药物组2例)及B组2例(依沙吖啶1例,药物组1例)。④依沙吖啶注射及药物引产2种引产方法的急诊手术(钳胎盘术及清宫术)率分别为27.1%和28.6%,天花粉组急诊手术率最低(3.8%)。结论:①终止边缘型胎盘前置状态中孕患者<16孕周可首选药物引产,≥16孕周可首选依沙丫啶引产;②部分及完全型胎盘前置状态中孕患者可首选天花粉引产;③钳刮术是引产失败及急诊处理出血的最佳方式之一,宫腔纱条填塞能有效止血;④宫颈条件差、孕周偏大(孕周>20周)的完全型胎盘前置状态患者可选用小型剖宫产术。Objective： To discuss the best way to induce labor of mid-trimester pregnancy with placenta praevia.Methods： A total of 107 cases of placenta praevia in mid-trimester pregnancy were analyzed retrospectively.They were devided into group A（the marginal placenta praevia group） and group B（the total partial placenta praevia group）,and each group was divided into two sub groups which were the 16-week pregnancy and ≥16-week.Results： 1） The success rates of three methods of induced abortion（amniocentesis injection of rivanol,crystal trichosanthin and mifepristone combined misoprostol） in group A were 100.0%,80.0%,and 88.9%;in group B were 93.3%,100.0%,66.7%;in ≥ 16-week group were 100%,94.1%,75.0%;and in 16-week group were 90.9%,88.9%,92.4%.2） Induction by using crystal trichosamthin in all the groups,the amount of bleeding was the least and the time of induction and staying in hospital was the longest（P0.05）.3） There are 10 cases complicated with hemorrhage that the total amount of bleeding is ≥300 ml,4 in group A（1 with mifepristone,3 with rivanol） and 6 in group B（1 with mifepristone,3 with rivanol,1 with trichosanthin,1 by sesarean section）.There are 6 cases failed,4 in group A（2 with mifepristone,2 with trichosanthin） and 2 in group B（1 with rivanol,1 with mifepristone）.4） The emergency surgery（embryulcla and curettage） rates of using ravanol and mifepristone were 27.1% and 28.6%,the lowest was 3.8% by using trichosamthin.Conclution： 1） Rivanol could be the first choice when we terminate 16-week pregnancy with the marginal placenta praevia,and mifepristone could be the best choice for 16-week pregnancy with the marginal placenta praevia.2） Crystal trichosanthin could be the first choice to total partial placenta praevia.3） Embryulcla is the best emergent treatment when bleeding trend appears.Intrauterine packing with gauze can effectively reduce bleeding.4） Sesarean section can be the treatment to total placenta praevia when,poor condition of the cer

关 键 词：胎盘前置状态 引产 天花粉 依沙吖啶 钳胎盘术 小型剖宫产 

分 类 号：R714.2[医药卫生—妇产科学]