瘢痕子宫孕中期引产方式的探讨  

Induced termination of second trimester pregnancy in women with scarred uterus

作　　者：焦海宁[1] 刘华[1] 刘延[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院妇产科,上海200025

出　　处：《中国医师杂志》2017年第3期407-410,共4页Journal of Chinese Physician

摘　　要：目的探讨瘢痕子宫孕妇孕中期引产的适宜方法。方法选择2010年1月至2016年7月在上海交通大学医学院附属瑞金医院产科于孕中期引产的瘢痕子宫孕妇共120例，引产指征为胎儿畸形，妊娠并发症，胎死宫内及个人原因。其中，距离前次子宫手术的间隔时间〈2年35例，≥2年85例。肝功能正常者采用米非司酮＋利凡诺羊膜腔注射引产法；羊水过少、孕周过小、利凡诺羊膜腔注射困难或注射失败者采用米非司酮＋米索前列醇引产法。共有62例孕妇采用利凡诺引产（利凡诺组），58例孕妇采用米索前列醇引产（米索组）。记录两组孕妇入院时一般情况，包括年龄、孕周、孕次、产次；记录前次子宫手术方法、有无并发症及距离前次手术间隔时间；记录本次引产方式，记录孕妇用药至宫缩发动的时间，用药至胎儿娩出的时间；观察产后出血量，胎盘滞留率，胎盘胎膜残留率、疼痛情况及引产成功率等情况。结果⑴利凡诺组与米索组孕妇的年龄、孕次、产次、距前次子宫手术的间隔时间分别比较，差异无统计学意义（P〉0.05）；两组孕妇孕周比较，差异有统计学意义（P〈0.01）。⑵两组孕妇引产的成功率及产后出血量差异无统计学意义（P〉0.05），但米索组孕妇用药后宫缩发动的时间及分娩时间明显短于利凡诺组（P〈0.01）；米索组孕妇24 h内分娩率89.66%（52/58）明显高于利凡诺组22.58%（14/62）（P〈0.01）。⑶利凡诺组不良事件发生率83.87%（52/62）与米索组70.69%（41/58）比较差异无统计学意义（P〉0.05）。利凡诺组孕妇胎盘滞留率（19.23%，10/52）明显低于米索组（48.78%，20/41）（P〈0.01）；而利凡诺组胎盘胎膜残留率（75%，39/52）明显高于米索组（48.78%，20/41）（P〈0.01）。间隔时间〈2年的孕妇与≥2年的孕妇，在胎盘滞留、胎盘胎膜残留、产后出血发生�Objective To investigate the suitable mode of induced termination of pregnancy at sec- ond trimester for women with scarred uterus. Methods A retrospective study was performed in 120 cases of second trimester pregnant women with scarred uterus, who requested termination of pregnancy in Department of Obstetrics, Ruijin Hospital of Shanghai Jiaotong University from January 2010 to July 2016. The indications of termination of pregnancy were fetal anomaly, serious pregnant complication, intrauterine fetal deaths and personal factors. The interval time of previous operation to this pregnancy were recorded. It was 〈 2 years in 35 cases and ≥2 years in 85 cases. The patients with normal hepatic function began to take mifepristone combined with ethacridine lactate （group A,62 cases）. The method of mifepristone combined with misoprostol was used in the patients who failed to amniotomy to inject ethacridine lactatebecause of oligo- hydramnios or small gestational age （group B ,58 cases）. The detail information of every patient was recorded, including age,gestational weeks, gravidity, parity, the mode of previous operation, previous operation time and indication, the mode of induced labor inthis pregnancy, the interval time from administration to uterine contraction, delivery or not and the interval time from induction to delivery, postpartum hemorrhage, the successful rate of induce labor,and placental retention ratio. Results （1） It had no significant difference between groups A and B in age, gravidity, parity and the interval time of previous operation to this pregnancy （ P 〉 0.05 ）. There was significant difference between two groups in gestational weeks of induction （ P 〈 0. 01 ）. （2） It had no significant difference between two groups in successful rate of induction and postpartum hemorrhage （ P 〉 0. 05 ）, but the time from induction to regular uterine contractionand delivery in group B was significant shorter than that of group A （P 〈 0. 01 ）. The rate of delivery with 24 h

关 键 词：子宫/病理学 瘢痕 引产 妊娠中期 

分 类 号：R719.3[医药卫生—妇产科学]