晚期妊娠死胎引产方法及综合方式引产效果分析  

Analysis on the method and comprehensive method of inducing labor for stillbirth in the third trimester

作　　者：张欢[1] 赵云[1] 杜树国[1] 柳溪 黄婷婷 江红 王静玲 ZHANG Huan;ZHAO Yun;DU Shuguo;LIU Xi;HUANG Tingting;JIANG Hong;WANG Jingling(Department of Obstetrics,Maternal and Child Health Hospital of Hubei Province,Hubei Wuhan 430070,China)

机构地区：[1]湖北省妇幼保健院产科,湖北武汉430070

出　　处：《中国妇幼健康研究》2021年第1期80-83,共4页Chinese Journal of Woman and Child Health Research

基　　金：湖北省卫计委联合基金资助项目(WJ2018H0133)。

摘　　要：目的探讨晚期妊娠死胎引产方法及运用综合方式引产的效果。方法回顾性分析2017年1月1日至12月31日湖北省妇幼保健院收治的140例晚期妊娠引产病例,将引产时死胎设为观察组(42例),胎儿存活设为对照组(98例)。比较两组病例的一般情况、引产时间及并发症,并分析综合方式引产与单一方式引产的并发症差异。结果观察组与对照组孕妇的产次(Z=-2.258)、妊娠期糖尿病患病率(χ^2=4.444)、分娩时身体质量指数(BMI)(t=0.138)、住院天数(t=6.848)比较差异均有统计学意义(均P<0.05)。观察组仅需使用催产素引产率显著高于对照组(χ^2=5.051),引产时间显著短于对照组(t=4.546),差异均有统计学意义(均P<0.05)。综合方式引产的引产时间(t=7.984)、产后出血量(t=3.284)、产后出血率(χ^2=10.256)、产后输血率(χ^2=13.453)、产褥病率(χ^2=10.256)均高于单一方式引产,差异均有统计学意义(均P<0.05)。结论晚期妊娠死胎使用米非司酮配伍利凡诺或COOK球囊安全、有效,综合方式引产的应用可减少引产过程中的中转剖宫取胎的几率,但需要警惕产后出血、产褥感染等并发症。Objective To investigate the method of inducing labor for stillbirth in late pregnancy and the effect of using comprehensive method.Methods A retrospective analysis was conducted on 140 cases of induction of labor at third trimester pregnancy in the Maternal and Child Health Hospital of Hubei Province on January 1 to December 31,2017.The stillbirth was set as observation group(42 cases)and the fetal survival was set as control group(98 cases).The general conditions,labor induction time and complications of the two groups were compared,and the differences in complications between comprehensive and single induction labor were analyzed.Results There were statistically significant differences between the observation group and the control group in terms of parity,prevalence of gestational diabetes,body mass index(BMI)at delivery,and hospitalization days(Z/χ^2/t=-2.258,4.444,0.138 and 6.848,respectively,all P<0.05).The rate of only using oxytocin in the observation group was significantly higher than that of the control group,and the time was significantly shorter than that of the control group,and the differences were statistically significant(χ^2/t=5.051 and 4.546,respectively,all P<0.05).The time of induction,the postpartum hemorrhage,the rate of postpartum blood transfusion,and the rate of puerperal disease in the comprehensive induction of labor were all higher than those in the single method of induction of labor,and the differences were statistically significant(χ^2/t=7.984,3.248,10.265 and 13.453,respectively,all P<0.05).Conclusion It is safe and effective to use mifepristone combined with rivanol or COOK balloon to induced labor for stillborn fetuses in the third trimester pregnancy.The application of comprehensive induction of labor can reduce the chances of transiting to cesarean section during labor induction,but it is necessary to be alert to complications such as postpartum hemorrhage and puerperal infection disease.

关 键 词：死胎 晚期妊娠 引产 米非司酮 利凡诺 COOK球囊 

分 类 号：R719.3[医药卫生—妇产科学]