经阴道彩色多普勒超声对药物流产效果的早期预测

Study on the medical abortion effects by transvaginal color Doppler sonography

目的寻找判断药物流产完全与否的早期、客观的超声影像学指标。方法2003年7-11月东南大学附属中大医院应用经阴道彩色多普勒超声技术，对服用米非司酮配伍米索前列醇终止早孕的妇女，作药物流产前后孕囊着床部位螺旋动脉血流信号和血流动力学参数的比较。第15天仍有不规则阴道出血者全部行清官手术和病理检查，并与超声检查结果作对照。结果40例宫内旱孕中，第15天经临床或病理证实属于完全流产者22例（55．0％），螺旋动脉呈高阻血流；不全流产者18例（45．0％），螺旋动脉呈低阻血流；超声诊断的灵敏度为94．4％，特异度为100．0％，误诊率为0，漏诊率为5．6％。结论孕囊排出当天即可通过着床部位的血供状态预测流产效果。RI可能是最敏感的指标，RI〉0．6，预示完全流产；RI≤0．6，预示第15天有可能为不全流产。

Objective To investigate the uterine spiral arterial blood flow during the course of early pregnancy medical abortion and to find which is the most important factor in the abortion. Methods From July to November 2003, in the Zhongda Hospital of Southeast University, a study of spiral arterial flow in the basal deciduas was performed by transvaginal sonography in 40 normal pregnancies before and after mifepristone 150mg and mifoprostol 600μg had been taken. On day 15, all subjects who still had irregular vaginal bleeding were performed D＆C and compared with pathology. Results About 22 women （55.0%） belonged to complete abortion, and 18 women （45.0%） belonged to incomplete abortion. The sensitivity of the method was 94.4% ,specificity was 100. 0% ,misdiagnosis rate was 0,and false negative rate was 5.6%. The RI of the complete abortion group was higher,and the RI of the incomplete group was lower. Conclusion After the pregnancy sac is excluded, the spiral arterial flow in the basal deciduas affects the abortion. RI may be the most sensitive ultrasonic hemodynamic parameter. RI 〉 0.6 foresees complete abortion and RI ≤0.6 foresees incomplete abortion.