延期妊娠终止妊娠时机及方式探讨

Study on the timing and approach of pregnant termination for prolonged pregnancy

目的探讨延期妊娠终止妊娠时机,以确定适当的处理措施。方法回顾性分析我院产科2005年10月～2007年9月分娩的妊娠41～41+6周且无妊娠合并症的初产妇278例的临床资料。结果延期妊娠组羊水过少、羊水Ⅲ度污染、胎儿窘迫、新生儿窒息、巨大儿和剖宫产率均较足月分娩组高(P<0.05);延期妊娠引产干预组羊水Ⅲ度污染、剖宫产率均较延期妊娠自然临产组高,而阴道自然分娩率低(P<0.05);用地诺前列酮做引产前预处理+催产素引产较直接催产素静点引产组有较高的自然分娩率和较低的剖宫产率及引产失败率(P<0.05)。结论延期妊娠属于高危妊娠,在综合监测提示胎盘功能良好状态下仍可继续妊娠,不适当的干预可增加难产率,引产前的预处理可增加自然分娩机会。

Objective To explore the appropriate timing of delivery and approach of induced labor in women with prolonged pregnancy. Method A retrospective analysis was performed on deliveries at 41 and 41^＋6 weeks of gestation from October 2005 to September 2007 in our hospital. Results Compared to the deliveries at term, 278 prolonged pregnancy presented higher proportion with oligohydramnios, Ⅲ° meconiumstained amniotic fluid, fetal distress in uterus, apnoea neonatorum, macrosomia and operative deliveries （all P〈0. 05）. The frequency of Ⅲ° meconiumstained amniotic fluid and Cesarean delivery was higher in the induction group than the spontaneous onset of deliveries in the prolonged pregnancy （both P〈0. 05）. And the rate of vaginal delivery was lower in the induction group （P〈0. 05）. The applying of dinoprostone for cervical ripen before induction was an important factor of delivery outcome , resulting in significantly higher rates of spontaneous vaginal delivery, lower rates of Cesarean section and failed induction of labor. Conclusions Although prolonged pregnancy is high-risk, no intervention is recommended if the placental function is fine. Improper intervention may increase probability of dystocia. Pretreatment before induction may be helpful in spontaneous delivery.