初孕剖宫产后再次早孕不同流产方式的探讨

Study on the abortion methods of re-pregnancy after caesarean section in the first gestation

目的:探讨初孕剖宫产后再次早孕的最佳流产方式。方法:对166例初孕剖宫产术后再次早孕妇女的不同流产方式进行回顾性分析分为A(药物流产术)、B(药物流产后立即清宫术)、C(B超监护下无痛人流术)3组。结果:A组的流产成功率最低为80.9%,出血量多为(50.3±10.5)mL,流血时间较长为(13.4±3.6)d,与B[100%、(10.8±3.7)mL、(6.6±1.7)d]、C[98%、(8.5±2.7)mL、(7.1±1.8)d]两组比较差异有统计学意义(P<0.01),且A组术后感染率(14.7%)亦高于B(2.1%)、C(2%)两组,经比较差异有统计学意义(P<0.05);但B组中度腹痛的发生率(41.7%)较A(13.2%)、C(0)两组高,差异有统计学意义(P<0.01);再孕距剖宫产的时间2年以内的以药流即刻清宫为主,2年以上的以无痛人流为主(P<0.01)。结论:初孕剖宫产术后2年内的瘢痕子宫早孕宜首选药流后立即清宫术,2年以上的早孕以B超监护下无痛人流术为最佳流产方式。

Objective To explore the best abortion method of the re-pregnancy women after caesarean section in the first gestation. Methods One hundred and sixty-six cases of re-pregnant women with previous caesarean section were analyzed retrospectively on abortion modes. All the women were divided into 3 groups. Group A（drug abortion）, group B（had immediately curettages after drug abortion） and group C（painless induced abortion by B-ultrasound monitoring）. Results Group A, of the low success rate of abortion（80.9%）, large quantity of hemorrhage volume [ （50.3 ± 10.5）roLl and long bleeding time [（13.4 ± 3.6） d], had statistically significant differences with group B [100%, （10.8 ± 3.7）mL, （6.6 ± 1.7）d] and C [98%, （8.5 ± 2.7） mL, （7.1 ± 1.8） d] （P 〈 0.01）, and the postoperative infection rate of group A （14.7%） was higher than group B （2.1%） and C（2%）（P 〈 0.05）; the incidence of moderate abdominal pain of group B （41.7%） was higher than group A （13.2%） and C （0） groups （P 〈 0.01）. Women with re-pregnant time within two years after the previous cesarean section had instantly curettages after drug abortion, otherwise, the re-pregnant time more than two years had painless induced abortion （P 〈 0.01 ）. Conclusions Within two years after the previous cesarean section, wmnen with scar uterus in early pregnancy should have immediately curettages after drug abortion; for more than two years after the previous cesarean section, painless induced abortion by B-ultrasound monitoring is the best way for re-pregnancy women.