疤痕子宫妊娠药物引产的护理措施

Nursing methods in medical abortion for women with a cesarean scar

目的:研究疤痕子宫妊娠引产的护理措施。方法:46例疤痕子宫妊娠孕周16w～24w,平均(20.21±1.1)w;因各种原因主动要求终止妊娠,随机将46例患者分为两组,A组29例,单用利凡诺,B组17例,利凡诺联合米非司酮。观察宫缩发动时间,胎儿胎盘娩出时间、总产程、引产成功率及产后出血量等情况。结果:46例均在用药后72h分娩,无子宫破裂。两组引产时段的比较:引产时间,宫缩开始到引产结束分别:A组(36.45±2.39)h,(7.85±2.39)h;B组(30.25±2.32)h,(4.25±2.42)h。两组比较,差异有非常显著性(P<0.01)。两组注药后宫缩发动时间比较差异有非常显著性(P<0.01)。两组产后出血量比较差异无显著性(P>0.05)。B组宫颈成熟达97%,A组为26%。两组比较,差异有非常显著性(P<0.01)。A组由于宫颈不成熟,宫缩发动及产程时间长,产程中孕妇疼痛剧烈,B组因宫颈成熟,宫缩发动时间短,产程中宫缩与宫颈扩张同步进行,从而使产程明显缩短,孕妇无剧烈疼痛及并发症。两组产后出血量均<500ml。B组17例孕妇宫缩痛明显减轻,产程缩短。结论:羊膜腔内注射利凡诺100mg和经腹羊膜腔内注射利凡诺100mg同时空腹给米非司酮50mg,12小时1次,连服3次均安全有效。但米非司酮联合利凡诺用于疤痕子宫妊娠引产,比利凡诺单独使用,产程明显缩短,孕妇无剧烈疼痛,易被病人接受,护理措施简单,具有良好的社会效益和经济效益,是更值得推广的引产方法。

Objective ： To study the nursing methods in medical abortion during mid - trimester in women who have had a prior Caesarean section. Methods ： 46 normal pregnant women with a prior Caesarean section were randomly assigned A group and B group. Their pregnant week range from 16w to 24w, with average of 20.2± 1. 1 w. They request for abortion for different reasons. For A group, Ethacridine Lactate was placed; while for B group, both Ethacridine Lactate and Mifepristone were applied. The uterine contraction interval, ripen certix interval, total time for abortion, successful abortion rate and blood loss were obversed. Results： For all 46 women taking drugs, parturition occurred after 72 hours and there was no case of scar rupture. The abortion time is （36.45±2.39）h, （7.85 ± 2.39）h for A and （30.25±2.32）h, （4.25 ± 2.42）h for B, which differed significantly （P 〈 0. 01 ）. The uterine contraction interval differed significantly （P 〈 0. 01 ）. The ripen cervix rate was 26% and 97% for group A and group B, respectively, with significant difference （ P 〈 0.01 ）. Because of mature uterine, the uterine contraction and cervi- cal expansion occur simultaneously and thus reduce abortion time and reduce pain for pregnant women. The blood losses of the two groups neither exceed 500ml. And pain and abortion time for B group is significantly lower. Conclusions： Ethacridine injection alone is also useful and convenient; however, the association of Ethacridine Lactate and Mifepristone is more efficient and safer, with significant shorter duration of labor. The combination is highly acceptable by patients as a result of the painlessness. Also, the nursing steps are simple, and cause little pain to patient. Therefore, it has potent social and medical advantages, and can be a potential promising induction choice.