剖宫产后瘢痕子宫中期妊娠引产的方法探讨

Investigation on method of induced midtrimester pregnancy of scarred uterus after cesarean

目的:探讨剖宫产后瘢痕子宫中期妊娠引产的适宜方法。方法:将120例中期妊娠要求引产的瘢痕子宫妇女分为两组,其中因孕周过小、羊水过少,依沙吖啶羊膜腔内注射困难或注射失败者采用米非司酮配伍米索前列醇引产法(A组),共42例,其余采用米非司酮联合依沙吖啶引产法(B组),共78例。观察两组的引产效果及安全性。结果:两组方法引产成功率(A组为95.24%,B组为94.87%)、产后出血量[A组(60.42±28.20)ml,B组(62.60±24.43)ml]比较,差异无统计学意义(P>0.05);A组引产总产程[(4.25±2.38)h]明显短于B组[(9.32±2.16)h],两组比较,差异有统计学意义(P<0.05);A组引产胎盘滞留率(10.00%)明显高于B组(2.70%),差异有统计学意义(P<0.05)。120例引产中,1例发生子宫破裂,1例并发穿透性胎盘植入致大出血而行子宫切除,2例均为先行依沙吖啶羊膜腔内注射引产后应用米索前列醇加强宫缩或引产失败后改为米索前列醇引产,产程均较长。结论:剖宫产后瘢痕子宫中期妊娠引产使用米非司酮联合依沙吖啶羊膜腔内注射引产和米非司酮配伍米索前列醇引产均为可行的,但需严密观察产程,注意瘢痕子宫引产并发症的发生。

Objective： To investigate the suitable method of induced midtrimester pregnancy of scarred uterus after cesarean.Methods： 120 midtrimester pregnant women required induced labor were divided into 2 groups,the method of mifepristone combined with misoprostol were used in the women who failed to amniotomy to inject Ethacridine Lactate because of small gestational age or oligohydramnios（group A,42 cases）,the method of Mifepristone combined with Ethacridine Lactate were adopted by the others（group B,78 cases）.The efficacy and safety of induced labor of two groups were investigated.Results： It had no significant difference between the two groups in the achievement ratios of induced labor（group A 95.24%,group B 94.87%） and postpartum hemorrhage [group A（60.42±28.20） ml,group B（62.60±24.43） ml]（P0.05）;total stage of labor of group A [（4.25±2.38） h] was shorter than group B [（9.32±2.16） h]（P0.05）;the incidence of retained placenta in group A（10.00%） was significant higher than group B（2.70%）（P0.05）.There was 1 case of uterine rupture and 1 case of placenta increta which cause postpartum hemorrhage and hysterectomy.2 cases adopted the method of Mifepristone combined with Ethacridine Lactate,then add Misoprostol to strengthen constraction of uterus or change the method of induced labor because of failing to induced,the stages of labor of 2 cases were longer.Conclusion： Both of methods of Mifepristone combined with Ethacridine Lactate and the Mifepristone combined with Misoprostol are feasible to induced midtrimester pregrnancy of scarred uterus after cesarean,but the course of induction and labor must be observed carefully to prevent the indication.