早孕期终止瘢痕子宫患者意外妊娠的临床分析

Clinical analysis of unplanned pregnancy termination in patients with scarred uterus during early pregnancy

目的分析瘢痕子宫意外妊娠患者行人工流产的特点及结局。方法回顾性分析该院2010年1月年至2011年3月收治的599例剖宫产术后意外妊娠行人工流产患者的临床资料,将其中588例瘢痕子宫妊娠患者根据流产方式分为两组:人工流产组(n=274)及药物流产后清宫组(n=314),同期收治的600例非瘢痕子宫意外妊娠人工流产患者(其中,采用无痛人工流产手术300例,药物流产后清宫300例)的临床资料作为对照。结果 599例患者中,11例因子宫切口妊娠住院行腹腔镜手术治疗。588例瘢痕子宫妊娠患者中,人工流产组及药物流产后清宫组患者手术成功率的差异无统计学意义(P>0.05),但均低于非瘢痕子宫组(P<0.05);瘢痕子宫与非瘢痕子宫比较,患者术后阴道流血时间、血人绒毛膜促性腺激素(hCG)恢复至正常时间,差异无统计学意义(P>0.05);妊娠距前次剖宫产术时间在1年内的人工流产的成功率显著低于1年后(P<0.05)。结论剖宫产术后意外妊娠行人工流产手术难度大,风险高,非切口妊娠患者应选择合理的流产方式以降低手术风险。

Objective To analyze the characeristics and ending of induced abortion conducted in unplannedly pregnant women with scarred uterus. Methods Clinical data of 599 patients admitted to hospital with unplanned pregnancy after cesarean section who had been subjected to induced abortion from January 2010 to March 2011 were retrospectively analyzed. Among them, 588 pregnant women with scarred uterus were divided into 2 groups according to the abortion methods which were induced abortion group （n= 274） and curettage after medical abortion group（n= 314）. The clinical data of 600 unplannedly pregnant women without scarred uterus（300 cases of painless induced abortion and 300 cases of curettage after medical abortion） in the same period served as control. Results Among 599 patients,ll patients hospitalized due to uterine incision pregnancy and treated with laparoscopic surgery. In 588 pregnant women with scarred uterus, the success rates of surgery of patients in induced abortion group and curettage after medical abortion group showed no significantly differenee（P〉0.05）, however, they were both markedly lower than those of patients without scarred uterus（P〈0.05）. Compared the patients with scar uterine and the patients without scar uterine,the duration of postoperative vaginal bleeding and blood human choronie gonadotrophin（hCG） returning to normal value demonstrated no significantly difference（P〉0.05）. The success rate of induced abortion accepted at the time within a year from previous cesarean section was obviously lower than that of induced abortion accepted after a year（P〈0.05）. Conclusion Induced abortion after cesarean section due to unplanned pregnancy is difficult and risky,and reasonable abortion method should be conducted in the patients without uterine incision pregnancy to reduce the surgical risk.