瘢痕子宫妇女中期妊娠引产的临床研究

Clinical observation of labor induced in mid-pregnancy women with scarred uterus

目的探讨米非司酮联合米索前列醇配伍依沙吖啶用于瘢痕子宫中期妊娠引产的效果及对产程的影响。方法选取2008年1月至2010年8月妊娠16～28周瘢痕子宫的妇女96例，随机分成米非司酮联合米索前列醇配伍依沙吖啶组（观察组）和依沙吖啶组（对照组）。观察组（羊膜腔注射依沙吖啶）术前1d下午空腹口服米非司酮100mg，手术当天上午空腹再服米非司酮100mg，然后羊膜腔内注入依沙吖啶100mg，同时米索前列醇100μg置后穹窿。对照组羊膜腔注射依沙吖啶100mg。结果用药至宫缩发动时间：观察组（10±6）h，对照组（34±8）h；总产程：观察组（6．2±2．4）h，对照组（10．8±4．0）h；产后出血量：观察组（91±26）ml，对照组（126±32）ml；胎盘、胎膜残留率：观察组10．42％，对照组22．92％；引产成功率：观察组95．83％，对照组87．5％。观察组在用药至宫缩发动时间、总产程时间明显短于对照组（P〈0．01）；观察组产后出血量，胎盘、胎膜残留率明显低于对照组，引产成功率高于对照组（P〈0．05）。结论米非司酮联合米索前列醇配伍依沙吖啶提高了瘢痕子宫中期妊娠引产的安全性、有效性，值得临床推广。

Objective To observe the efficacy of mifepristone-misoprostol combination with ethacridine in delivery process for induction of labor in mid-pregnancy of scarred uterus. Methods From January 2008 to August 2010, 96 cases of women who wanted to terminate unwanted pregnancy with scarred uterus（from 16 weeks to 28 weeks） were randomly divided into two groups. The observational group were administered with 100 mg of mifepristone fasting on the afternoon of the day before operation and once again on the next morning, and the ethacridine 100 mg was injected by amniocentesis, in the meantime 100 μg misoprostol was placed into cervical entrance. The control group were administered with 100 mg ethacridine intra-amniotic cavity, then they were retrospectively analyzed. Results The observational group compared with the control group in the ejection time of fetus and placenta, total stage of labor, there was a significant difference （P 〈 0. 01 ）. There were significant differences in the amount of postpartum hemorrhage and the rate of fetal, membranes retention, the success rate of labor induction （P 〈 0.05 ）. Conclusions Mifepriston-misoprostol combined with ethacridine can elevate the safety and efficiency of intermediate induced labor of scarred uterus.