双球囊在中晚期高危妊娠引产中应用的有效性及安全性

Safety and Efficacy of Double Balloon Dilation in Induction of Labor during Second-and Third-trimester High Risk Pregnancy

目的探讨双球囊在中晚期高危妊娠引产中应用的有效性和安全性。方法收集2010年6月～2011年8月40例年龄在19～40岁的中晚期高危妊娠妇女。病例包括:早发型重度子痫前期合并肝肾损害10例,子痫3例,糖尿病合并重度子痫前期小于28周3例,死胎8例,妊娠合并白血病1例,双胎输血综合征2例,肾功能不全伴胎儿生长受限(FGR)5例,妊娠合并血小板减少性紫癜(ITP)2例,重度子痫前期合并HELLP综合征3例,胎儿畸形合并羊水过少3例。放置方法:子宫球囊插入宫颈后置于宫颈内口并充生理盐水80mL,宫颈-阴道球囊放置于宫颈外口并充生理盐水80mL,12～24h后无宫缩或宫缩不规律,阴道放置米索前列醇或静脉滴注小剂量催产素。结果 40例高危妊娠的孕妇顺利引产39例,引产成功率达97.5%,自放置球囊到胎儿娩出平均时间26.5h。10例加用小剂量米索前列醇引产成功;7例加用小剂量催产素引产成功。结论对于中晚期高危妊娠妇女中孕周尚早,胎儿存活率低下或已发生死胎及有肝肾严重损害者,双球囊引产安全有效,避免了药物对肝肾的损害,避免了不必要的剖宫产,降低以后再生育的风险。

Objective To explore the safety and efficacy of double balloon dilation in induction of labor during second-and third-trimester pregnancy.Methods Forty women（age rang 19-40）,diagnosed as having a high-risk pregnancy,were recruited at the point of admission to our hospital during June 2010 to August 2011,and clinic data were analyzed.Out of 40 cases,10 women had early-onset severe pre-eclampsia with liver and kidney injury,3 had eclampsia,and 3 had diabetes with severe pre-eclampsia in less than 28 weeks pregnancy.There were also 8 cases of stillbirth,one case of leukemia,2 cases of twin-twin transfusion syndrome,5 cases of fetal growth restriction（FGR）accompanied by renal insufficiency,2 cases of idiopathic thrombocytopenic purpura（ITP）,3 cases of severe pre-eclampsia accompanied by HELLP syndrome,and 3 cases of fetal malformation along with oligohydramnios.Two balloons were placed in internal os and filled with 80 mL normal saline.Cervix-vaginal balloon was placed in outside os and filled with 80 mL normal saline.Misoprostol was given in the vagina or low dose oxytocin given intravenously if regular contraction did not occur after 12-24 h balloon management.Results Thirty-nine out of 40 high-risk pregnant women had successful induction of labor.Average time from the balloon placement to fetus delivery was 26.5 h.In total 39 successful cases,10 cases were given low dose misoprostol and 7 low dose oxytocin.Conclusion Double balloon dilation in induction of labor was proved to be safe and effective.This treatment is recommended for those who are at high risk pregnancy especially at middle and late stages because it prevents patients from drug-induced side effects on the liver and kidney,avoids the unnecessary cesarean section and lowers the risk on the next reproduction.