瘢痕子宫早期妊娠药物流产效果分析

Effect of Medical Abortion on Early Pregnancy of Women with a Scar Uterine

目的探讨米非司酮配伍米索前列醇终止瘢痕子宫早期妊娠的临床效果及注意事项。方法选择2009年6月-2011年6月在中国医科大学北京顺义医院因早孕≤49 d要求终止妊娠而无药流禁忌症的瘢痕子宫孕妇共96例,设为观察组;随机选择同期非瘢痕子宫妊娠96例作为对照组,实行药物流产,比较两组流产效果、阴道出血及胎囊排出时间等。结果两组孕妇药流的成功率、阴道出血量及出血持续时间、胎囊排出时间比较,差异无统计学意义(P>0.05);1例瘢痕处妊娠药流前漏诊,药流后1周大出血行子宫动脉栓塞术,保留了生育功能。结论瘢痕子宫早孕药物流产具有临床可行性,但药流前必须B超检查,明确胚胎着床位置,除外子宫瘢痕处妊娠,有预防出血和急救的措施,杜绝严重并发症;医务工作者要积极宣教,降低剖宫产率,对剖宫产患者术后采取严格避孕措施。

Objective To investigate the clinical effects and key points of medical abortion with mifepristone and misoprostol on early pregnancy of women with a scar uterine. Methods From 2009.6 to 2011.6,96 pregnant women with a scar uterine were enrolled into the observation group and 96 pregnant women without a scar uterine were enrolled into the control group. The preg- nancy of all patients was not more than 45 days. All patients in both groups underwent the medical abortion with mifepristone and misoprostol. The curative effects, vaginal bleeding volume and duration and time for expulsion of the gestational sac were compared between the two groups. Results The difference in the success rate of drug abortion, bleeding volume and duratmn of vaginal bleeding, time for expulsion of the gestational sac were not statistically significant between the two groups（P ~ 0.05 ） ; One case of scar pregnancy was missed before drug abortion, vaginal bleeding occurred one week later, and uterine artery embolization were performed to retain reproductive function. Conclusion The medical abortion on early pregnancy of women with a scar uterine is feasible. The follow measures are needed： B ultrasound examination to define embryo implantation position before drug abortion ; emergency treatment for preventing bleeding. The medical workers should actively make propaganda and education so as to reduce the rate of cesarean section, and contraceptive measures should be effectively implemented in cesarean section patients.