剖宫产术后瘢痕子宫妊娠中晚期引产方式探讨

Clincal effectiveness of the induction of labor in women with previous uterine scar at the second and third trimester

目的探讨剖宫产术后瘢痕子宫妊娠的中晚期引产方式的选择和临床效果。方法回顾性分析中国医科大学附属盛京医院2008年1月至2013年12月收治的98例孕周为16～32周、因母体因素或胎儿异常原因行引产的瘢痕子宫妊娠孕妇的临床资料，其中米非司酮联合水囊组44例，米非司酮联合依沙吖啶组54例，对比其产程、产后出血量、引产成功率、胎盘胎膜残留率。结果两组孕妇产后出血量比较差异无统计学意义（P〉0．05）。米非司酮联合水囊组孕妇引产时间明显短于米非司酮联合依沙吖啶组，两组比较差异有统计学意义（P〈0．05）。米非司酮联合依沙吖啶组引产的成功率为98．15％，米非司酮联合水囊组引产的成功率为88．64％，两组比较差异无统计学意义（P〉0．05）。米非司酮联合依沙吖啶组产后清宫率较米非司酮联合水囊组高（88．89％vs．50．00％）。结论米非司酮联合水囊或依沙吖啶引产均适用于瘢痕子宫妊娠的中晚期引产；在某些情况下，水囊引产也是可以应用的相对安全有效的引产方式，但需要进行严密监测。

Objective To investigate the methods and clinical effectiveness of the induction of labor in women with previous uterine scar at the second and third trimester. Methods A retrospective study was performed in 98 cases of pregnant women with scarred uterus, who requested termination of pregnancy due to fetal abnormality or maternal complications in Shengjing Hospital of China Medical University between January 2008 and December 2013. There were 44 women who had been used mifepristone combined with water balloon insertion （ Group A） and 54 women who had been used mifepristone combined with Ethacridine Lactate intrauterine injection （ Group B）. Compare the interval time from induction to delivery, postpartum hemorrhage, the successful rate of induced labor, placental retention ratio and side effect. Results There was no significant difference between two groups in postpartum hemorrhage （ P 〉 0. 05 ）. There was significant difference between two groups in the interval time from induction to delivery （ P 〈 0. 05 ）. The interval time of Group A was shorter than other group （P 〈 0. 05）. The successful ratio induction of Group B is 98. 15% , and Group A is 88.64%. The ratio of residual of placenta and membranes in group B was significant higher than Group A（ 88.89% vs. 50.00% ）. Conclusion The two methods of induction are suitable to the pregnant women with previous uterine scar, water balloon also could be choose in some cases, which need to he careful monitoring.