剖宫产术后高危妊娠药物流产临床分析

Clinical analysis of high risk medical abortion after caesarean section

目的探讨剖宫产术后高危妊娠药物流产现状,及产后避孕的有效方法。方法回顾性分析2012年1月至2013年12月北京妇产医院150例住院行药物流产+B超下清宫术的剖宫产术后患者的临床资料。结果米非司酮配合卡前列甲酯流产成功率为98.0%,流产中平均出血量为(36.5±10.3)ml,平均住院时间为(4.3±1.2)d,无明显并发症发生。不同剖宫产次数患者文化程度及避孕情况的差异无统计学意义(P>0.05);但不同剖宫产次数患者本次妊娠距离末次剖宫产时间的差异有统计学意义(P<0.01),1次剖宫产术后患者发生再次妊娠时间明显短于≥2次剖宫产术后患者。不同剖宫产次数患者再次妊娠流产时间的差异无统计学意义(P>0.05);但不同剖宫产次数患者再次妊娠流产中出血量的差异有统计学意义(P<0.05),≥2次剖宫产术后再次妊娠患者流产中出血量明显增加。结论米非司酮配合卡前列甲酯结合B超下清宫术是终止剖宫产术后高危妊娠的有效方法;呼吁医疗机构大力宣传剖宫产术后避孕知识,落实科学有效的避孕方法。

Objective To analyze the high risk induced abortion inpatients after caesarean section in Beijing Ob-stetrics and Gynecology Hospital, and understand the status in order to put forward the countermeasures and effective con-traception measures. Methods One hundred and fifty cases of re-pregnant women who were treated by induced abortion associated with curettages （uterine aspiration） guided by B mode ultrasound were analyzed retrospectively from Jan-uary, 2012 to December, 2013. Results The success rate of abortion using Mifepristone and Carboprost methylate was 98.0%, the average vaginal bleeding was （36.5±10.3）ml, the average days in hospital were （4.3±1.2）d without evident com-plications. No significant differences were observed among the number of caesarean sections and educational levels and contraception conditions （P〉0.05）, but there was significant differences between the number of caesarean sections and the interval from the last caesarean section （P〈0.01）. No evident differences were observed between the number of caesarean sections and the time of abortion （P〉0.05）, but there was significant differences between the number of caesarean sections and hemorrhage volume during abortion （P〈 0.05）. Conclusion Mifepristone and Carboprost methylate associated with curettages （uterine aspiration） guided by B mode ultrasound are effective to terminate high risk pregnancy after caesarean section. Medical institutions should vigorously promote contraceptive knowledge and implement safe and effective contra-ceptive measures after cesarean section.