瘢痕子宫中期妊娠引产方法探讨

Labor Induction for Second Trimester Pregnancy in Women with Scar Uterus

目的探讨瘢痕子宫中期妊娠引产方法的临床效果和安全性。方法选择2010年11月至2013年10月在重庆市第九人民医院就诊的67例瘢痕子宫中期妊娠要求引产的患者,随机分成两组,A组患者39例,B组患者28例。两组均先服用米非司酮150 mg（分5次服用）,A组给予米索前列醇0.4 mg阴道后穹窿上药,以后每4∽6小时根据宫缩情况上药0.2 mg。B组给予乳酸依沙吖啶100 mg经腹壁羊膜腔内注药。比较两种方法用药后宫缩开始时间、胎儿娩出时间、用药至胎儿娩出时间,引产成功率、阴道出血情况、胎盘胎膜残留率及引产并发症发生率等情况。结果 A组用药至宫缩开始时间、宫缩开始至胎儿娩出时间和用药开始至胎儿娩出时间分别为（5.1±2.6）h、（4.4±2.1）h和（9.5±4.0）h,均较B组（19.6±5.4）h、（7.0±2.2）h和（26.7±7.3）h短（t=13.098,t=5.039,t=11.348,均P〈0.01）。A、B两组引产成功率分别为100.0%和92.9%,两组比较差异无统计学意义（P〉0.05）。两组阴道出血、胎盘胎膜残留率及并发症的发生率比较差异无统计学意义（P〉0.05）。结论米非司酮配伍米索前列醇和米非司酮配伍乳酸依沙吖啶用于瘢痕子宫中期妊娠引产均安全有效,米非司酮配伍米索前列醇引产产程更短。

Objectives To investigate the results and safety of a protocol for second-trimester induction for women with scar uterus.Methods A total of 67 women with scar uterus requesting for labor induction in Chongqing Ninth People′s Hospital from Nove.2010 to Oct.2013 were retrospectively analyzed, and they were assigned to group A（n=39）and group B（n=28） randomly.The two groups were administered 150 mg mifepristone at first.Group A was then given misoprostol 0.4 mg vaginally as a starting dose followed by 0.2 mg vaginally every 4-6 hours,while group B was injected ethacridine lactate 100 mg through transabdom-inal amniocentesis.The beginning time of uterine contraction,delivery time,drug to delivery time,successful induction rate,vagnal bleeding, fetal membranes residue rate, and complications of the two methods were compared.Results The beginning time of uterine contraction,labor time in group A was （5.1 ±2.6） h, （4.4 ±2.1） h and（9.5 ±4.0） h,which were significantly shorter than group B（19.6 ±5.4） h,（7.0 ± 2.2） h and （26.7 ±7.3） h （t=13.098,t=5.039,t=11.348,all P〈0.01）;the success rate in group A was 100.0%,in group B was 92.9%, the difference was not statistically significant （ P 〉0.05 ） .The inci-dence of vaginal bleeding,residual fetal membranes and complications of the two groups had no statistically significant difference（ P〉0.05） .Conclusion Mifepristone plus misoprostol and mifepristone and ethacri-dine lactate are both effective and safe for the induction of mid-term pregnancy of women with scar uterus, while the former combination has shorter labor time .