43例中期引产产后出血临床分析

Clinical analysis of 43 cases of hemorrhage associated with the second trimester abortion

目的分析中期引产后出血的临床特征,提出预防和治疗中期引产后出血的医疗建议。方法回顾性分析广州医科大学附属第三医院产科2002年7月至2014年7月发生的43例中期引产出血病例的临床特点。结果中期引产出血共43例,占总引产病例的2.72%（43/1 581）,其中难免流产予催产素引产组产后出血11例,占该组5.91%（11/186）;米非司酮＋米索前列醇引产组产后出血6例,占该组2.11%（6/284）;利凡诺尔引产产后出血20例,占该组1.92%（20/1 040）;剖宫取胎产后出血6例,占该组28.57%（6/21）。水囊引产组50例未发生产后出血。产后出血量为300~2 200 ml。严重出血者（出血大于1 000 ml）共6例。引产出血的主要原因是胎盘胎膜因素74.41%（32/43）、宫缩乏力18.6%（8/43）和凝血功能异常6.97%（3/43）。治疗包括输液输血容量复苏和营养支持,按摩子宫并宫缩剂加强宫缩,必要时予清宫排空子宫止血。贫血发生率为25.58%（11/43）,产褥感染发生率为23.25%（10/43）。结论中期引产产后出血发生率低,主要病因是胎盘胎膜残留,其次为宫缩乏力和凝血功能异常,治疗主要为三级预警,排空子宫、加强宫缩、控制感染和纠正贫血。预防则为防止意外妊娠和出生缺陷等高危因素,做好计划生育工作。

Objective To analyze the clinical features of hemorrhage associated with the second trimester abortion in different way, and propose the clinical medical advice for prevention and treatment of hemorrhage associated with the second trimester abortion. Methods A retrospective analysis of 43 cases of the clinical features which hemorrhage associated with the second trimester abortion that came from the department of Obstetrics, the Third Afficiliated Hospital of Guangzhou Medical University in July 2002 to July 2014. Results A total of 43 cases of hemorrhage associated with second trimester abortion, accounting for 2.72% of second trimester abortion cases （43/1 581 ）. In which, 11 cases were the inevitable abortion with oxytocin induced labor group, 5.91% of the group （11/186） ; 6 cases were induced labor with mifepristone plus misoprostol group, 2.11% of the group （6/284）; 20 cases were induced labor with Rivanol, 1.92% of the group （20/1 040）; 6 cases were hysterotomy delivery, 28.57% of the group （6/21）. 50 cases of induced of labor with Water sac had no postpartum hemorrhage. Postpartum haemorrhage amount was 300 ~ 2 200 ml. 6 cases were severe bleeding （greater than 1 000 ml）. The main reasons of the hemorrhage in second trimester abortion were the placental or membranes factors, 74.41% （32/43）, uterine inertia of 18.6% （8/43） and blood coagulation dysfunction 6.97% （3/43）. Managements included transfusion blood products for capacity recovery and nutritional support treatments, massage the uterine, injection contractions agent to strengthen contractions, or curettage uterine. Anemia incidence rate was 25.58% （ 11/43 ） ; puerperal infection rate was 23.25% （ 10/43 ）. Conclusion The incidence of hemorrhage associated with the second trimester abortion was low, and the main causes were placental membranes residue, uterine inertia and blood coagulation dysfunction. Managements include level-3 alert, emptying of uterus, strengthening contractions, infection control and correction of anemia. Prevention is to avoid accidental pregnancy and birth defects risk factors, and enforce the birth control program.