瘢痕子宫孕妇中期妊娠引产术的临床观察与护理

Clinical observation and nursing care of pregnancy induced labor in pregnant women with uterine scar uterus

目的探讨瘢痕子宫孕妇孕中期引产的安全性、效果及并发症的情况。方法将60例瘢痕子宫孕中期孕妇分为利凡诺组（32例）和米索前列醇组（28例），分别按照相应的用药方案引产和护理干预，观察孕妇宫缩情况，记录自服药至出现宫缩的时间、用药至分娩的时间、引产后的出血量、胎盘残留情况、引产成功率及子宫破裂的发生情况。结果两组孕妇在引产成功率和产后出血量方面比较差异无统计学意义（P〉O．05）。利凡诺组孕妇口服药物后至出现宫缩的时间和分娩的时间要长于米索前列醇组孕妇，两组比较差异有统计学意义（P〈0．05）。米索前列醇组的孕妇有25例在服药24h内分娩，分娩率达到89．3％；利凡诺组孕妇仅有5例在服药24h内分娩，分娩率为15．6％，24例孕妇在服药48h后才开始分娩。米索前列醇组的孕妇出现胎盘残留需要清宫治疗者仅有6例，胎盘残留率为21．4％，而利凡诺组孕妇有14例出现胎盘残留，胎盘残留率为43．8％，两组比较差异有统计学意义（P〈0．05）。结论对瘢痕子宫孕中期引产的孕妇要提高关注、严密观察引产过程，及时发现、处理问题，瘢痕子宫孕中期引产的效果是相对可靠的。

Objective To investigate the safety, efficacy and complications of induced labor in the second trimester of pregnant women with scar uterus. Methods 60 pregnant women with scar uterus during the second trimester were divided into rivanol group （32 cases） and misoprostol group （28 cases）, respectively underwent induced abortion and nursing intervention in accordance with the corresponding therapy. Observed maternal uterine contraction, recorded the time from medication to uterine contraction, the time from medication to delivery, the amount of bleeding after induced labor, residual placenta, the success rate of induced abortion and uterine rupture. Results There were no statistically significant differences in the success rate of induced abortion and the amount of bleeding after induced labor between two groups （P〉0.05）. The time from medication to uterine contraction, the time from medication to delivery of rivanol group were longer than those of misoprostol group, with statistically significant differences between two groups （P〈0.05）. There were 25 cases of delivery within 24 hours after medication in misoprostol group, with the delivery rate of 89.3%; there were 5 cases of delivery within 24 hours after medication in rivanol group, with the delivery rate of 15.6%, there were 24 cases of delivery 48 hours after medication. There were 6 cases （21.4%） of residual placenta who needed dilatation and curettage in misoprostol group, 14 cases （43.8%） in rivanol group, with statistically significant difference between two groups （P〈0.05）. Conclusions We should pay more attention, closely observe the process of labor induction for induced labor in the second trimester of pregnant women with scar uterus, timely detect and deal with problems. The effect of uterine scar pregnancy induced abortion is relatively reliable.