中期妊娠合并胎盘前置状态的引产方式研究

Study on Mode of Induction of Placenta Previa in Mid-term Pregnancy

目的:分析并研究中期妊娠胎盘前置状态适宜的引产方式。方法:回顾性分析郑州大学第三附属医院收治的95例胎盘前置状态中孕引产的病例。根据彩超提示胎盘位置分为边缘性组(A组),部分/完全性组(B组),按照其孕周分为<16周组及≥16周组,通过对比分析不同引产方法的引产结局,研究适宜的引产方式。结果:(1)药物引产所用时间相对较长,出血量少。(2)药物引产、依沙吖啶羊膜腔注射引产的引产成功率在A组、B组、<16周组、≥16周组分别为89.47%、96.43%,91.67%、100%;86.67%、100%,93.75%、96.88%;子宫动脉栓塞术(介入)+药物引产、介入+依沙吖啶、剖宫取胎术在B组孕周≥16周的引产成功率分别为66.67%、100%、100%。(3)引产失败共6例,其中A组3例(药物引产2例,依沙吖啶1例),B组3例(药物引产1例,介入+药物引产2例)。(4)药物引产、依沙吖啶、介入+药物引产的急诊手术率分别为9.68%、3.03%、33.33%,介入+依沙吖啶在B组孕周≥16周的急诊手术率最低为0。结论:边缘性胎盘前置状态中孕引产者,<16周可选择药物引产,≥16周可选择依沙吖啶;部分/完全性胎盘前置状态中孕引产者,<16周可选择药物引产,≥16周可选择介入+依沙吖啶引产,引产过程中急诊情况如阴道大出血等可行钳刮术。

Objective:To analyze and study the suitable mode of induction for placenta previa in mid-term pregnancy.Method:A retrospective analysis of 95 cases of placental previa in the third affiliated hospital of Zhengzhou University were divided into the marginal group(group A)and the partial/complete group(group B).According to the gestational age,they were divided into<16 weeks group and≥16 weeks group.By comparing and analyzing the outcome of different methods of induced labor,the suitable mode of induced labor was studied.Result:(1)The time taken for drug induction was relatively long and the amount of bleeding was small.(2)The successful rate of induced labor induced by drug induction and drug injection of ethacridine into amniotic cavity the group A,group B,<16 weeks group and≥16 weeks group were respectively 89.47%and 96.43%,91.67%and 100%,86.67%and 100%,93.75%and 96.88%.The success rates of uterine artery embolization(interventional)combined with drug induced labor,interventional combined ethacridine and fetal dissection at gestational weeks≥16 weeks in group B were 66.67%,100%,100%respectively.(3)Induction of labor failure in 6 cases,including 3 cases in group A(2 cases of drug induction,1 case of ethacridine),3 cases of group B(1 case of drug induction,2 cases of interventional combined drug induction).(4)The emergency operation rates of interventional combined drug induction were respectively 9.68%,3.03%,33.33%.Interventional combined ethacridine had the lowest emergency operation rate 0 in group B with gestational age≥16 weeks.Conclusion:In the marginal placenta previa,the induction of labor in the pregnancies,<16 weeks may choose drug induction,≥16 weeks may choose ethacridine;partial/complete placental pre-pregnancy induces,<16 weeks may choose drug induction,≥16 weeks may choice interventional combined ethacridine.During the induction of labor,emergency cases such as vaginal bleeding and other feasible forceps curettage.