妊娠中期胎盘前置状态的引产方式探讨

Investigation the Ways for Mid-Trimester Induced Abortion with Placenta Previa

目的:探讨妊娠中期胎盘前置状态适宜的引产方式。方法:回顾性分析河南省人民医院产科引产的胎盘前置状态患者89例(孕14~27+6周),A组为米非司酮联合依沙吖啶引产(64例),口服米非司酮50 mg,2次/d,连用5 d,第5天下午在彩色超声引导下行羊膜腔穿刺并注入依沙吖啶100 mg;B组为剖宫取胎组(25例),比较2组的一般情况、引产情况及再次妊娠情况。结果:A组的分娩期出血量和住院费用均明显少于B组,差异均有统计学意义(均P<0.05);A组非完全性胎盘前置状态患者引产成功率96.3%(52/54),完全性胎盘前置状态患者引产成功率70%(7/10),前者的剖宫取胎率明显低于后者(P=0.024);2组患者再次妊娠时,A组异常胎盘概率明显低于B组,差异有统计学意义(P=0.014)。结论:妊娠中期胎盘前置状态患者引产前口服5天米非司酮后行羊膜腔穿刺依沙吖啶引产,能够减少分娩期出血量,降低住院费用,减少剖宫取胎对产妇的损伤,并且能够减少再次妊娠后胎盘发生异常的概率,可作为临床选择之一。

Objective:To explore the suitable method of induced labor in the condition of placenta previa during middle pregnancy. Methods:Retrospective analysis of 89 cases of placenta previa patients induced abortion in Department of Obstetrics of Henan Provincial People′s Hospital. Group A was induced by Mifepristone combined with Ethacridine (64 cases), which received oral mifepristone 50 mg twice a day for 5 days and followed by amniocentesis administration of Ethacridine 100 mg under the guidance of color doppler ultrasound on the 5th day afternoon. Group B was treated with abdominal hysterotomy (25 cases). The general situation, induction of labor and repregnancy of the 2 groups were compared. Results:The amount of bleeding and hospitalization cost in group A were significantly lower than those in group B, and the difference was statistically significant (P<0.05). The success rate of induced labor in patients with incomplete placenta previa and complete placenta previa were 96.3%(52/54) and 70%(7/10), respectively. The rate of cesarean section of the former is significantly lower than that of the latter (P=0.024). When re-pregnancy, the probability of abnormal placenta in group A was significantly lower than that in group B, and the difference was statistically significant (P=0.014). Conclusions:For patients with placenta previa in the second trimester, induction of labor by amniocentesis after oral administration of Mifepristone can reduce the amount of bleeding during labor, reduce the cost of hospitalization, and reduce the injury of parturient by abdominal hysterotomy. It can reduce the probability of placental abnormity in the second pregnancy and can be used as one of the clinical choices.