三种不同引产方法对瘢痕子宫孕中期引产成功率及宫颈成熟度的影响

Effects of Three Different Methods of Induction of Labor on the Success Rate of Induction and Cervical Maturity in the Second Trimester of Scar

目的:探讨三种不同引产方法对瘢痕子宫孕中期引产成功率及宫颈成熟度的影响.方法:随机选择2015年1月-2019年6月在笔者所在医院行中期引产的瘢痕子宫200例,按随机数字表法分为三组,双球囊+米非司酮组(A组)有67例,双球囊+利凡诺组(B组)67例,利凡诺+米非司酮组(C组)66例,A组行米非司酮联合宫颈的COOK双球囊放置术治疗,B组行利凡诺联合宫颈的COOK双球囊放置术治疗,C组行利凡诺联合米非司酮治疗,观察三组孕妇的引产成功率、血清SP-1、IGFBP-1水平、并发症等情况.结果:A组、B组的引产有效率显著高于C组,差异有统计学意义(P<0.05);A组、B组的引产总时间、产程开始到胎儿娩出的时间均显著短于C组(P<0.05),A组与B组相比差异无统计学意义(P>0.05).三组孕妇的开始有规律宫时间、引产出血比例比较差异无统计学意义(P>0.05);引产后A组、B组的Bishop评分显著高于引产前,且显著高于C组,差异有统计学意义(P<0.05),三组孕妇的血压在引产前、引产后比较差异无统计学意义(P>0.05);引产前三组之间的血清人妊娠特异性1糖蛋白(SP-1)、胰岛素样生长因子结合蛋白-1(IGFBP-1)水平比较差异无统计学意义(P>0.05),用药后24 h、产后12 h A组、B组的血清SP-1均显著低于C组,IGFBP-1水平均显著高于C组,差异有统计学意义(P<0.05);C组并发症显著高于A组、B组,差异有统计学意义(P<0.05).结论:双球囊+米非司酮、双球囊+利凡诺可有效促进瘢痕子宫孕中期的宫颈成熟,影响血清SP-1、IGFBP-1水平,缩短引产时间,引产成功率较高,并且并发症较少.

Objective:To investigate the effects of three different methods of induction of labor on the success rate of induction of labor and cervical maturity in the second trimester of scar.Method:A total of 200 cases of scar uterus induced by mid-term in our hospital from January 2015 to June 2019 were randomly selected.Three groups were randomly divided:67 cases of double balloon+Mifepristone group(group A).67 cases of double balloon+Rivanol group(group B),66 cases of Rivanol+Mifepristone group(group C).Group A was treated with Mifepristone combined with cervical COOK double balloon placement,group B was treated with Rivanol combined with cervical COOK double balloon placement,and group C was treated with Rivanol plus Mifepristone.The induction success rate,serum SP-1,IGFBP-1 levels and complications of the three groups of pregnant women were observed.Result:The induction rate in group A and group B were significantly higher than that in group C(P<0.05).The total time of induction of labor and the time from the beginning of labor to the delivery of the fetus in the A group and the B group were significantly shorter than that in the C group(P<0.05).The difference between the A group and the B group was small(P>0.05).There was no significant difference in the proportion of regular uterine time and rate of induction of labor in the three groups of pregnant women(P>0.05).The Bishop scores of group A and group B after induction of labor were significantly higher than those before induction of labor,and significantly higher than that of group C,the difference was significant(P<0.05).The blood pressure of the three groups of pregnant women were not meaningful before induction of labor and after induction of labor(P>0.05).There was no significant difference in serum SP-1 and IGFBP-1 levels among the three groups before induction of labor(P>0.05).Serum SP-1 levels in group A and group B were significantly lower than group C after 24 hours of treatment and 12 hours after delivery.The level of IGFBP-1 was significantly higher than that of group C,and the difference was statistically significant(P<0.05).The complication of group C was significantly higher than that of group A and group B(P<0.05).Conclusion:Double balloon+Mifepristone,double balloon+Rivanol can effectively promote cervical ripening in the second trimester of scar,affect serum SP-1,IGFBP-1 levels,shorten induction time,high induction rate success rate,and concurrent less symptoms.