米非司酮联合依沙吖啶用于瘢痕子宫中期妊娠引产效果及对宫颈成熟度的影响

Effect of mifepristone combined with ethacridine for treating pregnant women with induced labor of scarred uterus during the second trimester of pregnancy and its influence on their cervical ripening

目的:探究米非司酮联合依沙吖啶羊膜腔内注射对瘢痕子宫中期妊娠引产效果。方法:分析2017年1月-2021年12月本院收治的有终止妊娠需求的153例瘢痕子宫中期妊娠引产孕妇,根据引产方法分为观察组(米非司酮口服+依沙吖啶羊膜腔注射78例)和对照组(依沙吖啶羊膜腔穿刺75例),比较两组用药后宫颈成熟度,围术期指标、引产结局、用药不良反应及术后并发症发生率。结果:观察组用药后6 h、12 h及18 h的Bishop宫颈成熟度评分(7.01±1.18、8.25±1.23、9.02±1.37)分均高于对照组(6.59±1.02、7.38±1.19、8.17±1.62)分,宫缩发动时间(20.12±2.15h)、引产时间(4.12±0.68h)、产后2 h出血量(126.27±20.13ml)均低于对照组(25.30±3.06h、5.03±0.75h、139.48±19.54ml)(均P<0.05),引产出血量与对照组无差异(P>0.05);完全引产率(78.2%)高于对照组(58.7%),胎盘胎膜残留率(15.4%)、清宫率(20.5%)均低于对照组(29.3%、36.0%)(均P<0.05),引产成功率(93.6%)与对照组(88.0%)无差异(P>0.05);宫颈水肿及宫颈裂伤的发生率(6.4%)低于对照组(17.3%)(P<0.05),发烧、子宫出血等用药不良反应发生率(10.3%)与对照组(6.7%)无差异(P>0.05)。结论:米非司酮联合依沙吖啶用于瘢痕子宫中期妊娠引产,可提高宫颈成熟度,减少宫缩时间及引产时间,降低产后出血量、清宫率及宫颈损伤,未增加不良反应,安全性较好。

Objective:To explore the intervention effect of mifepristone combined with ethacridine for treating pregnant women with induced labor of scarred uterus during the second trimester of pregnancy.Methods:The clinical data of 153 pregnant women with scarred uterus who had terminated the pregnancy by induced labor during the second trimester of pregnancy in the hospital from January 2017 to December 2021 were analyzed retrospectively.According to different method of labor induction,these women were divided into observation group(78 women with oral mifepristone combined with ethacridine amniocentesis for terminating their pregnancy)and control group(75 women with ethacridine amniocentesis for terminating their pregnancy).The cervical maturity situation,the perioperative indicators,the outcomes of labor induction,the rate of drug adverse reactions,and the incidence of postoperative complications of the women were compared between the two groups.Results:The Bishop scores of cervical maturity(7.01±1.18 points,8.25±1.23 points,and 9.02±1.37 points)of the women in the observation group in 6,12,and 18 h after treatment were significantly higher than those(6.59±1.02 points,7.38±1.19 points,and 8.17±1.62 points)in the control group.The onset time of uterine contraction(20.12±2.15h),the labor induction time(4.12±0.68h),and the postpartum 2 h blood loss(126.27±20.13ml)of the women in the observation group were significantly lower than those(25.30±3.06h,5.03±0.75h,and 139.48±19.54ml)of the women in the control group(all P<0.05).There was no significant difference in the blood loss during labor induction of the women between the two groups(P>0.05).The complete rate of labor induction(78.2%)of the women in the observation group was significantly higher than that(58.7%)of the women in the control group,and the rates of placental membranes residual(15.4%)and uterine curettage(20.5%)of the women in the observation group were significantly lower than those(29.3%and 36.0%)of the women in the control group(all P<0.05).The success rate of labor induction(93.6%vs.88.0%)of the women had no significant difference between the two groups(P>0.05).The incidence of cervical edema and cervical lacerations(6.4%)of the women in the observation group was significantly lower than that(17.3%)of the women in the control group(P<0.05).There was no significant difference in the incidence(10.3%vs.6.7%)of adverse drug reaction,such as fever and uterine bleeding,of the women between the two groups(P>0.05).Conclusion:Mifepristone combined with ethacridine for inducing labor of the women with scarred uterus during the second trimester of pregnancy can improve their cervical ripening,shorten the time of their uterine contractions and the time of labor induction,decrease their amount of postpartum bleeding and their incidences of uterine curettage and cervical lacerations,and which does not increase the adverse reaction of the women,with better safety.