瘢痕子宫妊娠晚期引产方法探讨

目的 观察应用宫颈球囊联合半量依沙吖啶在妊娠晚期瘢痕子宫患者引产中的疗效及安全性.方法 收集2012年1月至2016年1月西安交通大学第一附属医院、陕西友谊医院、陕西省第四人民医院及兵工521医院4家三甲医院妇产科或产科收治的96例瘢痕子宫妊娠晚期引产患者,按照引产方式不同分为观察组和对照组.对照组43例,采用米非司酮联合100mg依沙吖啶;观察组53例,采用单宫颈球囊联合50mg依沙吖啶.分别对比两组患者的引产成功率、总引产时间及总产程时间,治疗后12h、24h宫颈Bishop评分情况,分娩相关并发症的发生率,以及对肝肾功能及血压的影响.结果 观察组患者的引产成功率、总引产时间及总产程时间优于对照组,差异有统计学意义(χ2=5.596、t=3.459、t=2.869,均P<0.05),治疗后12h及24h观察组宫颈评分高于对照组,差异有统计学意义(t值分别为-3.420、-2.625,均P<0.05);观察组产时应用缩宫素、宫颈裂伤的比例及对患者肝肾功能的影响明显小于对照组,差异均有统计学意义(χ2值分别为14.479、6.398、5.113、3.921,均P<0.05).结论 针对妊娠晚期瘢痕子宫引产的患者,使用单宫颈球囊联合半量依沙吖啶治疗的效果良好,值得在临床上推广.

Method of labor induction in scar uterus patients in late trimester of pregnancy

Objective To observe the clinical effects and safety of cervical balloon combined with half -dose ethacridine in labor induction in scar uterus patients in late trimester of pregnancy .Methods Totally 96 cases of scar uterus in late trimester of pregnancy treated with labor induction and admitted in gynecology and obstetrics department or obstetrics department in four tertiary first -class hospitals of First Affiliated Hospital of Xi ' an Jiaotong University , Shaanxi Friendship Hospital , Shaanxi Fourth People ' s Hospital and Ordnance Industry 521 Hospital were collected and divided into observation group and control group according to different labor induction methods .Forty-three patients in the control group were treated with mifepristone combined with 100mg ethacridine and 53 patients in the observation group were treated with single cervical balloon combined with 50mg ethacridine.Success rate of labor induction , duration of induction, length of total stages of labor, cervical Bishop score at 12 hours and 24 hours after treatment , incidence of complications associated with induction , influence on hepatorenal function and blood pressure were compared between two groups .Results Success rate of induction , duration of induction and length of total stages of labor in the observation group were better than those in the control group , and differences had statistical significance (χ2 =5.596, t=3.459,t=2.869, all P<0.05).Cervical Bishop scores at 12 hours and 24 hours after treatment in the observation group were higher than those in the control group , and the differences were statistically significant ( t value was -3.420 and -2.625, respectively, both P<0.05).Oxytocin use rate, cervical laceration rate and influence on liver and kidney function in the observation group were less than those in the control group , and the differences were statistically significant (χ2 value was 14.479, 6.398, 5.113 and 3.921, respectively, all P<0.05).Conclusion Single cervical balloon combined with half-dose ethacridine has good effect in scar uterus patients in late trimester of pregnancy with labor induction .It is worthy of clinical applicaiton .