几种特殊早期妊娠用药物流产临床观察

近年来，随着剖宫产率增加，瘢痕子宫增多，瘢痕子宫在哺乳期再次妊娠逐渐增加。改革开放后，未婚先孕增多。一些人缺乏避孕知识或缺乏对人流危害的认识，反复人流或1年内两次以上人流增多。加之其他高危因素，使人流风险增加，给手术带来一定困难。为把上述高危人流风险降低，我院对上述早孕实行药物流产。药物流产是服药后使胚胎组织自行排出，没有手术创伤，也没有手术造成的痛苦。     

剖宫产术后子宫切口部位早期妊娠9例临床分析

剖宫产术后子宫切口部位妊娠临床上十分罕见，但随着剖宫产率的逐年提高，其作为刮宫产的远期并发症之一，也有上升趋势。在相关文献中此类疾病临床表现各异，早期诊断困难，其临床上易出现子宫破裂和难以控制的大出血。本院从2002年11月～2006年11月共收治9例剖宫产后子宫切口部位早期妊娠要求终止患者，现将处理方法分析并报道如下。     

复方米非司酮用于高危早期妊娠药物流产的临床观察

目的:探讨复方米非司酮对高危早期妊娠药物流产的效果。方法:要求终止妊娠的早孕妇女117例,均具有高危妊娠因素,复方组63例,贯序口服复方米非司酮配伍米索前列醇药物流产;单方组54例,贯序口服米非司酮配伍米索前列醇药物流产。结果:复方米非司酮组和米非司酮组完全流产率分别为93．65%和90．74%;排出孕囊时间为2．7±2．6h和2．9±3,0h;流产时出血量为21．3±19．1ml和27．0±17．5 ml;流产后出血时间为12．0±2．6d和13．2±3．1d;转经时间为32．8±5．0d和35．4±6．7d。结论:复方米非司酮可缩短流产时间,提高完全流产率,减少流产失血量,用于高危早期妊娠药物流产的临床效果优于米非司酮。     

剖宫产术后子宫疤痕早期妊娠14例临床分析

剖宫产术后子宫疤痕妊娠（cesarean scar pregnancy,CSP）是指妊娠着床于前次剖宫产疤痕处,为一种少见的异位妊娠,也是剖宫产术后的远期并发症之一。随着剖宫产率的上升,CSP发生率也逐年增加[1-2],由于对其认识不足,易造成误诊、误治或治疗不恰当,以致引起严重后果。     

复发性流产患者早期妊娠胚胎丢失的预测

复发性流产(RSA)在我国指与同一配偶连续发生3次或以上的自然流产。80%以上的自然流产胚胎丢失发生于早孕时期,因此,对于再次妊娠的RSA患者,在早孕阶段正确预测其胚胎丢失可能,有助于调整患者保胎方案,提高妊娠成功率,降低保胎患者的经济、精神负担。文章结合相关文献,简述临床上或实验室预测早期胚胎丢失的指标。     

妊娠晚期并发黄疸出血肾衰的临床病理分析

妊娠晚期并发黄疸出血肾衰的临床病理分析延边医学院病理学教研室（１３３０００）李日镛延边医学院附属医院妇产科（１３３０００）安奎彦延边妇幼保健院妇产科（１３３００１）金红１病历摘要患者２９岁，住院号９８７５２。孕４２周，于１９９０年８月１０日１９时临产...     

异位妊娠误行药物流产7例临床分析

米非司酮配伍米索前列腺素用于抗早孕已广泛应用于临床,其完全流产率达90%以上[1],获得了良好的临床效果。异位妊娠若误诊为宫内妊娠而行药物流产,则可人为地导致异位妊娠的流产或破裂,甚至危及患者的生命。2005年1月至12月我院收治了7例异位妊娠误行药物流产破裂出血的患者,经     

宫腔镜治疗妊娠物残留36例临床分析

早孕流产、中孕流产及足月分娩后妊娠物残留是较常见而难以处理的并发症。官腔内妊娠物残留，轻者导致不规则出血或持续性阴道流血而致贫血、感染，重者引起盆腔、腹腔感染、宫腔粘连、继发不孕等，过去遇到这类问题常常是盲目清官，但有时难以奏效。现对我院36例临床及超声怀疑有妊娠残留做宫腔镜及诊刮术满意效果报告如下。     

The efficacy of immediate post-abortion intrauterine device insertion

Ovulation returns soon after abortion, with half of the women ovulating by 21 days after the procedure. Immediate post-abortion insertion provides immediate contraceptive protection. Clinicians have feared that rates of uterine perforation due to intrauterine devices (IUDs) and expulsion of IUDs may be higher in the post-abortal uterus due to its softness and enlargement. This study was carried out to assess the safety and efficacy of IUD insertion immediately after induced abortion compared with insertion during the first menstrual cycle after abortion. All women were counseled about a method of contraception, particularly copper T-380A, and divided into two groups: Group 1 included 226 women who preferred immediate IUD insertion, and Group 2 included 100 women who opted for interval-IUD insertion during the first menstrual cycle after abortion. All women were followed-up at two and eight weeks after insertion of the IUDs. Severe bleeding was observed 10.62% in Group 1 and 6% in Group 2. Expulsion rate was 7.08% and 8% in Groups 1 and 2, respectively, which was not statistically significant. Pelvic inflammatory disease (PID) was observed in one case in Group 1. However uterine perforation was not noted in either group. In conclusion, insertion of an IUD immediately after an induced abortion is safe and if a woman asks for a modern contraceptive method it could be offered.     

107例子宫腺肌瘤局灶切除术的临床疗效分析

目的：探讨子宫腺肌瘤局灶切除术的可行性及安全性。方法：回顾分析2005年10月-2012年3月南京医科大学附属苏州医院收治的有症状的107例子宫腺肌瘤患者治疗资料,所有患者均坚决要求保留子宫,均行子宫腺肌瘤局灶切除术,其中100例行经腹小切口子宫腺肌瘤局灶切除术,7例行腹腔镜下子宫腺肌瘤局灶切除术。比较分析患者手术时间、术中出血量、术后痛经及月经量的改善情况及子宫腺肌瘤复发情况。结果：术后6个月的随访中,接受随访的79例患者痛经症状均完全消失,43例月经过多患者月经量均恢复正常。术后48个月接受随访的28例患者中,有2例（7.1%）患者部分缓解,均予口服止痛药治疗;术后60个月接受随访的14例患者中,2例（14.3%）患者部分缓解,1例予口服止痛药治疗,1例予左炔诺孕酮宫内缓释系统（LUG-IUS,商品名曼月乐）治疗;2例（14.3%）患者痛经程度与术前级别相同,术后60个月行全子宫切除术。7例不孕患者中有1例术后3年妊娠,足月分娩;3例已育患者分别于术后2个月～1年妊娠,均行药物流产,另3例不孕患者术后至今未孕。结论：大多数有症状的子宫腺肌瘤患者可通过子宫腺肌瘤局灶切除术,达到完全缓解痛经及月经量过多的症状,疗效确切,可以成为替代全子宫切除术的成功手术方式,值得临床推广应用。     

Prevention of postpartum haemorrhage: a distributional approach for analysis

Background

There is empirical evidence that measured postpartum blood loss has a lognormal distribution. This feature can be used to analyze events of the type ‘blood loss greater than a certain cutoff point’ using a lognormal approach, which takes into account all the quantitative observations, as opposed to dichotomizing the variable blood loss volume into two categories. This lognormal approach uses all the information contained in the data and is expected to provide more efficient estimates of proportions and relative risk when comparing treatments to prevent postpartum haemorrhage. As a consequence, sample size can be reduced in clinical trials, while keeping the statistical precision requirements.

Methods

The authors illustrate how a lognormal approach can be used in this situation, using data from a clinical trial and the event ‘blood loss greater than 1000 mL’.

Results

Estimates of the proportions of this event for each treatment, and relative risks obtained with this method are presented and compared with the standard estimates obtained by dichotomizing measured blood loss volume. An example of how the blood loss distributions of two treatments can be compared is also presented. Different scenarios of the sample size needed to compare two treatments or interventions are presented to illustrate how with the lognormal approach the size of a clinical trial can be reduced.

Conclusions

A distributional approach for postpartum blood loss using the lognormal distribution fitted to the data results in more precise estimates of risks of events and relative risks, compared to the use of binomial proportions of events. It also results in reduced required sample size for clinical trials.

Trial registration

This paper reports a secondary analysis for a trial that was registered at clinicaltrials.gov (NCT00781066).