子宫动脉栓塞术在胎盘前置孕妇中期引产中的价值

目的评价子宫动脉栓塞术在胎盘前置孕妇中期引产中的效果和安全性。方法选择2008年3月～2010年8月在温州医学院附属第二医院产科超声确诊胎盘前置状态要求终止妊娠的孕妇(观察组)和同期无胎盘前置需要终止妊娠的孕妇(对照组)各16例。观察组行子宫动脉栓塞术,术后12h无宫缩者及对照组均予利凡诺尔100mg羊膜腔注射+米非司酮口服75mg/d×2天。记录临产时间、产程、失血量、术前及产后第2天血常规、恶露持续时间、月经复潮时间,以及发热、下肢疼痛、臀部疼痛等栓塞后综合征。结果 (1)观察组13例引产成功,3例失败,成功率达81.25%。对照组16例全部成功,成功率100%,两组比较差异无统计学意义(P>0.05)。(2)观察组产程时间522(418～1408)min长于对照组383(246～538)min,差异有统计学意义(P<0.05),但是观察组从血管栓塞到引发宫缩时间与对照组从利凡诺尔羊膜腔注射到引发宫缩时间(1182.67±837.39)min vs(1779.19±1063.35)min],差异无统计学意义(P>0.05)。(3)观察组与对照组产妇失血量;住院时间;恶露持续时间(20.73±5.83)天vs(21.69±5.37)天];月经复潮时间(43.40±7.87)天vs(46.75±5.58)天]比较,差异均无统计学意义(P>0.05)。(4)观察组栓塞后综合征主要表现为发热,发生率50%(8/16),下肢疼痛发生率18.75%(3/16)和臀部疼痛发生率25%(4/16),对症治疗均缓解。结论子宫动脉栓塞术联合利凡诺尔羊膜腔注射用于胎盘前置孕妇中期引产,是一种安全可靠的新方法,可减少阴道出血风险,值得在有介入专科的医院进行推广。

Value of Uterine Artery Embolization in the Mid-term Induction of Labor in Pregnant Women with Placenta Praevia

Objective To evaluate the effectiveness and the safety of uterine artery embolization(UAE) in the mid-term odinopoeia in pregnant women with placenta praevia.Methods From March 2008 to August 2010,in the Department of Obstetrics,The Second Hospital Affiliated of Wenzhou Medical College,in the women who needed to terminate pregnancy in mid-term,sixteen pregnant women with placenta praevia were chosen as study group,and another sixteen women without placenta praevia as control group.The women in study group were all treated with UAE,but the women in control group were inducted only with Rivanol 100mg injected into amniotic cavity and mifepristone 75mg per day for 2 days.Women in the study group were treated as in the control group if the labor did not occur 12 hours after UAE.All the women were recorded the time of labor began,birth process,blood loss of puerpera,duration of lochia,time of menstrual recovery,complications of UAE.Preoperative and post-natal day 2 blood routine exeminations were evaluated.Results(1) 13 patients in the study group,all 16 cases in control group were successfully induced.No significant difference was reached in achievement rate(81.25% vs 100%,P>0.05).(2) The birth process of the women in study group was significantly longer than that in control group 522(418-1408)min vs 383(246-538)min,P<0.05].But the time from UAE to labor began of the women in study group was significantly shorter than that in control group(1182.67±837.39)min vs(1779.19±1063.35)min,P>0.05].(3) The blood loss of puerperal,the length of stay haspital,the duration of lochia (20.73±5.83)days vs(21.69±5.37)days] and the time of menstrual recovery(43.40±7.87)days vs(46.75±5.58)days] were not sifnificantly different between the women in two groups(P>0.05).(4) Complications of UAE in study group were as follows:the occurrence rate of fever was 50%(8/16),the incidence of lower limb pain was 18.75%(3/16),the incidence of hip pain was 25%(4/16).All syndromes eased after symptomatic treatment.Conclusions It is an useful method to combine UAE with Rivanol intra-amniotic injection for the mid-term induction of labor in pregnant women with placenta praevia.It may avoid or reduce the risk of vaginal bleeding and be worthy of being spread in the hospital with artery embolization technique.