剖宫产术后再次妊娠合并前置胎盘及植入中期引产方法的初探

发布时间：2018-01-02 19:02

  本文关键词：剖宫产术后再次妊娠合并前置胎盘及植入中期引产方法的初探　出处：《山东大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 氯化钾 瘢痕子宫 胎盘前置状态 胎盘植入 引产

【摘要】：研究目的:瘢痕子宫、胎盘前置状态并胎盘植入中期终止妊娠既往多直接剖宫取胎,但术中大出血风险较高。有研究表明,完全性前置胎盘引产前先向胎儿心腔内注射KCL能减少引产过程中出血量。因此,我们尝试将KCL胎儿心腔内注射应用在胎盘前置状态及胎盘植入需中期引产的患者中,探讨其是否能有效减少引产过程中出血量,同时探寻中期妊娠引产新方法。研究方法:选取山东大学齐鲁医院2012年3月-2017年2月期间,瘢痕子宫、胎盘前置状态并胎盘植入中期妊娠引产患者共29例,入组标准:瘢痕子宫、本次妊娠孕周为14-27+6周、胎盘前置状态并植入,自愿放弃本次妊娠。主要依据彩超或MRI表现诊断胎盘前置状态并胎盘植入。自愿选择引产前行KCL胎儿心内注射14例为观察组;直接剖宫取胎15例为对照组。观察组先行KCL胎儿心内注射,植入轻者可自行发动宫缩或给予米索前列醇引产;植入程度深者复查彩超证实胎死宫内后出院,门诊定期复查胎盘血流及β-HCG水平,待胎盘血流明显减少后再次入院行超声引导下经阴钳夹术。对照组术前无特殊处理,直接行剖宫取胎术。观察两组患者临床资料。数据采用SPSS23.0进行录入与统计。计量资料符合正态分布、方差齐性者组间差异比较采用两独立样本t检验,以X±S描述。非正态分布者、方差不齐者用非参数检验。计数资料采用卡方检验或Fisher精确检验法。P0.05认为差异有统计学意义。结果:1.一般情况:分别比较观察组和对照组患者在年龄、孕次、既往剖宫产次数及流产次数等差异无统计学意义(P0.05)。2.两组各结局指标对比:观察组平均出血量(902.14±1060.3)ml,平均输红细胞量(3.89±3.28)U。对照组平均出血量(2546.7±1686.9)ml,平均输红细胞量(10.93±6.84)U。两组间出血量及输注红细胞量比较差异有统计学意义。引产前先行KCL减胎术比起直接剖宫取胎,出血量及输血量均明显降低。两组间住院费用差异无统计学意义(P0.05)。住院天数差异有统计学意义(P0.05),先行KCL减胎治疗者住院天数长于直接剖宫取胎组。子宫切除:观察组0例,对照组2例;转ICU:观察组0例,对照组1例。两组子宫切除率、转ICU率、无统计学差异。两组均无严重感染及严重凝血功能障碍者。3.观察组妊娠结局分为三种:KCL注射后经阴分娩(n=5),KCL注射后行超声引导下经阴钳夹术(n=4),KCL注射后剖宫取胎(n=5)。行组间比较,三组在年龄、孕周、既往孕产史、出血量、输血量、住院天数方面差异均无统计学意义。KCL注射后经阴分娩与KCL注射后剖宫取胎住院费用存在差异,P=0.015(P0.017),KCL注射后经阴分娩比KCL注射后剖宫取胎住院费用少。植入程度浅的患者注射KCL后更易自动发动宫缩经阴引产,自注射KCL至经阴分娩平均天数12天(2～21天)。穿透性胎盘植入自注射KCL至行超声引导下经阴钳夹术平均108天(86～152天),β-HCG降至正常平均116.5天(89～134天)。4.KCL注射后剖宫取胎组与直接剖宫取胎组对比:两组在年龄、孕周、出血量、输血量、住院天数、住院费用方面差异无统计学意义。5.术后随访:大多数患者均于产后1～2个月月经正常复潮。结论:1.剖宫产术后再次妊娠合并前置胎盘及植入患者中期妊娠引产前先行KCL胎儿心内注射,待胎盘血流明显减少后再经阴引产是一种安全、经济的引产方案,可以有效避免再次开腹手术。2.氯化钾胎儿心内注射后死胎3-4个月并不会影响凝血功能。
[Abstract]:Objective: scar uterus, placenta previa and placenta implantation mid pregnancy termination were directly cesarean, but intraoperative hemorrhage risk is higher. Studies have shown that complete placenta previa before induction to fetal heart cavity injection of KCL can reduce the amount of bleeding during labor. Therefore, we try to use the KCL fetal heart in the application of cavity injection of placenta previa and placenta implantation for mid-term pregnancy patients, to investigate whether it can effectively reduce the amount of bleeding in the process of induced abortion, and to explore the new method of mid pregnancy abortion. Methods: from Qilu Hospital of Shandong University in March 2012 -2017 year in February period, scar uterus, placenta previa placenta implantation and pregnancy induced labor in patients with a total of 29 inclusioncriteria: Cases of uterine scar, the pregnancy 14-27+6 weeks of pregnancy, placenta previa and implantation, voluntarily give up this pregnancy. According to ultrasound or MRI The diagnosis of placenta previa and placenta implantation. Voluntary induced abortion KCL before fetal heart injection in 14 cases of the observation group; direct cesarean section of 15 cases as control group. The observation group received KCL fetal intracardiac injection, implantation of the light can be launched their own contractions or give misoprostol; implantation depth review of ultrasound confirmed intrauterine discharge fetal death, periodic review of outpatient service of placental blood flow and beta -HCG level, the placental blood flow was significantly reduced after readmission for ultrasound-guided transvaginal clipping. Control group without special treatment for caesarean operation. Two groups were observed in patients with clinical data. The data were analyzed by SPSS23.0 measurement data input and statistics. In line with normal distribution and homogeneity of variance differences between groups were compared using two independent samples t test, with X + S. Non normal distribution, heterogeneity of variance and non parametric test for count data by chi square test or Fish Er exact test.P0.05 considered statistically significant. Results: 1. general conditions: To compare the observation group and the control group of patients in age, pregnant times, no significant previous cesarean and abortion times difference (P0.05) between the two groups: the observation group outcomes.2. average amount of bleeding (902.14 + 1060.3 ml), the average amount of red blood cell transfusion (3.89 + 3.28) U. control group, the average amount of bleeding (2546.7 + 1686.9) ml, the average volume of red blood cell transfusion (10.93 + 6.84) U. was statistically significant between the two groups in bleeding and transfusion of red blood cells. The difference of KCL before induction of fetal reduction than directly caesarean section, the amount of bleeding and blood transfusion were significantly reduced. The hospitalization expenses between the two groups showed no significant difference (P0.05). There was statistical significance difference (P0.05), hospitalization days before KCL treatment of fetal reduction hospitalization longer than direct cesarean group. Uterus resection: 0 cases in the observation group, the control group 2 渚，

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