疤痕子宫中晚期妊娠采取利凡诺尔配伍米非司酮引产的临床分析

发布时间：2018-07-10 09:05

本文选题：疤痕子宫 + 妊娠中期引产　；参考：《浙江大学》2016年硕士论文

【摘要】：研究背景：妊娠中晚期的疤痕子宫孕妇,一方面因胎儿已较大,另一方面又由于既往子宫手术史导致的子宫局部疤痕问题,在面临计划生育因素、胎儿畸形、死胎或孕母合并严重妊娠期并发症、合并症等原因而不得不以引产方式终止妊娠时,其面临的风险也将大于同期非疤痕子宫孕妇。目前国内对于疤痕子宫的中晚期引产方式尚无定论,其中,利凡诺尔羊膜腔注射配伍米非司酮口服的引产方式较为常用。因此,评价该方式对于疤痕子宫孕妇的安全性及有效性极有实践意义。目的：评价利凡诺尔羊膜腔注射配伍米非司酮口服的引产方式对于疤痕子宫中晚期引产的安全性和有效性。方法：回顾性选取于2013年1月1日至2015年12月31日进入浙江大学医学院附属妇产科医院产科住院的妊娠中晚期引产病例,采用病例对照研究,对比得出利凡诺尔羊膜腔注射配伍米非司酮口服的引产方式对于疤痕子宫孕妇的有效性及安全性。将369例符合条件的入选病例按是否合并有疤痕子宫分成2组：A组155例孕中晚期需行利凡诺尔羊膜腔注射配伍米非司酮口服引产的孕妇合并有疤痕子宫；B组214例孕中晚期需行利凡诺尔羊膜腔注射配伍米非司酮口服引产的孕妇不合并有疤痕子宫。比较两组孕妇的一般情况,胎儿及其附属物超声指标情况,从利凡诺尔羊膜腔注射至宫缩发动的时间,从利凡诺尔羊膜腔注射至胎儿娩出的时间,引产的成功率,产后出血,胎盘胎膜残留,严重的引产并发症和意外事件发生情况等,初步评价利凡诺尔羊膜腔注射配伍米非司酮口服的引产方式对于疤痕子宫孕妇的安全性和有效性。结果：A组在年龄、孕次、产次方面均显著大于B组,而其孕周显著小于B组；A组在胎儿超声测量指标上显著小于B组；A组用药至宫缩发动平均时间为26.30±8.17小时,B组用药至宫缩发动平均时间为26.44±9.86小时,两者相比无统计学差异；A组用药至胎儿娩出平均时间为35.18±9.39小时,B组用药至胎儿娩出平均时间为33.88±10.87小时,两组相比无统计学差异；A、B两组引产成功率分别为93.5%和97.2%,B组高于A组,但差异无统计学意义；A组共43例发生引产后胎盘胎膜残留,残留率为27.7%,B组共48例发生胎盘胎膜残留,残留率为22.4%,A组和B组产后出血率分别为4.5%和1.9%,胎盘早剥发生率分别为1.9%和0.9%,胎盘植入发生率分别为2.6%和0.5%,以上结果两组比较均无统计学差异；A组和B组平均住院天数分别为6.57±2.02天和6.65±2.35天,无统计学差异；将A组中孕中期和孕晚期的病例分组比较,其引产成功率(孕中期92.8%vs孕晚期96.6%)、利凡诺尔注射至宫缩发动平均时间(孕中期26.16±7.28h vs孕晚期26.52±9.49h)、利凡诺尔注射至胎儿娩出的平均时间(孕中期34.68±8.06h vs孕晚期35.97±11.22h)等指标均无统计学差异,引产后胎盘、胎膜宫内残留率(孕中期34.0%vs孕晚期17.2%)比较,两者间有统计学差异,但其他并发症诸如产后出血(孕中期5.2%vs孕晚期3.4%)、胎盘植入(孕中期4.1%vs孕晚期0%)和胎盘早剥(孕中期3.1%vs孕晚期0%)的发生率均没有统计学上的差异,两者在平均住院日的比较上(孕中期6.13±1.82天vs孕晚期6.73±1.82天)亦无统计学差异。结论：1、在严格控制指证,排除高危人群的情况下,利凡诺尔羊膜腔注射配伍米非司酮口服用于疤痕子宫或非疤痕子宫孕妇的孕中晚期引产均安全有效；2、针对疤痕子宫孕妇,孕中期引产发生相关并发症的潜在风险可能高于孕晚期引产；3、未来可以针对行利凡诺尔羊膜腔注射配伍米非司酮口服引产的患者进行引产后的随访,以便评估该方法对患者远期预后的影响。
[Abstract]:Background: pregnant women with the middle and late pregnancy scar uterus, on the one hand because of the larger fetus, on the other hand, caused by previous uterine surgical history caused by the uterine scar problem, in the face of family planning factors, fetal malformation, stillbirth or pregnant mother with severe pregnancy complications, complications, complications, and so on to terminate pregnancy induced abortion. The risk of pregnancy will also be greater than that of non scar womb pregnant women at the same time. At present, there is no conclusion in China for the middle and late induction of labor in the scar uterus. Among them, the use of rivanol amniotic injection with mifepristone is more commonly used. Therefore, the evaluation of the safety and effectiveness of this method is very true for the pregnant women with scar uterus. Objective: To evaluate the safety and effectiveness of the introduction of rivanol amniotic fluid injection combined with mifepristone for induction of labor in the middle and late stages of the scar uterus. Methods: a retrospective selection was selected from January 1, 2013 to December 31, 2015 to enter the middle and late pregnancy induced labor in the obstetrics and Gynecology Hospital Affiliated to the hospital of Zhejiang University medical college. For example, a case-control study was used to compare the effectiveness and safety of the rivanol amniotic injection with mifepristone for the pregnant women of the scar uterus. 369 cases of eligible cases were divided into 2 groups according to whether or not they were combined with scar uterus. In group A, 155 cases in the middle and late stages of pregnancy were required to be injected with lamb amniotic cavity and amniotic cavity. The pregnant women with non - ketone induced abortion were combined with scar uterus. In group B, 214 cases of pregnant women who had to be injected with mifepristone in the middle and late stages of pregnancy did not have scar uterus. Compare the general situation of the two groups of pregnant women, fetal and its appendage ultrasound indicators, from the rivanol amniotic cavity injection to the uterine contraction. A preliminary evaluation of the safety and effectiveness of the rivanol amniotic fluid injection combined with mifepristone for the pregnant women of the scar uterus, the time of the delivery of the fetus from the vanorin amniotic cavity, the success rate of induced labor, the postpartum hemorrhage, the placental placenta and fetal membrane, the serious induced complications and the occurrence of accidents. In group A, group A was significantly larger than group B in age, pregnancy and production, but the pregnancy week was significantly smaller than group B, and group A was significantly less than group B in fetal ultrasound measurement; the average time of drug use to uterine contraction in group A was 26.30 + hours, and the average time of drug use to uterine contraction in group B was 26.44 + 9.86 hours, and there was no statistical difference between the two groups; the drug of group A was not statistically different. The average time of delivery to the fetus was 35.18 + 9.39 hours, and the average time for the delivery of the B group to the fetus was 33.88 + 10.87 hours. There was no statistical difference between the two groups. A, the B two group was 93.5% and 97.2% respectively, and the group B was higher than the A group, but the difference was not statistically significant; in the A group, there were 43 cases of residual placenta and fetal membrane after induction of labor, and the residual rate was 27.7%, B The residual rate of placenta and fetal membrane in 48 cases was 22.4%. The postpartum hemorrhage rates in group A and B were 4.5% and 1.9% respectively, and the incidence of placental abruption was 1.9% and 0.9% respectively. The incidence of placental implantation was 2.6% and 0.5% respectively. The above results were not statistically significant in the two groups, and the average days of hospitalization in the group A and the B group were 6.57 + 2.02 days and 6.65 + 2.35. There was no statistical difference between the middle pregnancy and the late trimester of pregnancy in group A. The success rate of induction of labor (96.6% in the late trimester of pregnancy in the middle of pregnancy), the average time of rivanol injection to the uterine contraction (26.52 + 9.49h in the late stage of pregnancy 26.16 + 7.28h VS), the average time (34.68 + 8.06h vs pregnancy in the mid-term pregnancy) There was no statistical difference between the late 35.97 + 11.22h), placenta after induction and the rate of intrauterine fetal membrane (17.2% in the late trimester of pregnancy). There were statistical differences between the two, but other complications such as postpartum hemorrhage (3.4% in the late trimester of 5.2%vs in the middle of pregnancy), placenta implantation (0% in the late trimester of pregnancy in the middle of pregnancy) and placental abruption (3.1%vs pregnancy at the middle of pregnancy) There was no statistical difference in the incidence of period 0%. There was no statistical difference between the two in the average days of hospitalization (6.13 + 1.82 days in the middle period of pregnancy, 6.73 + 1.82 days in the late vs pregnancy). Conclusion: 1, in the case of strict control and exclusion of high-risk groups, the rivanol amniotic injection combined with mifepristone for scar uterus or non scars. The middle and late pregnancy induction of pregnant women with scar uterus is safe and effective. 2, the potential risk of related complications in the mid-term pregnancy for pregnant women with scar uterus may be higher than that in the late pregnancy; 3, the future can be followed up to evaluate the method for the patients who have been injected with Mifepristone with the amniotic cavity injection. The effect on the long-term prognosis of the patients.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R719.31

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