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目的分析中期引产后出血的临床特征,提出预防和治疗中期引产后出血的医疗建议。方法回顾性分析广州医科大学附属第三医院产科2002年7月至2014年7月发生的43例中期引产出血病例的临床特点。结果中期引产出血共43例,占总引产病例的2.72%(43/1 581),其中难免流产予催产素引产组产后出血11例,占该组5.91%(11/186);米非司酮+米索前列醇引产组产后出血6例,占该组2.11%(6/284);利凡诺尔引产产后出血20例,占该组1.92%(20/1 040);剖宫取胎产后出血6例,占该组28.57%(6/21)。水囊引产组50例未发生产后出血。产后出血量为300~2 200 ml。严重出血者(出血大于1 000 ml)共6例。引产出血的主要原因是胎盘胎膜因素74.41%(32/43)、宫缩乏力18.6%(8/43)和凝血功能异常6.97%(3/43)。治疗包括输液输血容量复苏和营养支持,按摩子宫并宫缩剂加强宫缩,必要时予清宫排空子宫止血。贫血发生率为25.58%(11/43),产褥感染发生率为23.25%(10/43)。结论中期引产产后出血发生率低,主要病因是胎盘胎膜残留,其次为宫缩乏力和凝血功能异常,治疗主要为三级预警,排空子宫、加强宫缩、控制感染和纠正贫血。预防则为防止意外妊娠和出生缺陷等高危因素,做好计划生育工作。
Objective To analyze the clinical features of bleeding after mid-term induction of labor and to propose medical advice on the prevention and treatment of post-labor bleeding after mid-term. Methods The clinical features of 43 cases of induced abortion in mid-term induced abortion were analyzed retrospectively from July 2002 to July 2014 in the Third Affiliated Hospital of Guangzhou Medical University. Results A total of 43 cases of induced abortion in mid-term, accounting for 2.72% (43/1 581) of the total cases of induced abortion, which inevitable miscarriage of oxytocin induced labor postpartum hemorrhage in 11 cases, accounting for 5.91% (11/186) of the group; mifepristone + Misoprostol induced labor postpartum hemorrhage in 6 cases, accounting for 2.11% (6/284) of the group; rivanol bleeding after induction of labor in 20 cases, accounting for 1.92% (20/1 040); cesarean section after childbirth bleeding 6 cases accounted for 28.57% of the group (6/21). 50 cases of induced abortion group no postpartum hemorrhage. Postpartum hemorrhage volume of 300 ~ 2 200 ml. Severe bleeding (bleeding greater than 1 000 ml) a total of 6 cases. The main causes of induction of bleeding were placental membrane factors 74.41% (32/43), uterine atony 18.6% (8/43) and coagulation dysfunction 6.97% (3/43). Treatment includes transfusion volume recovery and nutritional support, massage uterus and uterine contractions to strengthen the contractions, if necessary, to the Qing emptying the uterus to stop bleeding. The incidence of anemia was 25.58% (11/43), and the incidence of puerperal infection was 23.25% (10/43). Conclusions The incidence of postpartum hemorrhage during the second trimester is low. The main cause is residual placenta, followed by uterine atony and coagulation dysfunction. The treatment mainly includes three levels of early warning, emptying the uterus, strengthening contractions, controlling infection and correcting anemia. Prevention is to prevent high-risk factors such as unwanted pregnancies and birth defects, so that family planning work well.