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目的探讨终止瘢痕子宫中期妊娠安全有效的方法。方法回顾性分析比较瘢痕子宫中期妊娠3种引产方法[利凡诺羊膜腔注射引产(A组,82例)、米非司酮联合利凡诺引产(B组,39例)、利凡诺联合米非司酮、米索前列醇引产(C组,35例)]在引产时间(用药到分娩时间)、总产程、出血量、胎盘胎膜残留率及软产道损伤等方面的差异。结果仅A组2例行2次注药后成功引产,余均1次用药即成功。3组的引产成功率无统计学差异。引产时间、总产程、出血量、胎盘胎膜残留率及软产道损伤有统计学差异。瘢痕子宫3种引产方法中,B、C组与A组相比,引产时间、总产程缩短,胎盘胎膜残留率降低,宫颈裂伤减少,差异均有统计学意义(P均<0.05),出血量有所减少,但差异无统计学意义(P>0.05)。B组与C组间上述指标相近(P均>0.05)。C组软产道损伤率较B组稍高,但差异无统计学意义(P>0.05),C组发生子宫破裂1例。结论瘢痕子宫中期妊娠利凡诺羊膜腔注射引产及在此基础上联合米非司酮或联合米非司酮、米索前列醇3种方法安全、有效、可行,联合米非司酮的方法可缩短产程,减少并发症,提高引产的安全性和有效性;联合米非司酮、米索前列醇的引产方法需进一步临床观察。
Objective To investigate the safe and effective method of terminating scar pregnancy in the second trimester of pregnancy. Methods A retrospective analysis was conducted to compare three induced abortion methods in mid-term uterine scar pregnancy (rivanol induced amniotic injection induced abortion (group A, n = 82), mifepristone combined with rivanol induction (group B, n = 39) Mifepristone and misoprostol induction group (C group, 35 cases)] in the induction of labor time (medication to delivery time), total labor, amount of bleeding, residual fetal membranes rate and soft birth canal and other differences. Results A group of 2 patients in 2 cases after successful injection of labor, the remaining one medication that is successful. The success rate of induction of labor in the three groups had no statistical difference. Maternal induction of labor, total labor, bleeding volume, residual rate of fetal membranes and soft birth canal injury were statistically different. Compared with group A, the induction rate of labor, the shortening of total labor, the decrease of residual rate of fetal membranes and the reduction of cervical laceration were found in groups B and C compared with those in group A (all P <0.05) The amount of bleeding decreased, but the difference was not statistically significant (P> 0.05). The above indexes were similar in group B and group C (all P> 0.05). The injury rate of soft birth canal in group C was slightly higher than that in group B, but the difference was not statistically significant (P> 0.05). In group C, uterine rupture occurred in 1 case. CONCLUSIONS: It is safe, effective and feasible to use mifepristone or mifepristone combined with mifepristone and misoprostol on the basis of this study. Shorten the labor process, reduce complications and improve the safety and effectiveness of induction; combined with mifepristone and misoprostol induction of labor needs further clinical observation.