發(fā)布時(shí)間：2018-07-10 09:05

  本文選題：疤痕子宮 + 妊娠中期引產(chǎn)��； 參考：《浙江大學(xué)》2016年碩士論文

【摘要】：研究背景：妊娠中晚期的疤痕子宮孕婦,一方面因胎兒已較大,另一方面又由于既往子宮手術(shù)史導(dǎo)致的子宮局部疤痕問(wèn)題,在面臨計(jì)劃生育因素、胎兒畸形、死胎或孕母合并嚴(yán)重妊娠期并發(fā)癥、合并癥等原因而不得不以引產(chǎn)方式終止妊娠時(shí),其面臨的風(fēng)險(xiǎn)也將大于同期非疤痕子宮孕婦。目前國(guó)內(nèi)對(duì)于疤痕子宮的中晚期引產(chǎn)方式尚無(wú)定論,其中,利凡諾爾羊膜腔注射配伍米非司酮口服的引產(chǎn)方式較為常用。因此,評(píng)價(jià)該方式對(duì)于疤痕子宮孕婦的安全性及有效性極有實(shí)踐意義。目的：評(píng)價(jià)利凡諾爾羊膜腔注射配伍米非司酮口服的引產(chǎn)方式對(duì)于疤痕子宮中晚期引產(chǎn)的安全性和有效性。方法：回顧性選取于2013年1月1日至2015年12月31日進(jìn)入浙江大學(xué)醫(yī)學(xué)院附屬婦產(chǎn)科醫(yī)院產(chǎn)科住院的妊娠中晚期引產(chǎn)病例,采用病例對(duì)照研究,對(duì)比得出利凡諾爾羊膜腔注射配伍米非司酮口服的引產(chǎn)方式對(duì)于疤痕子宮孕婦的有效性及安全性。將369例符合條件的入選病例按是否合并有疤痕子宮分成2組：A組155例孕中晚期需行利凡諾爾羊膜腔注射配伍米非司酮口服引產(chǎn)的孕婦合并有疤痕子宮；B組214例孕中晚期需行利凡諾爾羊膜腔注射配伍米非司酮口服引產(chǎn)的孕婦不合并有疤痕子宮。比較兩組孕婦的一般情況,胎兒及其附屬物超聲指標(biāo)情況,從利凡諾爾羊膜腔注射至宮縮發(fā)動(dòng)的時(shí)間,從利凡諾爾羊膜腔注射至胎兒娩出的時(shí)間,引產(chǎn)的成功率,產(chǎn)后出血,胎盤(pán)胎膜殘留,嚴(yán)重的引產(chǎn)并發(fā)癥和意外事件發(fā)生情況等,初步評(píng)價(jià)利凡諾爾羊膜腔注射配伍米非司酮口服的引產(chǎn)方式對(duì)于疤痕子宮孕婦的安全性和有效性。結(jié)果：A組在年齡、孕次、產(chǎn)次方面均顯著大于B組,而其孕周顯著小于B組；A組在胎兒超聲測(cè)量指標(biāo)上顯著小于B組；A組用藥至宮縮發(fā)動(dòng)平均時(shí)間為26.30±8.17小時(shí),B組用藥至宮縮發(fā)動(dòng)平均時(shí)間為26.44±9.86小時(shí),兩者相比無(wú)統(tǒng)計(jì)學(xué)差異；A組用藥至胎兒娩出平均時(shí)間為35.18±9.39小時(shí),B組用藥至胎兒娩出平均時(shí)間為33.88±10.87小時(shí),兩組相比無(wú)統(tǒng)計(jì)學(xué)差異；A、B兩組引產(chǎn)成功率分別為93.5%和97.2%,B組高于A組,但差異無(wú)統(tǒng)計(jì)學(xué)意義；A組共43例發(fā)生引產(chǎn)后胎盤(pán)胎膜殘留,殘留率為27.7%,B組共48例發(fā)生胎盤(pán)胎膜殘留,殘留率為22.4%,A組和B組產(chǎn)后出血率分別為4.5%和1.9%,胎盤(pán)早剝發(fā)生率分別為1.9%和0.9%,胎盤(pán)植入發(fā)生率分別為2.6%和0.5%,以上結(jié)果兩組比較均無(wú)統(tǒng)計(jì)學(xué)差異；A組和B組平均住院天數(shù)分別為6.57±2.02天和6.65±2.35天,無(wú)統(tǒng)計(jì)學(xué)差異；將A組中孕中期和孕晚期的病例分組比較,其引產(chǎn)成功率(孕中期92.8%vs孕晚期96.6%)、利凡諾爾注射至宮縮發(fā)動(dòng)平均時(shí)間(孕中期26.16±7.28h vs孕晚期26.52±9.49h)、利凡諾爾注射至胎兒娩出的平均時(shí)間(孕中期34.68±8.06h vs孕晚期35.97±11.22h)等指標(biāo)均無(wú)統(tǒng)計(jì)學(xué)差異,引產(chǎn)后胎盤(pán)、胎膜宮內(nèi)殘留率(孕中期34.0%vs孕晚期17.2%)比較,兩者間有統(tǒng)計(jì)學(xué)差異,但其他并發(fā)癥諸如產(chǎn)后出血(孕中期5.2%vs孕晚期3.4%)、胎盤(pán)植入(孕中期4.1%vs孕晚期0%)和胎盤(pán)早剝(孕中期3.1%vs孕晚期0%)的發(fā)生率均沒(méi)有統(tǒng)計(jì)學(xué)上的差異,兩者在平均住院日的比較上(孕中期6.13±1.82天vs孕晚期6.73±1.82天)亦無(wú)統(tǒng)計(jì)學(xué)差異。結(jié)論：1、在嚴(yán)格控制指證,排除高危人群的情況下,利凡諾爾羊膜腔注射配伍米非司酮口服用于疤痕子宮或非疤痕子宮孕婦的孕中晚期引產(chǎn)均安全有效；2、針對(duì)疤痕子宮孕婦,孕中期引產(chǎn)發(fā)生相關(guān)并發(fā)癥的潛在風(fēng)險(xiǎn)可能高于孕晚期引產(chǎn)；3、未來(lái)可以針對(duì)行利凡諾爾羊膜腔注射配伍米非司酮口服引產(chǎn)的患者進(jìn)行引產(chǎn)后的隨訪,以便評(píng)估該方法對(duì)患者遠(yuǎn)期預(yù)后的影響。
[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.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R719.31

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