米非司酮配伍利凡诺在双胎妊娠中孕引产中的应用
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摘要
目的探讨分析米非司酮配伍利凡诺在双胎妊娠胎儿中孕引产中的应用效果。方法将本院2016年1月至2017年12月因胎儿畸形及严重并发症引产的双胎妊娠孕妇28例做为研究对象,对照组选择同期单胎中孕引产者56例,两组均使用米非司酮配伍利凡诺引产,观察对比两种治疗方案临床效果,并分析其应用价值。结果研究组在规律宫缩至胎盘娩出时间,总引产时间及产后出血量均多于对照组(P<0.05),差异有统计学意义;两组在羊膜腔注射利凡诺后至规律宫缩开始时间差异无统计学意义。研究组产后发热人数明显高于对照组,两者差异有统计学意义(P<0.05),两者在组织残留数,引产成功率,软产道损伤的发生率上差异无统计学意义;两组均未发生子宫破裂等严重并发症,研究组发生一例胎盘早剥但差异无统计学意义。结论在双胎妊娠中孕引产中采用米非司酮配伍利凡诺,能够有效诱发宫缩,不增加组织残留率,在引产成功率及软产道损伤严重并发症的发生上与单胎中孕引产无明显差异,且对于单绒双羊及双绒双羊双胎妊娠孕妇,单羊膜腔利凡诺注射即可获得较好效果,减少了孕妇多次穿刺的痛苦,有临床推广应用价值。
Objective To explore the effect of mifepristone assisted rivanol in mid pregnancy abortion with twin pregnancy.Methods From January 2016 to December 2017,28 cases mid-twin pregnancy who required induced labor because of fetal abnormalities and severe complication were choosed as study group and 56 cases single mid-pregnancy as control group both of them induced labor with Mifepristone assisted rivanol.The clinical effects of the two groups were observed and compared.Results The time between regular uterine contraction to placental delivery,the total induced labor time and postpartum haemorrhage in study group were significantly more than control group(P<0.05).There was no statistically significant difference.In the start time of regular contractionsthe after amniotic injection rivanol.The incidence rate of complications in study group such as postpartum fever was higher than the control group(P<0.05).There was no significant difference in tissue residues,the success rate of induced labor,soft birth canal injury and serious complications such as uterine rupture.Placental abruption occur in one case,but the difference has no statistically significant.Conclusion Mid-pregnancy induced labor in twin pregnancy with mifepristone assisted rivanol,can effectively induce contractions,does not increase the rate of tissue residues,the success rate of induced labor,soft birth canal injury and serious complications have no difference between the single mid-pregnancy induced labor.For monochorionic diamniotic twin and double chorionic double amniotic membrane twin,single amniotic injection rivanol can obtain good effect,reduce the pregnant women stinging pain for two times.We think the method have clinical application value.
Objective To explore the effect of mifepristone assisted rivanol in mid pregnancy abortion with twin pregnancy.Methods From January 2016 to December 2017,28 cases mid-twin pregnancy who required induced labor because of fetal abnormalities and severe complication were choosed as study group and 56 cases single mid-pregnancy as control group both of them induced labor with Mifepristone assisted rivanol.The clinical effects of the two groups were observed and compared.Results The time between regular uterine contraction to placental delivery,the total induced labor time and postpartum haemorrhage in study group were significantly more than control group(P<0.05).There was no statistically significant difference.In the start time of regular contractionsthe after amniotic injection rivanol.The incidence rate of complications in study group such as postpartum fever was higher than the control group(P<0.05).There was no significant difference in tissue residues,the success rate of induced labor,soft birth canal injury and serious complications such as uterine rupture.Placental abruption occur in one case,but the difference has no statistically significant.Conclusion Mid-pregnancy induced labor in twin pregnancy with mifepristone assisted rivanol,can effectively induce contractions,does not increase the rate of tissue residues,the success rate of induced labor,soft birth canal injury and serious complications have no difference between the single mid-pregnancy induced labor.For monochorionic diamniotic twin and double chorionic double amniotic membrane twin,single amniotic injection rivanol can obtain good effect,reduce the pregnant women stinging pain for two times.We think the method have clinical application value.
引文
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[10]陈藕景,柴泽英,赵勤.不同厚度子宫下段在瘢痕子宫中期引产中的安全性分析[J].中国妇幼健康研究,2016,27(S1):215-216.
[11]中华医学会围产医学分会胎儿医学学组.中华医学会妇产科学分会产科学组.双胎妊娠临床处理指南(第二部分)---双胎妊娠并发症的诊治[J].中国产前诊断杂志,2015,7(4):58-64.
[12]Parra-Cordero M,Bennasar M,Martinez JM,et al.Cord Occlusion in Monochorionic Twins with Early Selective Intrauterine Growth Restriction and Abnormal Umbilical Artery Doppler:A Consecutive Series of 90 Cases[J].Fetal Diagn Ther,2016,39(3):186-191.
[13]Peeva G,Bower S,Orosz L,et al.Endoscopic Placental Laser Coagulation in Monochorionic Diamniotic Twins with Type II Selective Fetal Growth Restriction[J].Fetal Diagn Ther,2015,38(2):86-93.
[14]Bennasar M,Eixarch E,Martinez JM,et al.Selectiveintrauterine growth restriction in monochorionic diamniotic twin pregnancies[J].Semin Fetal Neonatal Med,2017,22(6):376-382.
[15]中华医学会妇产科学分会产科学组.妊娠晚期促子宫颈成熟与引产指南(2014)[J].中华妇产科杂志,2014,49(12):881-885.
[2]Obican S,Brockc,Berkowitz R,et al.Multifetal pregnancy reduction[J].Clinical Obstetrics and Gynecology,2015,58(3):574-584.
[3]Wei Jun,Wu Qjun,Zhang Tiening,et al.Complications in multiple gestation pregnancy:A crosssectional study of ten maternal-fetal medicine centers in China[J].Oncotarget,2016,7(21):30797-30803.
[4]Bankada V,purra p,Ningappa AM,et al.Arare case of bilaterral broad ligament haematoma in twin pregnancy[J].J Cli Diagn Res,2015,9(10):QD03-QD05.
[5]符元春.产前超声检查在双胎妊娠并发症诊断及治疗中的价值[J].当代医学,2016,22(19):64-65.
[6]李云秀,付帅,柏智,等.宫颈扩张球囊促宫颈成熟及引产的效果[J].广东医学,2013,34(15):2358-2360.
[7]刘美芳.米非司酮配合羊膜腔内注射乳酸依沙吖啶在中期妊娠引产中的应用效果观察[J].当代医学,2017,23(26):61-62.
[8]严秀文.米非司酮配伍米索前列醇用于瘢痕子宫妊娠13-20周引产的临床观察[J].临床军医杂志,2010,8(1):454-455.
[9]刘军永.米非司酮配伍米索前列醇用于瘢痕子宫妊娠13-16周引产的临床观察[J].中国美容医学,2012,21(s2):219-220.
[10]陈藕景,柴泽英,赵勤.不同厚度子宫下段在瘢痕子宫中期引产中的安全性分析[J].中国妇幼健康研究,2016,27(S1):215-216.
[11]中华医学会围产医学分会胎儿医学学组.中华医学会妇产科学分会产科学组.双胎妊娠临床处理指南(第二部分)---双胎妊娠并发症的诊治[J].中国产前诊断杂志,2015,7(4):58-64.
[12]Parra-Cordero M,Bennasar M,Martinez JM,et al.Cord Occlusion in Monochorionic Twins with Early Selective Intrauterine Growth Restriction and Abnormal Umbilical Artery Doppler:A Consecutive Series of 90 Cases[J].Fetal Diagn Ther,2016,39(3):186-191.
[13]Peeva G,Bower S,Orosz L,et al.Endoscopic Placental Laser Coagulation in Monochorionic Diamniotic Twins with Type II Selective Fetal Growth Restriction[J].Fetal Diagn Ther,2015,38(2):86-93.
[14]Bennasar M,Eixarch E,Martinez JM,et al.Selectiveintrauterine growth restriction in monochorionic diamniotic twin pregnancies[J].Semin Fetal Neonatal Med,2017,22(6):376-382.
[15]中华医学会妇产科学分会产科学组.妊娠晚期促子宫颈成熟与引产指南(2014)[J].中华妇产科杂志,2014,49(12):881-885.