中期妊娠羊膜腔内注射依沙吖啶引产出血的高危因素
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摘要
目的采用羊膜腔内注射依沙吖啶终止中期妊娠,分析其引产出血的高危因素。方法选取同济大学附属第一妇婴保健院计划生育科2017年2月—2018年2月327例中期妊娠采用依沙吖啶引产患者,孕周在16～26周,收集患者年龄、孕周、双顶径、引产原因、前次分娩方式、既往孕次、胎盘位置、胎盘娩出情况、胎儿情况等临床资料,回顾性分析以上因素与引产出血量的相关性。结果中期妊娠引产后出血受多因素影响,胎盘因素(胎盘粘连)是最主要高危因素,居于首位,其次为胎儿因素(双胎及死胎),最后为既往孕次。结论依沙吖啶引产术前充分了解病史、评估高危因素,采取恰当的处理,对引产成功、减少出血并发症发生具有重要意义。
Objective To analyze the risk factors of bleeding in termination of midtrimester pregnancy with intraamniotic injection of ethacridine lactate. Methods The labor induction by intraamniotic injection of ethacridine lactate was performed in 327 pregnant women with gestation of 16 to 26 weeks in Shanghai First Maternity and Infant Hospital,Tongji University from February 2017 to February 2018. The association of maternal,fetal and placental factors with the volume of blood loss during labor induction was analyzed. Results Postpartum hemorrhage was affected by multiple factors during induced labor,and placental factors were the most important risk factors,followed by fetal factors( twin and stillbirth),and the history of previous pregnancy. Conclusion To reduce the postpartum bleeding,it is necessary to evaluate the risk factors and take appropriate treatment before induced labor with ethacridine lactate.
Objective To analyze the risk factors of bleeding in termination of midtrimester pregnancy with intraamniotic injection of ethacridine lactate. Methods The labor induction by intraamniotic injection of ethacridine lactate was performed in 327 pregnant women with gestation of 16 to 26 weeks in Shanghai First Maternity and Infant Hospital,Tongji University from February 2017 to February 2018. The association of maternal,fetal and placental factors with the volume of blood loss during labor induction was analyzed. Results Postpartum hemorrhage was affected by multiple factors during induced labor,and placental factors were the most important risk factors,followed by fetal factors( twin and stillbirth),and the history of previous pregnancy. Conclusion To reduce the postpartum bleeding,it is necessary to evaluate the risk factors and take appropriate treatment before induced labor with ethacridine lactate.
引文
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[16]李晓翠,徐蓓芬,方爱华,等.107例胎盘前置状态中期妊娠终止方法探讨[J].生殖与避孕,2011,31(11):780-785.
[17]温渝.中期妊娠引产合并剖宫产瘢痕处胎盘植入的处理体会[J].实用妇科内分泌电子杂志,2015,2(3):191-193.
[18]张晓峰,苗杰,范晓芬,等.利凡诺羊膜腔注射后行子宫动脉栓塞术对前置胎盘中期妊娠引产的临床价值探讨[J].中国医学装备,2015,12(2):93-94.
[2]曹泽毅.中华妇产科学:上册[M].北京:人民卫生出版社,2014:3090.
[3]中华医学会计划生育分会.临床诊疗指南与技术操作规范:计划生育分册(2017)(修订版)[M].北京:人民卫生出版社,2017.
[4]王彩燕,姚晓英,黄紫蓉,等.预防性子宫动脉栓塞术用于胎盘前置状态的中期妊娠终止的回顾性分析[J].中华生殖与避孕杂志,2018,38(2):131-134.
[5]陈蔚琳,刘鹏飞,金力,等.依沙吖啶羊膜腔注射中期引产术的安全性及有效性临床研究回顾性再评价[J].中国计划生育学杂志,2017,25(8):528-532.
[6]刘顺华,刘佳晔,等.米非司酮联合米索前列醇与羊膜腔外注射依沙丫啶在特殊妊娠中期引产中的疗效比较[J].中国妇幼保健,2018,33(4):868-872.
[7]黄紫蓉.常用中期妊娠引产方法的选择[J].中国计划生育学杂志,2017,25(8):508-510.
[8]彭巧珍,张卫社.孕中期前置胎盘状态引产相关问题[J].中华产科急救电子杂志,2015,4(2):77-80.
[9]乐杰,谢幸,林仲秋,等.妇产科学[M].7版.北京:人民卫生出版社,2008:36-134
[10]王欲,杜鹃.死胎患者产前母体D-二聚体水平变化的相关性研究[J].中国医科大学学报,2011,40(7):652-654.
[11]陈惠仪.前置胎盘、胎盘粘连、胎盘植入与人工流产的关系[J].中外医学研究,2012,10(9):124-125.
[12]赵金华,郭玉华,葛娜.前置胎盘合并胎盘植入的临床诊治分析[J].中国妇幼保健,2013,28(24):3935-3937.
[13]MARSHALLN E,FUR W,GUISE J M.Impact of multiple cesarean deliveries on maternal morbidity:Asystematic review[J].Am J Obstet Gynecol,2011,205(3):262.e1-e8.
[14]解其贵,杨志勇,邢雅欣,等.二胎政策开放前后5 706例剖宫产指征分析[J].同济大学学报(医学版),2017,38(3):90-93.
[15]CHEN C Q,LIN F K,WANG X Y,et al.Mifepristone combined with ethacridine lactate for the secondtrimester pregnancy termination in women with placenta previa and/or prior cesarean deliveries[J].Arch Gynecol Obstet,2017,295(1):119-124.
[16]李晓翠,徐蓓芬,方爱华,等.107例胎盘前置状态中期妊娠终止方法探讨[J].生殖与避孕,2011,31(11):780-785.
[17]温渝.中期妊娠引产合并剖宫产瘢痕处胎盘植入的处理体会[J].实用妇科内分泌电子杂志,2015,2(3):191-193.
[18]张晓峰,苗杰,范晓芬,等.利凡诺羊膜腔注射后行子宫动脉栓塞术对前置胎盘中期妊娠引产的临床价值探讨[J].中国医学装备,2015,12(2):93-94.