经阴道彩色多普勒超声早期预测药物流产不全及高危病例干预措施的研究

摘要

Objective To investigate the value of transvaginal color Doppler ultrasound in the early prediction of incomplete abortion and interventions for high - risk abortion cases. Methods Spiral artery blood flow signals in gestational sac during implantation and hemodynamic parameters were compared before and after medical abortion by transvaginal color Doppler ultrasound in 23 women who took mifepristone and misoprostol to terminate early pregnancy in our hospital from January 2010 to March 2010. Curettage and pathologic examination were performed in women who still had irregular vaginal bleeding on day 15 after medical abortion and compared with the results of ultrasound examination. Curettage was also performed in high - risk incomplete medical abortion cases as an intervention measure. Results Clinical and pathological examinations on day 15 postabortion confirmed that of 23 cases, complete abortion and incomplete abortion occurred in 20 and 3 cases respectively. Spiral artery blood flow showed high resistance in complete abortion cases and low resistance in incomplete abortion cases. PSV and EDV were significantly decreased,but PI, RI values significantly increased on the day of complete abortion compared with those before abortion; however, there was little changes in PSV, EDV, PI and RI on day 15 after medical abortion in patients with incomplete abortion. Compared with the values before abortion, PSV and EDV were significantly decreased, PI and RI significantly increased after intervention by curettage indicating successful abortion by the intervention. Conclusion Transvaginal color Doppler ultrasound can be used to identifv complete or incomplete abortion in early medical abortion cases.Curettage can be applied to intervene in high - risk incomplete medical abortion cases.%目的 探讨经阴道彩色多普勒超声早期预测药物流产不全,并探究药物流产高危病例的干预措施.方法 对2010年1月至2010年3月来我院进行阴道彩色多普勒超声技术检测的服用米非司酮配伍米索前列醇终止早孕的23例妇女,作药物流产前后孕囊着床部位螺旋动脉血流信号和血流动力学参数的比较.第15天仍有不规则阴道出血者全部行清宫手术和病理检查,并与超声检查结果作对照.当发生流产不全高危病例时,应用清宫术进行干预.结果 23例宫内早孕中,第15天经临床或病理证实属于完全流产者20例,螺旋动脉呈高阻血流;流产不全者3例,螺旋动脉呈低阻血流.完全流产患者流产当天血流动力学参数收缩期最大血流速度(PSV)、舒张期最小血流速度(EDV)值明显较流产前减小,而博动指数(PI)、阻力指数(RI)值明显增大;流产不全患者流产当天、流产第15天血流动力学参数PSV、EDV、PI、RI值与流产前相比变化很小,经清宫术干预后,PSV、EDV值明显较流产前减小,而PI、RI值明显增大,患者流产成功.结论 经阴道彩色多普勒超声可以对早期药物流产成功与否进行鉴别,当发生药物流产不全及高危病例时可以应用清宫术进行干预.