Cook水囊在瘢痕子宫中期妊娠引产中的临床应用研究

摘要

目的：探讨米索前列醇联合Cook水囊在瘢痕子宫中期妊娠引产中的应用价值。方法选择新疆医科大学第一附属医院计划生育病区剖宫产术后再孕、要求引产的患者50例。随机分为两组，对照组采用传统利凡诺引产，观察组采用米索前列醇联合Cook水囊引产。比较两组从规律宫缩至胎儿娩出时间、引产成功率、产后出血量、胎盘胎膜残留率及产道损伤情况。结果（1）对照组从规律宫缩至胎儿娩出时间为（14．6±3．26）h，观察组从规律宫缩至胎儿娩出时间为（7．3±2．56）h，两组相比差异有统计学意义（P ＜0．05）。（2）对照组引产成功率为92％，观察组引产成功率为100％，两组相比差异无统计学意义（P ＞0．05）。（3）对照组产后24 h出血量为（214±103）mL，观察组产后24 h出血量为（156±98）mL，两组相比差异有统计学意义（P ＜0．05）。（4）对照组患者胎盘胎膜残留率为44％，引产成功者中有2例宫颈轻度裂伤。观察组胎盘胎膜残留率为24％，与对照组相比，观察组完全流产率高，清宫率低，引产并发症少，两组相比差异有统计学意义（P ＜0．05）。结论对于瘢痕子宫中期妊娠的患者，在米非司酮软化宫颈的基础上，联合米索前列醇和 Cook水囊比单用依沙吖啶效果好，特别对于宫颈条件差、内口紧的患者，效果更佳。有引产成功率高、产后出血少、并发症少的优点。%Objective To investigate the clinical effect of Misoprostol in combination with Cook water sac terminating second trimester pregnancy with scar uterus.Methods 50 patients who voluntarily requested termination of pregnancy due to scar uterus were randomly divided into two groups:observation group and control group.Misoprostol in combination with Cook water sac was used in the observation group.A com-parison was made between two groups from regular uterine contract to fetal childbirth time,success rate of induced labor,postpartum blood loss and placental retention rate of membranes and the status of birth canal injury.Results The average time from regular uterine contract to fetal disengagement was (7.3± 2.56)hours in observation group (14.6±3.26).hours in control group,having statistical significance (P<0.05).The success rate of induced labor was 92% in control group while 100% in observation group, showing statistical significance (P <0.05).As to the amount of uterus bleeding 24h after delivery,obser-vation group was (156±98)mL and the control group was (214±103)mL,the differences between two groups was significant (P <0.05);placental retention rate of membranes was 44% in control group while 24% in observation group,the difference was significant (P<0.05).Conclusion Misoprostol in combina- tion with Cook water sac proves better than Ethacridine in the induction of labor in the second trimester for the scarreduterus,which especially serves patients with poor conditions of the tight cervix.It has advanta-ges of higher induction success rate,less postpartum blood loss and fewer complications.