余春梅

[摘要]目的 探讨终止瘢痕子宫（均为子宫下段剖宫产术后）中晚期妊娠的方法。方法 选取2012年8月～2013年8月在我院收治的瘢痕子宫中晚期妊娠要求终止妊娠的60例患者，按不同引产方式将患者分为三组，A组观察组患者28例，主要采用利凡诺尔羊膜内注射的方法进行引产；B组观察组患者16例，主要选择水囊引产的方法；C组观察组患者16例，主要选择米非司酮+米索前列醇的方法对患者进行引产。选取同期在我院接受非瘢痕子宫引产患者60例，分为三组，A组对照组21例，主要选择利凡诺尔羊膜腔内注射的方法进行引产，B组对照组患者25例，主要采用水囊引产的方法；C组对照组患者14例，主要采用米非司酮+米索前列醇的方法进行引产。比较两组患者胎儿、胎盘娩出时间和患者分娩过程中出血量以及产道损伤情况。结果 A观察组和A对照组、B观察组和B对照组、C观察组和C对照组之间胎儿娩出时间以及产时出血量比较，均无统计学意义（P>0.05）。结论 剖宫产术后半年后瘢痕子宫中晚期妊娠引产可以在严密观察下实施经腹羊膜腔内注射利凡诺、联合应用米非司酮与米索前列醇或者水囊引产法。

[关键词]米索前列醇；终止妊娠；米非司酮；瘢痕子宫

[中图分类号] R719.3 [文献标识码] B [文章编号] 2095-0616（2014）10-214-03

[Abstract] Objective To investigate the termination method of mid-and late pregnancy with uterine scar pregnancy（lower segment of uterus after cesarean section）. Methods 60 mid-and late pregnancy women with uterine scar pregnancy and required termination of pregnancy in our hospital between August 2012 and August 2013 were collected.The women were assigned to 3 groups according to the different ways of abortion. 28 cases in observation group A received transabdominal amniotic injection of rivanol，16 cases in observation group B received bladders abortion，16 cases in observation group C received mifepristone and misoprostol for abortion. 60 women accepted abortion and without uterine scar in the same period were collected and assigned to 3 groups， 21 cases in the control group A received transabdominal amniotic injection of rivanol， 25 cases in control group B received bladders abortion，14 cases in control group C received mifepristone and misoprostol for abortion.The parturition time of fetus and placenta，blood loss and birth canal injury during delivery were comparative analysised. Results The parturition time of fetus and intrapartum blood loss in observation group A and control group A， observation group B and control group B， observation group C and control group C had statistically significant（P>0.05）. Conclusion In the half of a year after cesarean section， women with advanced uterine scar pregnancy can accept abortion under close observation by transabdominal amniotic injection of rivanol， mifepristone and misoprostol combination， bladders abortion.

[Key words] Misoprostol；Termination of pregnancy；Mifepristone；Uterine scar

近几年，医院针对患者剖宫产的指征在逐渐放宽，进而导致医院的剖宫产率也在一定程度上有所增加，并且始终保持在一定的水平。所以瘢痕子宫避孕失败患者或者计划外妊娠需要终止患者的数量也在逐年增加[1]。