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目的:探讨胎盘前置状态中期妊娠的最佳终止方法。方法:回顾性分析107例中期妊娠合并胎盘前置状态终止妊娠病例,按胎盘位置分为边缘型组(A组)、中央型组(B组),每组再按孕周大小分为<16周组、≥16周组,比较各组引产结局。结果:①采用依沙吖啶、天花粉及米非司酮配伍米索前列醇(药物)引产成功率A组分别为100%,80%,88.9%;B组分别为93.3%,100%,66.7%;孕周≥16周组分别为100%,94.1%,75%;孕周<16周组分别为90.9%,88.9%,92.4%。②采用天花粉引产时各组的出血量及总出血量均最少,引产与住院时间均最长(P<0.05)。③引产出血≥300 ml者共10例,分别为A组4例(药物组1例,依沙吖啶组3例);B组6例药物组1例,依沙吖啶组3例,天花粉组1例,小型剖宫产1例);引产失败6例,分别为A组4例(天花粉2例,药物组2例)及B组2例(依沙吖啶1例,药物组1例)。④依沙吖啶注射及药物引产2种引产方法的急诊手术(钳胎盘术及清宫术)率分别为27.1%和28.6%,天花粉组急诊手术率最低(3.8%)。结论:①终止边缘型胎盘前置状态中孕患者<16孕周可首选药物引产,≥16孕周可首选依沙丫啶引产;②部分及完全型胎盘前置状态中孕患者可首选天花粉引产;③钳刮术是引产失败及急诊处理出血的最佳方式之一,宫腔纱条填塞能有效止血;④宫颈条件差、孕周偏大(孕周>20周)的完全型胎盘前置状态患者可选用小型剖宫产术。
Objective: To explore the best way to terminate the placenta previa. Methods: A total of 107 middle-term pregnant women with pre-placental termination of pregnancy were retrospectively analyzed. According to the placental location, they were divided into two groups: border-type group (group A) and central type (group B) Week group, ≥ 16 weeks group, comparing the outcome of each group. Results: ① The success rate of induction of labor induced by ethacridine, TCS and mifepristone was 100%, 80% and 88.9% respectively in group A and 93.3%, 100% and 66.7 respectively in group B %; Gestational age ≥16 weeks group were 100%, 94.1%, 75%; gestational week <16 weeks group were 90.9%, 88.9%, 92.4%. ② The total amount of bleeding and total bleeding in each group were the lowest when induced by TCS, and the longest induction of labor and hospitalization (P <0.05). ③ induced bleeding ≥ 300 ml were 10 cases, respectively, 4 cases in group A (drug group 1, according to ethacridine group 3 cases); B group 6 cases of drug group 1 cases, ethacridine group 3 cases, TCS Group 1, small cesarean section in 1 case); induced abortion in 6 cases, 4 cases in group A (2 cases of TCS, 2 cases of drug group) and 2 cases of group B (1 cases of ethacridine, 1 case of drug group ). (4) The rates of emergency operation (forceps and placenta accreta) of ezacrine injection and induced abortion were 27.1% and 28.6% respectively, and the lowest rate of emergency operation was 3.8%. Conclusion: (1) termination of the edge of the placenta previa in pregnant women <16 gestational weeks can be the first choice of drug induced labor, 16 weeks of pregnancy can be the preferred choice of azacrine induction of labor; ② partial and complete prenatal placenta in patients with prenatal choice of pollen abortion ; ③ forceps curettage is one of the best ways to induce labor failure and emergency treatment of bleeding, uterine gauze packing can effectively stop bleeding; ④ poor cervical conditions, gestational age is too large (gestational weeks> 20 weeks) of the complete placenta previa State patients can choose small cesarean section.