CAJ | 학술논문

目的：探讨瘢痕子宫合并前置胎盘孕妇孕中晚期行引产失败的危险因素。方法：收集2009年7月至2014年6月于浙江大学医学院附属妇产科医院就诊的24例有剖宫产史的瘢痕子宫合并前置胎盘孕妇的临床资料，这些孕妇均进行利凡诺尔羊膜腔注射引产，其中完全性前置胎盘孕妇则行子宫动脉栓塞术加利凡诺尔羊膜腔注射引产。引产失败或产前出血过多者则行剖宫取胎术。评估孕妇年龄、孕周、孕次、产次、剖宫产次数、前次手术距本次引产间隔时间；胎位、前置胎盘的具体位置、类型、是否有胎盘粘连或植入；此次妊娠引产指征、引产方法；产后出血量、宫腔残留率、引产成功率、行剖宫取胎术的手术指征、有无子宫破裂及行子宫切除术等情况。结果：24例孕妇引产最终阴道分娩成功率83．3％。对影响阴道分娩的上述因素进行单因素分析显示，仅前次手术距本次引产间隔时间有关（ P＜0．05）。分析前次手术距本次引产间隔时间≤13年与＞13年的孕妇分娩结局，结果后者剖宫取胎风险增加（ P＜0．05）。针对不同的前置胎盘类型分析结果显示：胎盘主要附着于子宫前壁或伴有植入的孕妇剖宫取胎风险也增加，而前置胎盘程度与剖宫取胎风险无关。前置胎盘孕妇是否进行子宫动脉栓塞术在引产出血量、感染情况、宫腔残留、住院天数及分娩结局方面差异均无统计学意义（均P＞0．05）。结论：瘢痕子宫合并前置胎盘孕妇经过相应选择与处理，存在引产后经阴道分娩的可行性。手术间隔时间＞13年、胎盘主要附着于子宫前壁或伴有植入者可能增加阴道分娩失败的风险，子宫动脉栓塞术可提高引产成功率。
목적：탐토반흔자궁합병전치태반잉부잉중만기행인산실패적위험인소。방법：수집2009년7월지2014년6월우절강대학의학원부속부산과의원취진적24례유부궁산사적반흔자궁합병전치태반잉부적림상자료，저사잉부균진행리범낙이양막강주사인산，기중완전성전치태반잉부칙행자궁동맥전새술가리범낙이양막강주사인산。인산실패혹산전출혈과다자칙행부궁취태술。평고잉부년령、잉주、잉차、산차、부궁산차수、전차수술거본차인산간격시간；태위、전치태반적구체위치、류형、시부유태반점련혹식입；차차임신인산지정、인산방법；산후출혈량、궁강잔류솔、인산성공솔、행부궁취태술적수술지정、유무자궁파렬급행자궁절제술등정황。결과：24례잉부인산최종음도분면성공솔83．3％。대영향음도분면적상술인소진행단인소분석현시，부전차수술거본차인산간격시간유관（ P＜0．05）。분석전차수술거본차인산간격시간≤13년여＞13년적잉부분면결국，결과후자부궁취태풍험증가（ P＜0．05）。침대불동적전치태반류형분석결과현시：태반주요부착우자궁전벽혹반유식입적잉부부궁취태풍험야증가，이전치태반정도여부궁취태풍험무관。전치태반잉부시부진행자궁동맥전새술재인산출혈량、감염정황、궁강잔류、주원천수급분면결국방면차이균무통계학의의（균P＞0．05）。결론：반흔자궁합병전치태반잉부경과상응선택여처리，존재인산후경음도분면적가행성。수술간격시간＞13년、태반주요부착우자궁전벽혹반유식입자가능증가음도분면실패적풍험，자궁동맥전새술가제고인산성공솔。
Objective: To investigate the risk factors of pregnancy termination at second and third trimester in women with scarred uterus and placenta previa .Mtehods:Clinical data of 24 pregnant women of second and third trimester with a scarred uterus and placenta previa ,who requested termination in Women ’s Hospital Zhejiang University School of Medicine from July 2009 to June 2014 , were retrospectively analyzed .The method of mifepristone combined with ethacridine lactate was adopted for all cases . Mifepristone combined with ethacridine lactate and uterine artery embolization were routinely given for patients with complete placenta previa . Cesarean section was performed for patients who failed to delivery or underwent massive vaginal bleeding before delivery. Age, gestational weeks, gravidity and parity, times of previous cesarean section , the interval from previous operation , the position and the type of placenta previa , placenta accretet , the indication and method of termination , postpartum hemorrhage , successful rate of labor induction , placental retention ratio and uterus rupture were documented .Results: The successful rate of labor induction was 83 .3%.The analysis showed that age , gestational weeks , gravidity and parity and times of previous cesarean section were not risk factors for failed labor induction , however the interval time from previous operation was related to induction failure ( P<0.05 ) .Patients with previous cesarean section ≥13 years were more likely to require cesarean section than those <13 years ( P<0 .05 ) .The placenta adhered to the antetheca of the uterus or placenta accrete increased risk to have cesarean section . There were no significant differences in postpartum hemorrhage , the successful rate of labor induction, placental retention ratio and the rate of uterine rupture between patients with uterine artery embolization and those without .Conclusion: The labor induction would be feasible for women with a scarred uterus and placenta previa in second and third-trimester pregnancy.The previous operation ≥13 years, the antetheca placenta or placenta accrete might increase the incidence of labor induction , while the uterine artery embolization would rise the successful rate of labor induction .