| Background:Because of the fetuses growing larger and the scars on the uteruses caused by previous surgeries, it can be a greater risk for the women with scarred uterus during second or third-trimester when they have to choose to terminate the pregnancies than that for normal pregnant women. The reasons why they have to go through a reduced abortion include family planning factors, fetal malformation, stillbirth and pregnancy with serious pregnancy complications or comorbidities etc.. At present, it is still inconclusive that which is the most advanced method of induced abortion for pregnant women with scarred uteruses during second and third-trimester. However, the way of intra-amniotic injection of ethacridine lactate in combination with mifepristone is more commonly used. Therefore, it is of great practical significance to evaluate the safety and effectiveness of the method for pregnant women with scarred uterus.Objectives:To evaluate the safety and effectiveness for induced abortion in the way of intra-amniotic injection of ethacridine lactate in combination with mifepristone for scarred uterus in second and third-trimester.Methods:Review the pregnant women in second and third-trimester who were admitted to Women’s Hospital of Zhejiang University School of Medicine during the period of January 1,2013 to December 31,2015 for the purpose of receiving a induced abortion. It’s aimed to find out the effectiveness and safety of rivanol combined with mifepristone for the women with scarred uterus. All 369 cases were divided into 2 groups according to whether the patients were with scarred uterus:Group A, a group of 155 cases who had scarred uterus; Group B, a group of 214 cases without scarred uterus. To compare the two groups in the following aspects:The general situation of the pregnant women, fetals and placentas prompted by ultrasound, time intervals from rivanol injection to uterine contraction and from rivanol injection to delivery, induction success rate, rates of postpartum hemorrhage, retained placenta, serious complications and accidents occurring.Results:Average age, gravidity, parity of Group A are significantly higher than that of Group B, and the gestational ages of Group A is significantly lower than that of Group B; Group A in the measurements of fetals by ultrasound are significantly lower than group B. The time interval from rivanol injection to uterine contraction in Group A comes to an average of 26.30±8.17 hours, compared the number of 26.44±9.86 hours in Group B, and there is no significant difference between them. The average time from rivanol injection to delivery is 35.18±9.39 hours in Group A, compared with the time of 33.88 ±10.87 hours in Group B, and there is no significant difference between them. The success rates of induced abortion in two groups are 93.5% and 97.2%, Group B is higher than Group A, but the difference was not statistically significant. There are 43 cases in Group A with retained placenta after induced labor, the residual rate was 27.7%, there are 48 cases in Group B with retained placenta, and the residual rate was 22.4%; the postpartum hemorrhage rates in Group A and Group B are 4.5% and 1.9%; the incidence rates of placental abruption in Group A and Group B are 1.9% and 0.9%; the incidence rates of placenta implantation are 2.6% and 0.5%. All the results above are no significant difference between the two groups. The average hospitalization days in the two groups are 6.57±2.02 days and 6.65±2.35 days, there are no significant difference. Divide Group A into another two groups acorrding to the gestational ages. The success rate of induced abortion(second-trimester 92.8% vs third-trimester 96.6%),time interval from rivanol injection to uterine contraction (second-trimester 26.16±7.28h vs third-trimester 26.52+9.49h), The average time from rivanol injection to delivery (second-trimester 34.68±8.06h vs third-trimester 35.97±11.22h) are all no significant difference. The rates of residual placenta and membranes (second-trimester 34.0% vs third-trimester 17.2%)are significantly different, but other complications such as postpartum hemorrhage (second-trimester 5.2% vs third-trimester 3.4%), placenta implantation (second-trimester 4.1% versus third-trimester 0%) and placental abruption (second-trimester 3.1% vs third-trimester 0%) have no statistical difference in the incidence. There is no statistical difference on average hospitalization days between the the two groups (second-trimester 6.13±1.82 days vs third-trimester 6.73±1.82 days).Conclusion1. It is safe and effective that pregnant women use the way of intra-amniotic injection of ethacridine lactate in combination with mifepristone to terminate pregnancy during second and third-trimester as long as taking the strict control of indications to exclude high-risk groups, no matter whether she’s combined with scarred uterus.2. The potential risk of complications associated with induced abortion during the second-trimester may be higher than that during the third-trimester for the pregnant women with scarred uterus.3. We can follow up the patients who underwent induced abortion in the way of intra-amniotic injection of ethacridine lactate in combination with mifepristone, in order to evaluate the influence of this method on the prognosis of the patients. |
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