A Study On The Influential Factor Of Three Medical Methods For Mid-trimester Termination Of Pregnancy And Retained Placenta

Objective1.To investigate the clinical effect of mifepristone combined with misoprostol rivanol and water-cyst on termination of the mid-trimester pregnacy and potential side effect.2.To investigate the influencing factor of Retained Placenta afterinduced abortion with three methods and the relation with the placenta expression of angiopoietin-1 (Ang-1) and angiopoietin 2 (Ang-2).Methods1.112 pregnant women,who had no choice but to terminate pregnancy of 13-24 weeks because of aristogenesis or birth control from March 2009 to October 2010 in our hospital, were selected for our study. After the principle of informed consent, the patients were divided into there groups-mifepristone and misoprostol(groupA,n=51), intra-amniotic injecton of rivanol(groupB,n=40) and cystic(groupC,n=21), then we investigated the clinical effect of three different methods in termination of midtrimester pregnancy.2.We compared hepatic and renal functions of three different methods before and after termination of midtrimester pregnancy;3.The expression of angiopoietin 1 (Ang-1) and angiopoietin 2 (Ang-2) was assayed by immunohistochemical staining, then we analysed the placenta expression of angiopoietin 1 (Ang-1) and angiopoietin 2 (Ang-2) and the relation with placenta remnants after induced labour of midtrimester pregnancy. Results1.112 women with midtrimester pregnancy were admitted for induction of labour, There were no statistical differences in the success rate of labor induction(P>0.05), The average interval from start of labor induction to onset of labor, total birth process and postpartum hemorrhage for early two hours in group A was significantly shorter than that in group B and C (P<0.05), The days of vaginal bleeding after labor induction in group A was significantly shorter than that in group C(P<0.05), the incidence of hypertonic uterine inertia, uncoordinated uterine inertia and grade III postpartum abdominal pain was significantly higher in group B and C than that in group A(P<0.05), the incidence of grade I postpartum abdominal pain was significantly lower in group B and C than that in group A(P<0.05). The incidence of abnormal hepatic and renal function after termination of midtrimester pregnancy was significantly higher in group B than Aand C (P<0.05)..2.The complete abortion rate was markedly higher in group A than that of group B and group C (P<0.05), incomplete abortion rate, the rate of Retained Placenta and uterine clearance rate was markedly lower in group A than that of lgroup B(P<0.05);The placenta expression of angiopoietin 1 (Ang-1) was higher in women with placenta remnants than the others (P<0.05),but the placenta expression of angiopoietin 2 (Ang-2) was lower in women with placenta remnants than the others (P<0.05); The placenta expression of angiopoietin 1 (Ang-1) was higher in group B and C than group A(P<0.05),but the placenta expression of angiopoietin 2 (Ang-2) was lower in group B and C than group A(P<0.05);3.Mifepristone and misoprostol, the high placenta expression of angiopoietin-2 and high spiral artery resistance index on 14days after induction of labor have a protective effect on Retained Placenta, but occurrence of uncoordinated contractions and the high Placenta expression of angiopoietin-1 are risk factors.4.vaginal bleeding after abortion were more than 14 days, implantation site spiral artery resistance index (RI)≤0.55group, placental remnants rate highter than the RI <0.6 Ogroup, the difference was statistically significant (P<0.05). Conclusions:1.Mid-trimester induced abortion by mefepristone with misoprostol,needing shorter average interval from start of labor induction to onset of labor,shorter total birth process, less postpartum hemorrhage for early two hours, days of vaginal bleeding,after labor induction, is surpass than the others, it is a safe, reliable and effective induction method.2.Mid-trimester induced abortion by mefepristone with misoprostol,the rate of Retained Placenta and uterine clearance rate also lower; Placenta remnants rate of the women with midtrimester pregnancy after induced abortion maybe have some connection with the way of induced abortion, the higher placenta expression of angiopoietin 1 (Ang-1) and the lower angiopoietin 2 (Ang-2), occurrence of uncoordinated contractions and spiral artery resistance index (RI) on 14days after induction of labor.3.The women with midtrimester pregnancy vaginal bleeding were more than 14 days after induced abortion, spiral artery resistance index implantation site (RI)≤0.55 can be used as one of reference for curettage.