| Part Ⅰ:Analysis of the appropriate scheme of labor induction in the state of placental previa in the second trimester of pregnancy[Objective]to explore the suitable induction scheme of placenta previa in the second trimester of pregnancy.[Materials and methods]the clinical data of 101 patients of placental previae with or without placenta implantation in the second trimester of pregnancy who were hospitalized in the first affiliated Hospital of Kunming Medical University from January 1,2016 to August 31,2022were collected.According to the different induction schemes,the patients were divided into three groups:mi+mi group(mifepristone+misoprostol,n=32),mi+yi group(mifepristone+ethacridine,n=50),mi+mi+yi group(mifepristone+misoprostol+ethacridine,n=19).The effects of three kinds of induced labor schemes for patients with exclusive placenta implantation in central(n=48)and non-central(n=42)placenta previa were analyzed respectively.2.Spss23.0 statistical software was used to process and analyze the data.The measurement data with normal distribution and homogeneous variance were represented by(x±s),the analysis of variance was used,and the LSD test was used for pairwise comparison between groups.There are one or more groups of measurement data with skewed distribution or uneven variance between groups,which are expressed by median and interquartile interval M(P25,P75),and analyzed by multi-sample nonparametric test.Counting data were expressed as examples or percentages[n(n%)],RxC contingency table is used for comparison,with the difference of P<0.05 being statistically significant.[Results]1.The gestational age of induced labor in Mi+Mi group was smaller than that in Mi+Yi group and Mi+Mi+Yi group,with statistical significance(P<0.05).There were more patients with scar uterus in Mi+Mi+Yi group than in Mi+Mi group and Mi+Yi group,and the difference was statistically significant(P<0.05).2.Comparison of induced labor in mifepristone+misoprostol group:The average blood loss(265ml)and the success rate of induced labor(93.75%)were not significantly different from those in the other two groups(P>0.05).2 patients with postpartum hemorrhage≥1000ml(6.25%).3.Comparison of induced labor in mifepristone+ethacridine group:The average blood loss was 405.8 ml;the success rate of induced labor(98%)was not statistically significant compared with the other two groups.5(10%)patients with postpartum hemorrhage≥1000ml.4.Comparison of mifepristone+misoprostol+ethacridine induced labor:the average blood loss 371.05ml,the success rate of induced labor(94.74%)compared with the other two groups,the difference was not statistically significant.Patients with postpartum hemorrhage≥1000ml 2(10.53%).5.Comparison of induced labor outcome between central placenta previa group and non-central placental previa group:Comparison of induced labor outcomes of three induced labor schemes in central and non-central placenta previa groups:There was no statistical difference in induced labor indexes among the three induced labor schemes(P>0.05).[Conclusion]According to the situation of patients with placenta previa in the second trimester of pregnancy,it is safe and feasible to give mifepristone+misopro stol,mifepristone+ethacridine,mifepristone+misopro stol+ethacridine to induce labor through vagina,and the success rate of induced labor is high.No patients have uterine rupture.Part Ⅱ the role of prophylactic UAE in labor induction in central placenta previa in the second trimester of pregnancy[Objective]to retrospectively analyze the effect of prophylactic uterine artery embolization(uterine artery embolization,UAE)on central placental previa and placental implantation in the second trimester of pregnancy.[Materials and methods]1.Subjects and methods:the data of 62 patients with central placental previa in the second trimester of pregnancy who were hospitalized in the Department of Obstetrics of the first affiliated Hospital of Kunming Medical University from January 1,2016 to August 31,2022 were collected and divided into central placenta previa group,(n=48)and placenta accreta group,(n=14).According to whether uterine artery embolization is used or not,placenta non-implantation group is divided into UAE group and non-UAE group;The general situation and induced labor outcome of patients were compared respectively,and the cesarean section patients in placenta implantation group were analyzed individually.2.SPSS23.0 software was used to analyze the data.The measured data with normal distribution and homogeneous variance were expressed by mean standard deviation(x±s),and t test was used for comparison between the two groups.Those who did not conform to the normal distribution were represented by median and quartile M(P25,P75),and nonparametric test was used for comparison between the two groups.The number of cases or percentage of counting data[n(n%)]was expressed,and chi-square test or Fisher exact probability method was used for comparison between groups.P<0.05 was statistically significant.[Results]1.Comparison of the general situation of induced labor between the placenta non-implantation group and the placenta implantation group:the times of pregnancy,parturition,cesarean section and the interval of cesarean section in the placenta implantation group were significantly higher than those in the non-placenta implantation group(P<0.05).There was no significant difference in age,gestational week,uterine cavity operation history and diseases between the two groups(P>0.05).2.Comparison of the outcome of labor induction between placenta nonimplantation group and placenta implantation group:The emergency operation rate of placenta accreta group was higher than that of nonplacenta accreta group(P<0.05).There was a large amount of bleeding in induced labor(P=0.002).The length of stay was long(P=0.001),and the cost of hospitalization was high(P=0.006).There was no significant difference in other indexes(P>0.05).3.Comparison of the outcome of induced labor between UAE group and non-UAE group in patients without placenta accreta:hospitalization cost UAE(12687.70±5337.32 yuan)was significantly higher than that of non-UAE group(5201.31±3600.07yuan).There was no significant difference in the time of induced labor,the volume of induced blood,the rate of blood transfusion,the rate of manual abruption of placenta,the rate of uterine clearance,the rate of emergency operation,the rate of hysterectomy and the time of hospitalization transferred to ICU between the two groups(P>0.05).4.Case analysis:4 patients with placenta accreta underwent cesarean section after preventive UAE,including 2 cases with intraoperative bleeding of 3000ml and hysterectomy;Another patient suffered from hemorrhagic shock without hysterectomy,with a cumulative bleeding volume of 3000ml;One patient underwent cesarean section after preventive UAE,and the bleeding during operation was 800ml.Two patients were induced to labor through vagina after preventive UAE,with 1 case bleeding 2000ml and 1 case bleeding 2800ml.The pregnancy was quickly terminated due to excessive bleeding but the soft birth canal conditions were feasible,such as clamping and curettage.The remaining 6 patients were treated with preventive UAE,and 2 patients were induced[Conclusion]①Central placenta previa without placenta implantation is safe and feasible for vaginal delivery;The success rate of induced labor with placenta implantation decreased significantly,and there were more complications.② Preventive UAE can not significantly improve the induced labor outcome of patients with central placenta previa without placenta implantation,but can reduce the induced labor bleeding of patients with placenta implantation to some extent and improve the adverse pregnancy outcome. |
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