| BackgroundMidtrimester pregnancy refers to the period between 14 weeks and less than 28weeks of pregnancy.In the pregnancy stage,the lower uterine segment is forming and the placenta occupies half of the uterine wall,so that the placenta position is more likely close to or covers the internal orifice of the cervix.The placental pre-position refers to the lower edge of the placenta reaching or covering the inner cervix before28 weeks of gestation.According to the positional relationship between the lower margin of placenta and the internal cervix of the cervix,it can be divided into complete(the lower margin of placenta completely covers the internal orifice of the cervix),partial(the lower margin of placenta partially covers the internal orifice of the cervix)and marginal(the lower margin of placenta reaches or approaches the internal orifice of the cervix),low placenta(distance between the lower margin of placenta and the internal orifice of the cervix<2cm).In recent years,with the improvement of perinatal health care and the improvement of prenatal diagnosis technology level.Fetal dysplasia can be detected by prenatal screening or prenatal diagnosis methods.At the same time,with the increase of high-risk pregnancy,some intrauterine phenomena of fetal death also occur from time to time.Therefore,pregnant women are faced with the choice of termination of pregnancy when they are diagnosed fetal death or fetal dysplasia in the midtrimester of pregnancy.When placenta previa is found by imaging examination,there may occur massive bleeding,infection,hysterectomize,multiple organ failure,even endangering the life of pregnant women in the process of termination of pregnancy.However,most pregnant women still have the desire of second pregnancy when they choose the middle pregnancy induced labor.In order to solve this dilemma,by comparing and analyzing the outcome of different methods of induced labor in different types of placental previa and different gestational weeks,the study is helpful to reduce the postpartum complications during labor and to preserve the mode of labor induction with appropriate fertility function,to provide data support for clinical work.ObjectiveBy comparing and analyzing the outcome of induced labor in different placental types of midtrimester pregnancy and different gestational weeks,the suitable mode of induced labor was studied,so as to reduce the postpartum complications.Data and methods1.Research objectFrom January 2015 to March 2018,the clinical data of 95 cases of pregnancy induced labor with placenta previa were retrospectively analyzed in our hospital.According to the placental location indicated by US or MRI,47 cases in group A were marginal(the lower margin of placenta reaches or approaches the internal orifice of the cervix),and 48 cases in group B were partial/complete(the lower margin of placenta partially or completely covers the internal orifice of the cervix),combining the characteristics of different induced labor modes,according to their gestational weeks<16 weeks and?16 weeks,they were further divided into group A1,group A2,group B1,group B2.2.Research methodThe clinical data of the patients,including age,number of pregnancies,number of deliveries,number of cesarean section,number of uterine cavity operation,termination of gestation weeks,placenta type,induced labor method,induced labor time,induced bleeding volume,hospitalization days,induction success rate and bleeding,infection and thrombus after induction of labor,were reviewed and recorded.3.Statistical methodSPSS 21.0 statistical software was used for data processing and analysis.T-test was used to compare the measurement data of normal distribution between the two groups,one-way ANOVA was used for comparison of normal and homogeneous variance among groups,and least significant difference test was used to compare the two groups data;Non-parametric test is used to compare metrological data of skewness distribution;The count data was analyzed using the?~2 test.With?=0.05 as the test level.Results1.General data comparison of each group of patientsThere was no significant difference in age,number of pregnancies,number of deliveries,number of cesarean section,and number of uterine cavity operation between the groups(P>0.05),it is comparable.2.Induced labor situation in marginal group(group A)The induced labor time of drug induction was longer than that of ethacridine,the difference was statistically significant(P<0.05);The amount of induced labor bleeding in drug induction was less than that in ethacridine,the difference was statistically significant(P<0.05);The hospitalization days of drug induction was longer than that of ethacridine,the difference was statistically significant(P<0.05);There was no significant difference in the induction success rate between drug induction and ethacridine(P>0.05).3.Induced labor situation in partial/complete group(group B)The induced labor time of drug induction was respectively longer than ethacridine,UAE+drug induction,UAE+ethacridine,cesarean section,the induction time of cesarean section is shorter than the other four methods of labor induction,the time of UAE+drug induction was longer than that of UAE+ethacridine,the difference was statistically significant(P<0.05).The amount of induced labor bleeding in caesarean section was more than that in the other four methods of labor induction,the amount of induced labor bleeding in UAE+ethacridine was more than that in drug induction,the difference was statistically significant(P<0.05).The hospitalization days of caesarean section was longer than the other four methods of labor induction,the difference was statistically significant(P<0.05).The success rate of induced labor in UAE+drug induction was lower than that in UAE+ethacridine and caesarean section,the difference was statistically significant(P<0.05).4.Induced labor situation with different placental types in different gestational weeks4.1 Induced labor situation in different gestational weeks of marginal(group A)In group A1,nine cases were treated by drug induction.In group A2,the induced labor time of drug induction was longer than that of ethacridine,the difference was statistically significant(P<0.05);The amount of induced labor bleeding in drug induction was less than that in ethacridine,the difference was statistically significant(P<0.05);The hospitalization days of drug induction was longer than that of ethacridine,the difference was statistically significant(P<0.05).There was no significant difference in the induction success rate between drug induction and ethacridine(P>0.05).4.2 Induced labor situation in different gestational weeks of partial/complete(group B)In group B1,six cases were treated by drug induction and one case was treated by ethacridine.In group B2,the induced labor time of drug induction was respectively longer than ethacridine,UAE+drug induction,UAE+ethacridine,cesarean section,the induction time of cesarean section is shorter than the other four methods of labor induction,the time of UAE+drug induction was longer than that of UAE+ethacridine,the difference was statistically significant(P<0.05);The amount of induced labor bleeding in caesarean section was more than that in the other four methods of labor induction,the difference was statistically significant(P<0.05).The hospitalization days of caesarean section was longer than the other four methods of labor induction,the difference was statistically significant(P<0.05).The success rate of induced labor in UAE+drug induction was lower than that in UAE+ethacridine and caesarean section,the difference was statistically significant(P<0.05).5.Comparison of induced labor in different types of placental previaThe time of induced labor in group A was longer than that in group B,the amount of induced labor bleeding in group A was less than that in group B,the hospitalization days in group A was less than that in group B,the difference was statistically significant(P<0.05).There was no significant difference in the success rate of induced labor between the two groups(P>0.05).6.Comparison of induced labor mode in different gestational weeksThe induced labor time of drug induction in<16 weeks was shorter than that in?16 weeks,and the amount of induced labor bleeding in<16 weeks was less than that in?16 weeks,the difference was statistically significant(P<0.05).There was no significant difference in the hospitalization days and the induction success rate in different gestational weeks(P>0.05).7.Emergency surgery in different modes of labor inductionIn this data,six cases were treated with emergency clamps due to vaginal bleeding of labor induction.Including one case was drug induction by group A1,one case was drug induction and one case was ethacridine by group A2,one case was drug induction by group B1,two cases were UAE+drug induction by group B2.The emergency cure rate of drug induction,ethacridine,and UAE+drug induction was9.68%,3.03%,and 33.33%,respectively.8.Induced labor complications8.1 BleedingOne case in group B2 had a bleeding volume of 1200ml at induced labor,which was due to fetal dysplasia at 25~+22 weeks of gestation in the caesarean section.4U of the same type of suspension red blood cells were infused during the operation due to blood loss.8.2 InfectionThere were ten cases occurred with postpartum fever,including three cases were eosacridine by group A2,two cases were UAE+drug induction,two cases were ethacridine,and three cases were cesarean section by group B2.8.3 Thrombosisone case was induced by UAE+ethacridine at 21~+22 weeks of gestation in group B2.Ultrasonic examination showed hypoechoic of the right leg intermuscular vein(thrombosis and occlusion).ConclusionsIn<16 weeks gestation induced labor with placenta previa,the success rate of vaginal induction is high,and the amount of induced labor bleeding by drug induction is low;In?16 weeks gestation,the effect of ethacridine is stable in patients with marginal placenta previa,and the amount of blood induced by UAE+ethacridine in patients with partial/complete placenta previa can be reduced compared with cesarean section,It is necessary to weigh the advantages and disadvantages and choose carefully for pregnant women with fertility requirements;Curettage with forceps is one of the methods to deal with the emergent cases of vaginal bleeding during induced labor. |
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