| Objective: This study retrospectively summarized the clinical characteristics of patients with induced labor in the second trimester of pregnancy,discussed the risk factors of pregnancy residue after mid-term pregnancy induction of labor,and selected a more optimized method of termination of second trimester and post-induction treatment,so as to reduce the harm caused to women by termination of second trimester.Methods: The clinical data of 154 patients with induced labor in the second trimester of pregnancy in × × hospital from January 2018 to January 2019 were analyzed retrospectively,and the occurrence of incomplete abortion in patients with induced labor in the second trimester of pregnancy was analyzed;according to whether uterine curettage was performed within 5 days after induced labor,the patients were divided into two groups: uterine clearance group(n = 70)and non-uterine clearance group(n =84);according to the abnormal vaginal bleeding after induced labor,ultrasound suggested abnormal intrauterine echo,and hysteroscopic embryo removal was performed again due to trophoblastic residual,the patients were divided into residual group(30 cases)and control group(124 cases).Univariate analysis was performed respectively on the data of the two groups,the differences between the two groups were compared in age,gestational weeks,times of pregnancy,history of abortion,history of cesarean section,white blood cells,hemoglobin,uterine leiomyoma complicated with adenomyoma,uterine mediastinum,depth of amniotic fluid,whether to remove the placenta by hand,the cause of induced labor,the mode of induced labor,whether uterine curettage was performed after induced labor,placental position and the time of abortion.The variables with significant differences in univariate analysis were included in the multivariate logistic regression model to analyze the factors of induced labor in the second trimester of pregnancy and the hysteroscopic manifestations and related risk factors of patients undergoing hysteroscopic embryo removal.Results: 1.In this study,the incidence of incomplete abortion was higher in the patients with second trimester induction,and 45%(70/154)of the patients underwent postpartum uterine curettage;19%(30/154)of the patients were performed hysteroscopic embryo removal in 15 days after induced labor.2.There were no statistically significant differences in age,number of pregnancies,number of abortions,blood leukocyte count,hemoglobin,amniotic fluid depth,time of expulsion,uterine leiomyoma complicated with adenomyoma,mediastinal uterus,whether the placenta was taken by hand,cause of labor induction,and placental position between uterine clearance group and non-uterine clearance group(P > 0.05).The postpartum uterine curettage rate of patients with a history of cesarean section,who operated induced labor in the second trimester of pregnancy,was 62.5%(20/32),and that of patients without a history of cesarean section was 41%(50/122).There was a statistically significant difference between the two groups(P = 0.030);The postpartum uterine curettage rate of patients with labor induction method of mifepristone combined with ethacridine was 53.7%(58/108),and that of patients with mifepristone combined with misoprostol was 26.1%(12/46).There was significant difference between the two groups(P=0.002).Multivariate analysis showed that the mode of induced labor was the independent risk factor of postpartum uterine curettage(OR=0.324,95%CI0.127-0.825,P=0.018).3.After induced labor,30 patients(19%)need hysteroscopic embryo removal because of trophoblastic residual,and the age of the patients was 24 and 41 years old,and the course of disease was 15 ? 90 days.Large amounts of grayish yellow,grayish brown or dark purple old organic residual tissue can be seen under hysteroscopy.Among them,there were 5 cases(16.6%)with residual located in the uterine horn,and26 cases were attached to the anterior wall of the uterus,the posterior wall of the uterus,the fundus wall of the uterus,the posterior wall of the fundus of the uterus,and the lower segment of the uterus near the inner mouth.16 cases(53%)had a history of uterine clearance after induced labor,3 cases(10%)were complicated with uterine adhesion,9 cases(30%)were complicated with uterine leiomyoma or adenomyoma,and 1 case was complicated with uterine mediastinum.In 2 cases,hysteroscopy showed dense adhesion between the residue and uterine wall,and it was considered as implantation.There were 30 cases with pathological diagnosis showed degeneration and necrosis of organized placental villi and degeneration of decidual tissue,among which 5cases were diagnosed with placental implantation.4.There were no statistically significant differences between residual group(patients performed hysteroscopic embryo removal due to trophoblastic residual)and control group in the number of pregnancies,cesarean section,discharge from hospital,and reasons for labor induction(P > 0.05);the average number of pregnancies was 2.84 in the residual group and 2.24 in the control group,and the difference between the two groups was statistically significant(P=0.01);the incidence of intrauterine pregnancy residue was 34.5%(19/55)in patients with gestational labor induction at 14-18 weeks,higher than that at 19-24 weeks 11%(7/63)or more11%(4/36),showing statistical differences(P=0.002;P=0.012);the incidence rate of uterine abnormalities(complicating with uterine fibroids,adenomyomas and uterine malformations)in the residual group was 36%(11/30),which was statistically significant compared with that of the control group(13.7%(17/124)(P=0.003).The incidence of intrauterine pregnancy residual with labor induction method of mifepristone combined with misoprostol was32.6%(15/46)higher than that in the mifepristone combined with rivanol induction group(13.8%(15/108)(P=0.007).Multivariate analysis showed that uterine abnormalities(complicating with uterine leiomyoma,adenomyoma,uterine septum),previous abortion history and gestational age of 12-18 weeks were risk factors for hysteroscopic hypodermis clearance(OR=3.521,95%Cl 1.277-9.709,P=0.015;OR=1.822,95%Cl 1.247-2.664,P=0.002;OR=0.297,95% 0.105-0.839,P=0.022).Conclusion: 1.The rate of incomplete abortion is high in the patients with induced labor in the second trimester of pregnancy.The incidence of incomplete abortion induced by mifepristone combined with misoprostol was lower than that of ethacine lactate.2.No matter postpartum uterine curettage is operated in a short time or not,there is a risk of trophoblastic residual.Uterine abnormalities(complicating with uterine leiomyoma,adenomyoma,uterine septum),previous abortion history and lower gestational age were risk factors for intrauterine pregnancy residues.3.All the remaining embryo materials are villus tissues,which are often accompanied by placental implantation.And it is suggested to take hysteroscopic embryo removal.If there is trophoblastic residual after mid-term pregnancy induction of labor and then complicated with uterine adhesion,it is necessary to follow up closely and make a good birth planning to reduce the induction of labor in the mid-term pregnancy. |
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