Hern W M
Boulder Abortion Clinic, 1130 Alpine Boulder, CO 80304, USA.
Int J Gynaecol Obstet. 2001 Dec;75(3):279-86. doi: 10.1016/s0020-7292(01)00478-7.
To analyze and determine the safety and effectiveness of induced fetal demise as an adjunctive method in outpatient abortion for patients with advanced pregnancies and to evaluate the independent effect of intrauterine misoprostol administered after amniotomy in late abortion.
During a 9-year period, 1677 abortions were performed for patients whose pregnancies ranged from 18 through 34 menstrual weeks in an outpatient facility. Of these, 832 were performed by one physician. Techniques for performing all the abortions included induction of fetal demise by intrauterine fetal injection of digoxin and/or hyperosmolar urea, serial multiple laminaria treatment of the cervix, amniotomy, oxytocin induction of labor, and assisted delivery or surgical evacuation of the fetus and placenta. In the last 411 of the 832 patients whose abortions were performed by one physician, misoprostol was placed in the lower uterine segment following amniotomy in order to enhance labor induction, cervical ripening, and fetal expulsion.
Of the entire group of 1677 cases, the median gestational age was 22 menstrual weeks. The median procedure time for all cases was 10 min. Measured median blood loss was 125 ml. Blood loss and procedure time increased with length of gestation, but these were not affected by misoprostol. There were three major complications (0.2%) in the overall series. Among patients seen by one physician (N=832), amniotomy-to-procedure time was shorter by 26 min for patients receiving misoprostol, and there was 27% more variability in amniotomy-to-procedure time among patients not receiving misoprostol. Complication rates for patients receiving misoprostol were the same as for those not receiving misoprostol. There were no major complications in the 832 patients seen by one physician, no uterine rupture or perforations, and no cervical lacerations.
Outpatient abortion may be performed safely from 18 through 34 menstrual weeks using combined surgical and medical procedures. Use of intrauterine post-amniotomy misoprostol was associated with reduced amniotomy-to-procedure time and reduced variability in the amniotomy-to-procedure time.
分析并确定诱导胎儿死亡作为晚期妊娠患者门诊流产辅助方法的安全性和有效性，并评估羊膜穿刺术后宫腔内给予米索前列醇在晚期流产中的独立作用。
在9年期间，为妊娠18至34孕周的患者在门诊进行了1677例流产手术。其中，832例由一名医生实施。所有流产手术的技术包括经宫腔胎儿注射地高辛和/或高渗尿素诱导胎儿死亡、宫颈连续多次放置海藻棒、羊膜穿刺、缩宫素引产以及辅助分娩或手术取出胎儿及胎盘。在由一名医生实施流产手术的832例患者中的最后411例，在羊膜穿刺术后将米索前列醇置于子宫下段，以增强引产、促宫颈成熟及促进胎儿排出。
在全部1677例病例中，中位孕周为22周。所有病例的中位手术时间为10分钟。测得的中位失血量为125毫升。失血量和手术时间随孕周延长而增加，但不受米索前列醇影响。整个系列中有3例严重并发症（0.2%）。在由一名医生诊治的患者（N = 832）中（接受米索前列醇的患者），羊膜穿刺至手术的时间比未接受米索前列醇的患者短26分钟，且未接受米索前列醇的患者羊膜穿刺至手术时间的变异性高27%。接受米索前列醇患者的并发症发生率与未接受米索前列醇的患者相同。在由一名医生诊治的832例患者中无严重并发症，无子宫破裂或穿孔，也无宫颈裂伤。
采用手术与药物联合方法，妊娠18至34周的门诊流产可安全进行。羊膜穿刺术后宫腔内使用米索前列醇与缩短羊膜穿刺至手术时间及降低羊膜穿刺至手术时间的变异性相关。
