Nathanson B N
JAMA. 1973 Apr 23;224(4):537.
Recently I observed the use of vaccuum aspiration in an attempt to induce abortion in a woman 16 weeks' pregnant, after dialation of the cervix to 14 mm under paracervical block anesthesia. Only amniotic fluid and a segment of the umbilical cord could be aspirated. The patient was returned to bed, and an oxytocin (Pitocin) infusion was begun. She aborted 24 hours later with no complications. Why is this procedure considered inferior to amniocentesis and saline solution instillation as a technique for inducing abortion?
Transcervical rupture of the fetal membranes for the purpose of inducing second trimester abortion is unreliable as a method and is fraught with the most serious complication of intrauterine infection (Schwartz, R.H.: Septic abortion, Philadelphia, J.B. Lippincott, 1968, p. 17). On the other hand, Roufa et al. (Clinical Obstetrics and Gynecology 14:119, 1971) report no failures of abortion and only 1 significant intrauterine infection in 229 patients aborted in the second trimester by the hypertonic, intraovular, saline solution instillation method. The cervicovaginal portion of the reproductive tract is bacteriologically a contaminated area teeming with a variety of organisms. White and Koontz (Obstetrics and Gynecology 32:402, 1968) cultured the cervices of 57 pregnant women in all trimesters of pregnancy, and a significant number of these women harbored pathogens. In general the skin is preferable to the cervicovaginal tract as a route of entry into the intraovular space.
最近我观察到在宫颈旁阻滞麻醉下将宫颈扩张至14毫米后，对一名怀孕16周的女性尝试使用真空吸引术引产。结果只吸出了羊水和一段脐带。患者被送回病床，并开始静脉滴注催产素（缩宫素）。24小时后她流产了，没有出现并发症。为什么这种方法被认为不如羊膜腔穿刺术和羊膜腔内注入生理盐水作为引产技术？
经宫颈胎膜破裂用于中期引产作为一种方法并不可靠，且充满了最严重的并发症——宫内感染（施瓦茨，R.H.：《感染性流产》，费城，J.B.利平科特出版社，1968年，第17页）。另一方面，鲁法等人（《临床妇产科学》14:119，1971）报告称，在229例采用高渗羊膜腔内注入生理盐水方法进行中期引产的患者中，没有引产失败的情况，只有1例发生了严重的宫内感染。生殖 tract 的宫颈阴道部分在细菌学上是一个被各种微生物污染的区域。怀特和孔茨（《妇产科学》32:402，1968）对57名处于妊娠各期的孕妇的宫颈进行了培养，其中相当一部分孕妇携带病原体。一般来说，相比于宫颈阴道途径，皮肤作为进入羊膜腔内的途径更可取。
