Brown H C, Jewkes R, Levin J, Dickson-Tetteh K, Rees H
Reproductive Health Research Unit, Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Hospital, University of the Witwatersrand, PO 2013 Bertsham, South Africa.
BJOG. 2003 Apr;110(4):371-7.
To describe the current management of incomplete abortion in South African public hospitals and to discuss the extent to which management is clinically appropriate.
A multicentre, prospective descriptive study.
South African public hospitals that manage gynaecological emergencies.
Hospitals were selected using a stratified random sampling method. All women who presented to the above sampled hospitals with incomplete abortion during the three week data collection period in 2000 were included.
A data collection sheet was completed at the time of discharge for each woman admitted with a diagnosis of incomplete, complete, missed or inevitable abortion during the study period. Information gathered included demographic data, clinical signs and symptoms at admission, medical management, surgical management, anaestetic management, use of blood products and antibiotics and complications. Three clinical severity categories were used for the purpose of data analysis and interpretation.
Detail of medical management, detail of surgical management, use of blood products and antibiotics, methods of analgesia and anaesthesia used, and use of abortifacients.
There is a trend towards low cost technology such as the use of manual vacuum aspiration and sedation anaesthesia; however, this is mainly limited to the better resourced tertiary hospitals linked to academic units. The use of antibiotics and blood products has decreased but much of the use is inappropriate. The use of abortifacients does include some use of misoprostol but merely as an adjunct to surgical evacuation.
The management of incomplete abortion remains a problem in South Africa, a low income country that is still managing a common clinical problem with costly interventions. The evidence of a trend towards low cost technology is promising, albeit limited to tertiary centres. This study has given us information as how to best address this problem. More training in low cost methods is needed, targeting in particular the district and regional hospitals, and reinforced by skills training focussed mainly on undergraduates and midwife post-abortion care programmes.
描述南非公立医院不完全流产的当前管理情况，并讨论管理在临床方面的适宜程度。
一项多中心前瞻性描述性研究。
处理妇科急症的南非公立医院。
采用分层随机抽样方法选取医院。纳入了2000年为期三周的数据收集期间，在上述抽样医院因不完全流产就诊的所有女性。
在研究期间，为每位诊断为不完全流产、完全流产、稽留流产或难免流产而入院的女性在出院时填写一份数据收集表。收集的信息包括人口统计学数据、入院时的临床体征和症状、药物治疗、手术治疗、麻醉管理、血液制品和抗生素的使用以及并发症情况。为了进行数据分析和解读，使用了三种临床严重程度类别。
药物治疗细节、手术治疗细节、血液制品和抗生素的使用、所采用的镇痛和麻醉方法以及堕胎药的使用情况。
存在采用低成本技术的趋势，如使用手动真空吸引术和镇静麻醉；然而，这主要限于与学术单位相关的资源较好的三级医院。抗生素和血液制品的使用有所减少，但很多使用并不恰当。堕胎药的使用确实包括一些米索前列醇的使用，但仅作为手术清宫的辅助手段。
在南非这个低收入国家，不完全流产的管理仍然是一个问题，该国仍在使用昂贵的干预措施来处理常见的临床问题。尽管低成本技术的趋势证据仅限于三级中心，但仍很有前景。本研究为我们提供了如何最好地解决这一问题的信息。需要针对地区和区域医院开展更多关于低成本方法的培训，并通过主要针对本科生和助产士流产后护理项目的技能培训加以强化。
