Keder Lisa M
Department of Obstetrics and Gynecology, Ohio State University, Columbus, USA.
Am J Obstet Gynecol. 2003 Aug;189(2):418-22. doi: 10.1067/s0002-9378(03)00107-8.
Surgical abortion in the first trimester comprises the majority of voluntary pregnancy interruptions performed in the United States. The majority of these procedures are done in outpatient settings with the patient under local anesthesia. Appropriate volume of and deep injection of local anesthetic can reduce pain associated with the procedure. Waiting between administration of the paracervical block and initiating the procedure does not affect pain. Intravenous administration of sedation and analgesia improves patient satisfaction but does not significantly affect pain ratings. Antibiotic prophylaxis is warranted. Vasopressin is useful for prevention of hematometra and hemorrhage. Less evidence supports the routine use of ergots. Preoperative cervical priming reduces the risk of cervical injury and uterine perforation. Attention to operative technique can reduce the risk of incomplete abortion. Routine postoperative care at 2 or 3 weeks is timed to identify complications and to reinforce pregnancy and sexually transmitted disease prevention.
孕早期手术流产占美国自愿终止妊娠手术的大部分。这些手术大多在门诊进行，患者接受局部麻醉。适当剂量和深度注射局部麻醉剂可减轻手术相关疼痛。宫颈旁阻滞给药与开始手术之间的等待时间不影响疼痛程度。静脉给予镇静和镇痛药物可提高患者满意度，但对疼痛评分无显著影响。有必要进行抗生素预防。血管加压素有助于预防子宫积血和出血。支持常规使用麦角的证据较少。术前宫颈准备可降低宫颈损伤和子宫穿孔的风险。注意手术技巧可降低不完全流产的风险。术后2或3周的常规护理旨在识别并发症并加强妊娠和性传播疾病的预防。
