Grimes David A, Creinin Mitchell D
Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599-7570, USA.
Ann Intern Med. 2004 Apr 20;140(8):620-6. doi: 10.7326/0003-4819-140-8-200404200-00009.
Internists care for many women who have had abortions and many who will seek abortions in the future. Each year, about 2% of all women of reproductive age have an abortion. Women having abortions tend to be young, white, unmarried, and early in pregnancy. Most abortions are done by suction curettage under local anesthesia in a freestanding clinic. However, medical abortion is growing in popularity as a nonsurgical alternative. The regimen approved by the U.S. Food and Drug Administration specifies mifepristone, 600 mg orally, followed 2 days later by misoprostol, 400 microg orally (within 49 days from last menses). Recent studies have recommended alternative approaches, such as mifepristone, 200 mg orally, followed in 1 to 3 days by misoprostol, 800 microg vaginally (up to 63 days). Medical abortion can be provided by a broader variety of physicians than can surgical abortion. The overall case-fatality rate for abortion is less than 1 death per 100,000 procedures. Infection, hemorrhage, acute hematometra, and retained tissue are among the more common complications. Referral back to the original abortion provider for management is advisable. Overall, induced abortion does not lead to late sequelae, either medical or psychiatric. Of importance, no link exists between induced abortion and later breast cancer. For physicians who are asked to help with a referral, the National Abortion Federation and Planned Parenthood Federation of America have helpful Web sites and networks of high-quality clinics. The cost of abortion (currently about 372 dollars at 10 weeks) has decreased in recent decades. Provision of ongoing contraception and encouragement of emergency contraception can reduce unintended pregnancies and the need for abortion.
内科医生会诊治许多有过堕胎经历以及未来可能寻求堕胎的女性。每年，约2%的育龄女性会进行堕胎。进行堕胎的女性往往年轻、白人、未婚且处于妊娠早期。大多数堕胎手术是在独立诊所通过局部麻醉下的吸刮术完成的。然而，药物流产作为一种非手术替代方法越来越受欢迎。美国食品药品监督管理局批准的方案规定口服600毫克米非司酮，两天后口服400微克米索前列醇（末次月经后49天内）。最近的研究推荐了替代方法，比如口服200毫克米非司酮，1至3天后阴道给药800微克米索前列醇（妊娠63天内）。与手术流产相比，更多种类的医生可以提供药物流产服务。堕胎的总体病死率低于每10万例手术1例死亡。感染、出血、急性子宫积血和组织残留是较为常见的并发症。建议转回最初的堕胎提供者处进行处理。总体而言，人工流产不会导致后期的医学或精神后遗症。重要的是，人工流产与后期乳腺癌之间不存在关联。对于被要求协助转诊的医生，美国国家堕胎联合会和美国计划生育联合会有实用的网站以及高质量诊所网络。堕胎费用（目前10周时约为372美元）在近几十年有所下降。提供持续的避孕措施并鼓励使用紧急避孕方法可以减少意外怀孕和堕胎需求。
