在法定医疗环境下的晚期妊娠终止。

Late pregnancy termination within a legislated medical environment.

作者信息

Dickinson Jan E

机构信息

School of Women's and Infants' Health, The University of Western Australia, Perth, Western Australia, Australia.

出版信息

Aust N Z J Obstet Gynaecol. 2004 Aug;44(4):337-41. doi: 10.1111/j.1479-828X.2004.00252.x.

DOI:10.1111/j.1479-828X.2004.00252.x

PMID:15282007

Abstract

AIMS

To review the indications and outcomes for abortion beyond 20 weeks' gestation within an environment of legislated notifiable pregnancy termination.

METHODS

In Western Australia legislation allowing abortion > or = 20 weeks' gestation for serious maternal-fetal conditions was enacted in May 1998. Late abortions are only permitted in a single state institution and are notifiable by law. All pregnancy terminations > or = 20 weeks' gestation performed since this legislation were prospectively identified with the indications and outcomes reviewed.

RESULTS

During the study period, 219 women underwent abortion > or = 20 weeks' gestation, representing 0.5% of all abortions in the state. Comparison with 438 contemporanous medical abortions for fetal anomaly at 14-20 weeks' gestations was made. Misoprostol was the primary abortifacient for both. The median maternal age for termination at 14-20 weeks was 32 years (interquartile range (IQR) 27, 36) and 30 years (IQR 26, 34) at > or = 20 weeks' gestation (P < 0.001). There was no significant difference in maternal gravidity or parity. The principal indications for terminations > or = 20 weeks were: karyotypic (28.8%); cardiac anomalies (15.5%) and neural tube defects (11.9%). Cardiac anomalies represented 5.0% of fetal anomaly terminations at 14-20 weeks (P < 0.01). The median time for medical abortion was 15.4 h (IQR 11.5, 23.2) at 14-20 weeks' gestation compared with 18.3 h (IQR 13.3, 26.1) at gestations greater than 20 weeks (P < 0.001). A total of 13.2% of terminations were performed at gestations beyond 24 weeks.

CONCLUSIONS

Abortion > or = 20 weeks' gestation under medically regulated legislation is used primarily for serious fetal anomalies. The women are younger and the abortion duration is greater for late pregnancy termination compared with those conducted at earlier gestations. The majority of late terminations occur < 23 weeks' gestation and the incidence has remained stable since the legislation was enacted.

摘要

目的

在法定可通报妊娠终止的环境下，回顾妊娠20周后堕胎的指征及结局。

方法

1998年5月，西澳大利亚州颁布立法，允许因严重母婴疾病在妊娠≥20周时进行堕胎。晚期堕胎仅允许在单一州立机构进行，且依法需通报。对自该立法实施以来所有妊娠≥20周的终止妊娠情况进行前瞻性识别，并对指征及结局进行回顾。

结果

在研究期间，219名妇女接受了妊娠≥20周的堕胎，占该州所有堕胎的0.5%。与同期438例14 - 20周因胎儿异常进行的药物流产进行了比较。米索前列醇是两者的主要堕胎药物。14 - 20周终止妊娠的产妇年龄中位数为32岁（四分位间距（IQR）27，36），妊娠≥20周时为30岁（IQR 26，34）（P<0.001）。产妇的妊娠次数和产次无显著差异。妊娠≥20周终止妊娠的主要指征为：染色体异常（28.8%）；心脏异常（15.5%）和神经管缺陷（11.9%）。心脏异常占14 - 20周胎儿异常终止妊娠的5.0%（P<0.01）。14 - 20周妊娠时药物流产的中位时间为15.4小时（IQR 11.5，23.2），而妊娠大于20周时为18.3小时（IQR 13.3，26.1）（P<0.001）。共有13.2%的终止妊娠在妊娠24周后进行。