Jewkes Rachel, Rees Helen, Dickson Kim, Brown Heather, Levin Jonathan
Medical Research Council, Gender and Health Group, Pretoria 0001, South Africa.
BJOG. 2005 Mar;112(3):355-9. doi: 10.1111/j.1471-0528.2004.00422.x.
In 1996 termination of pregnancy was legalised in South Africa. This article examines the impact of age on the epidemiology of incomplete abortion after legislative change. It draws comparison with the findings of a similar study undertaken in 1994.
Multicentre, prospective, descriptive study.
Forty-seven public hospitals in all nine provinces.
A stratified random sample of all hospitals treating gynaecological emergencies was drawn. All women of gestation under 22 weeks who presented with incomplete abortion during three weeks of data collection in 2000 were included.
A data capture sheet completed by a clinician from the case notes.
Demographic characteristics and clinical findings on admission by age of women.
Overall, there was a significant increase in the proportion of cases with no signs of infection on admission (from 79.5% to 90.1%) and a significant decrease in evidence of interference on evacuation (4.5% to 0.6%) between 1994 and 2000. Substantial age differentials were seen. Women over 30 were significantly less likely than those 21-30 years or under 21 to be low severity (65.5% vs 75.2% vs 76.4%, P= 0.0087) and more likely to have offensive products (16.3% vs 6.0% vs 6.4%, P= 0.01) than the younger women.
Legalisation of abortion had an immediate positive impact on morbidity, especially in younger women. This is an important change as teenagers had the highest morbidity in 1994. The trend is supported by evidence from the 1999-2001 Confidential Enquiry into Maternal Deaths, which further suggested that abortion mortality dropped by more than 90% since 1994.
1996年南非将堕胎合法化。本文探讨了立法变更后年龄对不完全流产流行病学的影响，并与1994年进行的一项类似研究结果进行比较。
多中心、前瞻性、描述性研究。
九个省份的47家公立医院。
从所有治疗妇科急症的医院中抽取分层随机样本。纳入了2000年数据收集的三周内出现不完全流产且妊娠22周以下的所有女性。
由临床医生根据病例记录填写数据采集表。
按女性年龄划分的入院人口统计学特征和临床检查结果。
总体而言，1994年至2000年间，入院时无感染迹象的病例比例显著增加（从79.5%增至90.1%），清宫时受到干预的证据显著减少（从4.5%降至0.6%）。观察到明显的年龄差异。30岁以上的女性与21至30岁或21岁以下的女性相比，病情较轻的可能性显著较低（65.5%对75.2%对76.4%，P = 0.0087），且有排出物异味的可能性更高（16.3%对6.0%对6.4%，P = 0.01）。
堕胎合法化对发病率产生了直接的积极影响，尤其是对年轻女性。这是一个重要变化，因为1994年青少年的发病率最高。1999 - 2001年孕产妇死亡保密调查的证据支持了这一趋势，该调查进一步表明自1994年以来堕胎死亡率下降了90%以上。
