From the Departments of Obstetrics and Gynecology and Radiology and the Center for Clinical Investigation, Brigham and Women's Hospital, Boston, Massachusetts; the Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts; and Women's Health Services, Brookline, Massachusetts.
Obstet Gynecol. 2011 Feb;117(2 Pt 1):307-316. doi: 10.1097/AOG.0b013e3182051519.
To estimate maternal morbidity associated with uterine evacuation for second-trimester fetal demise compared with that associated with induced second-trimester abortion.
This retrospective cohort study compared the maternal outcomes of two cohorts: 1) women diagnosed with fetal demise between 14 and 24 weeks who subsequently underwent dilation and evacuation or induction of labor; and 2) women undergoing induced abortion between 14 and 24 weeks by either dilation and evacuation or induction of labor. The primary outcome was major maternal morbidity. Assuming morbidity rates of 11% for fetal demise and 1% for induced second-trimester abortion, 94 patients were needed per group to detect significant difference in maternal morbidity (80% power, 5% alpha).
We identified 121 women with fetal demise and 121 women who underwent induced abortion for inclusion. There were no maternal deaths. In crude and adjusted analyses, treatment for fetal demise was not associated with increased maternal morbidity (25 of 121) compared with induced abortion (27 of 121) (adjusted odds ratio [OR], 1.15; 95% confidence interval [CI], 0.57-2.32). There were more blood transfusions in the fetal demise group (N=7) compared with the induced-abortion group (N=1) (P=.07). Induction of labor was more morbid than dilation and evacuation after adjusting for confounders (OR 5.36; 95% CI 2.46-11.69), primarily as a result of increased odds of infection requiring intravenous antibiotics. Gestational age of 20 weeks or greater was significantly associated with maternal morbidity (OR 2.59; 95% CI 1.39-4.84).
In the second trimester, uterine evacuation for fetal demise was not significantly associated with maternal morbidity compared with induced abortion. Induction of labor was more morbid than dilation and evacuation as a result of an increased risk of presumed infection.
II.
评估中期胎儿死亡后行子宫排空术相关的产妇发病率与中期引产相关发病率的差异。
本回顾性队列研究比较了两个队列的产妇结局：1）14-24 周诊断为胎儿死亡并随后行扩宫和排空术或引产的女性；2）14-24 周行扩宫和排空术或引产的因流产而行中期引产的女性。主要结局是严重产妇发病率。假设胎儿死亡的发病率为 11%，中期引产的发病率为 1%，每组需要 94 例患者才能检测到产妇发病率的显著差异（80%的功效，5%的 alpha）。
我们共纳入 121 例胎儿死亡患者和 121 例中期引产患者。无产妇死亡。在未经校正和校正分析中，与中期引产相比，胎儿死亡的治疗（121 例中有 25 例）与产妇发病率增加无关（121 例中有 27 例）（校正比值比 [OR]，1.15；95%置信区间 [CI]，0.57-2.32）。胎儿死亡组有更多的输血（7 例），而中期引产组有 1 例（P=.07）。校正混杂因素后，与扩宫和排空术相比，引产更具危害性（OR 5.36；95%CI 2.46-11.69），主要是由于感染需要静脉用抗生素的可能性增加。20 周或以上的妊娠龄与产妇发病率显著相关（OR 2.59；95%CI 1.39-4.84）。
在中期妊娠中，与中期引产相比，子宫排空术治疗胎儿死亡与产妇发病率无显著相关性。由于疑似感染风险增加，引产比扩宫和排空术更具危害性。
II。
