Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA.
Fetal Diagn Ther. 2012;31(1):63-8. doi: 10.1159/000333815. Epub 2011 Dec 22.
To determine whether potassium chloride (KCl)-induced feticide prior to termination by dilation and evacuation (D&E) improves surgical outcome.
We conducted a retrospective study of women who underwent second-trimester (13 0/7 to 23 6/7 weeks) D&E at an urban university-based hospital between January 2000 and July 2010. Women were divided into 3 cohorts: (1) D&E for termination of pregnancy after feticide, (2) D&E without feticide, and (3) D&E for spontaneous pregnancy loss. We compared maternal characteristics, various perioperative variables, and surgical outcomes for all 3 groups. Anesthesia time was used as a surrogate for operative time in the primary outcome.
We analyzed 128 pregnancies (group 1: n = 23, group 2: n = 53, group 3: n = 52). Baseline maternal characteristics did not differ among the 3 groups. Anesthesia time was longest in the termination with KCl group (group 1: 116.9 min vs. group 2: 94.5 min and group 3: 90.3 min, p = 0.004), however, the effect was mitigated after controlling for fetal size (p = 0.176). There was no difference in blood loss (p = 0.968). Complications were uncommon, however, cervical lacerations were more common in the termination with KCl group (2 vs. 0 and 0, p = 0.010).
Presurgical feticide with KCl was not associated with shorter anesthesia time. The decision to perform feticide should be based on other considerations, such as patient preference.
确定氯化钾（KCl）诱导胎儿死亡是否能改善扩张和排空（D&E）终止妊娠的手术结果。
我们对 2000 年 1 月至 2010 年 7 月在一所城市大学附属医院接受中期妊娠（13 0/7 至 23 6/7 周）D&E 的女性进行了回顾性研究。女性分为 3 组：（1）D&E 终止妊娠后行胎儿死亡术，（2）D&E 无胎儿死亡术，（3）D&E 自发性流产。我们比较了所有 3 组的母亲特征、各种围手术期变量和手术结果。麻醉时间用作主要结局的手术时间的替代指标。
我们分析了 128 例妊娠（组 1：n=23，组 2：n=53，组 3：n=52）。3 组的基线母体特征无差异。KCl 终止妊娠组的麻醉时间最长（组 1：116.9 分钟 vs. 组 2：94.5 分钟和组 3：90.3 分钟，p=0.004），然而，在控制胎儿大小后，这种影响减弱（p=0.176）。出血量无差异（p=0.968）。并发症并不常见，但 KCl 终止妊娠组宫颈裂伤更常见（2 例 vs. 0 例和 0 例，p=0.010）。
术前用 KCl 诱导胎儿死亡与麻醉时间缩短无关。进行胎儿死亡术的决定应基于其他考虑因素，如患者偏好。
