Contraception. 2013 Mar;87(3):331-42. doi: 10.1016/j.contraception.2012.10.024. Epub 2012 Dec 4.
Hemorrhage after abortion is rare, occurring in fewer than 1% of abortions, but associated morbidity may be significant. Hemorrhage can be caused by atony, coagulopathy and abnormal placentation, as well as by such procedure complications as perforation, cervical laceration and retained tissue. Evidence on which to make recommendations regarding risk factors and treatment for postabortion hemorrhage is extremely limited. Although medical abortion is associated with more bleeding than surgical abortion, overall bleeding for the two methods is minimal and not clinically different. Identifying patients who may be at increased risk of hemorrhage can help reduce blood loss with abortion. Specifically, women with a uterine scar and complete placenta previa seeking abortion at gestations greater than 16 weeks should be evaluated for placenta accreta. For women at high risk of hemorrhage, referral to a high-acuity center should be considered. We propose an algorithm for treating postabortion hemorrhage as follows: (1) assessment and exam, (2) massage and medical therapy, (3) resuscitative measures with laboratory evaluation and possible re-aspiration or balloon tamponade, and (4) interventions such as embolization and surgery. The Society of Family Planning recommends preoperative identification of women at high risk of hemorrhage as well as development of an organized approach to treatment. Further studies are needed on prophylactic use of uterotonic medication, intraoperative ultrasound and optimal delivery of the placenta after second-trimester medical abortion.
流产后出血很少见，不到 1%的流产会发生，但相关的发病率可能很高。出血可能由子宫收缩乏力、凝血功能障碍和异常胎盘引起，也可能由穿孔、宫颈裂伤和组织残留等手术并发症引起。关于流产后出血的危险因素和治疗方法的建议，证据非常有限。虽然药物流产比手术流产出血更多，但两种方法的总出血量都很少，在临床上没有区别。识别可能有更高出血风险的患者有助于减少流产时的失血。具体来说，对于有子宫瘢痕和完全前置胎盘、妊娠 16 周以上寻求流产的妇女，应评估胎盘植入的情况。对于有大出血高风险的妇女，应考虑转诊到高敏中心。我们提出了一种治疗流产后出血的算法，包括：（1）评估和检查，（2）按摩和药物治疗，（3）复苏措施和实验室评估，可能需要再次抽吸或球囊填塞，（4）介入治疗，如栓塞和手术。计划生育协会建议术前识别有大出血高风险的妇女，并制定有组织的治疗方法。需要进一步研究预防使用子宫收缩药物、术中超声和中期妊娠药物流产后胎盘的最佳分娩方式。
