堕胎后急诊就诊和并发症的发生率。

Incidence of emergency department visits and complications after abortion.

机构信息

Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California; John Snow, Inc, Arlington, Virginia; and Ibis Reproductive Health, Oakland, California. Ms. Zlidar is currently at the Public Health Institute, Washington, DC.

出版信息

Obstet Gynecol. 2015 Jan;125(1):175-183. doi: 10.1097/AOG.0000000000000603.

DOI:10.1097/AOG.0000000000000603

PMID:25560122

Abstract

OBJECTIVE

To conduct a retrospective observational cohort study to estimate the abortion complication rate, including those diagnosed or treated at emergency departments (EDs).

METHODS

Using 2009-2010 abortion data among women covered by the fee-for-service California Medicaid program and all subsequent health care for 6 weeks after having an abortion, we analyzed reasons for ED visits and estimated the abortion-related complication rate and the adjusted relative risk. Complications were defined as receiving an abortion-related diagnosis or treatment at any source of care within 6 weeks after an abortion. Major complications were defined as requiring hospital admission, surgery, or blood transfusion.

RESULTS

A total of 54,911 abortions among 50,273 fee-for-service Medi-Cal beneficiaries were identified. Among all abortions, 1 of 16 (6.4%, n=3,531) was followed by an ED visit within 6 weeks but only 1 of 115 (0.87%, n=478) resulted in an ED visit for an abortion-related complication. Approximately 1 of 5,491 (0.03%, n=15) involved ambulance transfers to EDs on the day of the abortion. The major complication rate was 0.23% (n=126, 1/436): 0.31% (n=35) for medication abortion, 0.16% (n=57) for first-trimester aspiration abortion, and 0.41% (n=34) for second-trimester or later procedures. The total abortion-related complication rate including all sources of care including EDs and the original abortion facility was 2.1% (n=1,156): 5.2% (n=588) for medication abortion, 1.3% (n=438) for first-trimester aspiration abortion, and 1.5% (n=130) for second-trimester or later procedures.

CONCLUSION

Abortion complication rates are comparable to previously published rates even when ED visits are included and there is no loss to follow-up.

LEVEL OF EVIDENCE

II.

摘要

目的

开展一项回顾性观察队列研究，以估计堕胎并发症发生率，包括在急诊科（ED）诊断或治疗的病例。

方法

利用 2009-2010 年加州医疗补助按服务付费计划覆盖的女性堕胎数据以及堕胎后 6 周内的所有后续医疗保健数据，我们分析了 ED 就诊的原因，并估计了堕胎相关并发症发生率和调整后的相对风险。并发症定义为在堕胎后 6 周内任何医疗来源接受与堕胎相关的诊断或治疗。主要并发症定义为需要住院、手术或输血。

结果

在 50273 名按服务付费 Medi-Cal 受益人中，共确定了 54911 例堕胎。在所有堕胎中，有 1 例（6.4%，n=3531）在堕胎后 6 周内到 ED 就诊，但只有 1 例（0.87%，n=478）因堕胎相关并发症而到 ED 就诊。大约每 5491 例中有 1 例（0.03%，n=15）涉及在堕胎当天用救护车转至 ED。主要并发症发生率为 0.23%（n=126，1/436）：药物流产为 0.31%（n=35），第一孕期吸引流产为 0.16%（n=57），第二孕期或更晚流产为 0.41%（n=34）。包括 ED 和最初堕胎机构在内的所有医疗来源的总堕胎相关并发症发生率为 2.1%（n=1156）：药物流产为 5.2%（n=588），第一孕期吸引流产为 1.3%（n=438），第二孕期或更晚流产为 1.5%（n=130）。