Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY; New York Presbyterian Hospital, New York, NY.
New York Presbyterian Hospital, New York, NY.
Am J Obstet Gynecol. 2017 Mar;216(3):278.e1-278.e5. doi: 10.1016/j.ajog.2016.10.031. Epub 2016 Oct 27.
Screening for fetal aneuploidy has evolved over the past 2 decades. Whether these advances impact gestational age at abortion has received little study.
We sought to describe trends in the gestational age at the time of abortion by fetal diagnosis over an 11-year study period. We hypothesized that gestational age at time of abortion would decrease for fetal aneuploidy but remain unchanged for structural abnormalities.
We conducted a retrospective case series of all women undergoing surgical abortion for fetal aneuploidy or structural abnormalities up to 24 weeks' gestation from 2004 through 2014 in a hospital operating room setting at a single, urban medical center. We excluded labor induction abortions (<1% of abortions at our medical center) and suction aspirations performed in the office practice. We performed suction aspiration up to 14 weeks and dilation and evacuation after that gestational age. We describe the median gestational age at abortion by fetal indication and year.
For women undergoing abortion for fetal aneuploidy (n = 392), the median gestational age at time of abortion decreased from 19.0 weeks (interquartile range 18.0-21.0) in 2004 to 14.0 weeks (interquartile range 13.0-17.0) in 2014 (Kruskal-Wallis P < .0001). For women undergoing abortion for fetal structural abnormalities (n = 586), the median gestational age was ≥20 weeks for each year during the study interval (P = .1). As gestational age decreased in the fetal aneuploidy group, fewer women underwent dilation and evacuation and more became eligible for suction aspiration (<14 weeks). In 2004, >90% of women underwent dilation and evacuation for either indication. By 2014, 31% of women with fetal aneuploidy were eligible for suction aspiration compared to 11% of those with structural anomalies.
Gestational age at the time of abortion for fetal aneuploidy decreased substantially from 2004 through 2014; earlier abortion is safer for women. In contrast, women seeking abortion for fetal structural abnormalities did not experience a change in timing. Legislation restricting gestational age at the time of abortion could disproportionately affect women with fetal structural abnormalities.
过去 20 年来，胎儿非整倍体的筛查已经取得了发展。这些进展是否会影响堕胎的孕龄，这方面的研究却很少。
我们旨在通过一项 11 年的研究来描述因胎儿诊断而进行堕胎的孕龄趋势。我们假设，对于胎儿非整倍体，堕胎的孕龄会降低，但对于结构异常，其孕龄则保持不变。
我们对 2004 年至 2014 年在一家城市医疗中心的手术室中因胎儿非整倍体或结构异常而进行手术堕胎的所有女性进行了回顾性病例系列研究。我们排除了在我们医疗中心进行的引产堕胎（占堕胎的比例<1%）和在诊所进行的吸引刮宫术。我们在 14 周之前进行吸引刮宫术，在 14 周之后进行扩张和刮宫术。我们按胎儿指征和年份描述堕胎时的中位孕龄。
对于因胎儿非整倍体而进行堕胎的女性（n=392），堕胎时的中位孕龄从 2004 年的 19.0 周（四分位距 18.0-21.0）下降到 2014 年的 14.0 周（四分位距 13.0-17.0）（Kruskal-Wallis P<0.0001）。对于因胎儿结构异常而进行堕胎的女性（n=586），在研究期间的每个年份，中位孕龄均≥20 周（P=0.1）。随着胎儿非整倍体组孕龄的下降，接受扩张和刮宫术的女性越来越少，而有资格接受吸引刮宫术的女性越来越多（<14 周）。在 2004 年，超过 90%的因任何原因进行堕胎的女性都接受了扩张和刮宫术。到 2014 年，31%的胎儿非整倍体女性有资格接受吸引刮宫术，而只有 11%的胎儿结构异常女性有资格接受这种手术。
从 2004 年到 2014 年，因胎儿非整倍体而进行堕胎的孕龄大幅下降；对于女性来说，早期堕胎更安全。相比之下，因胎儿结构异常而寻求堕胎的女性其堕胎时间没有变化。限制堕胎孕龄的立法可能会不成比例地影响到因胎儿结构异常而堕胎的女性。
