Lohr Patricia A, Parsons John H, Taylor Jeanette, Morroni Chelsea
British Pregnancy Advisory Service.
British Pregnancy Advisory Service.
Contraception. 2018 Apr 19. doi: 10.1016/j.contraception.2018.04.010.
To compare procedure duration, complications, and acceptability of dilation and evacuation (D&E) with and without feticide by intra-cardiac potassium chloride (KCL) injection.
We evaluated outcomes with D&E at 18-24 weeks of gestation in the 6 months before and 6 months after removing feticide with KCL from the guidelines of a national British abortion provider. We extracted demographic and procedure-related data from medical records and electronic databases. We surveyed women undergoing D&E in both time periods about acceptability and side effects.
We analyzed 291 cases with and 257 cases without KCL. Unadjusted mean procedure duration was shorter with KCL than without (12.7 vs. 16.1 min, respectively, p<.001). After adjustment for age, parity, Cesarean deliveries, gestational age, body mass index, surgeon, and number or duration of osmotic dilators used, KCL remained associated with a 3.5 min (95% CI 2.4-4.6) reduction in D&E duration. Uterine atony was more common with KCL than without (3% vs. 0%, respectively, p=.004), despite more frequent administration of prophylactic utero-tonics to women who received KCL (82% KCL vs. 73% no-KCL, p=.001). Women who had KCL reported more pain in the period between feticide and dilator placement and the evacuation than women who had not received feticide (49% vs. 25%, respectively, p<.001). Most women in both groups found their procedure very acceptable or acceptable (79% KCL vs. 87% no-KCL, p=.2).
Feticide with intra-cardiac KCL reduced D&E procedure duration, but was associated with more pain and uterine atony. Treatment acceptability was high with and without feticide.
Inducing fetal demise before dilation and evacuation with intra-cardiac potassium chloride may result in shorter operative times but does not appear to improve safety or acceptability. Level I evidence remains needed to support the use of feticide before surgical abortion.
比较采用心内注射氯化钾（KCL）实施或未实施胎儿安乐死情况下扩张刮宫术（D&E）的手术时长、并发症及可接受性。
我们评估了英国一家全国性堕胎服务机构在从指南中去除KCL胎儿安乐死方法之前6个月及之后6个月内，妊娠18 - 24周时进行D&E的结果。我们从病历和电子数据库中提取了人口统计学及与手术相关的数据。我们对两个时间段接受D&E的女性进行了关于可接受性和副作用的调查。
我们分析了291例使用KCL的病例和257例未使用KCL的病例。未调整的平均手术时长，使用KCL的短于未使用的（分别为12.7分钟和16.1分钟，p<0.001）。在对年龄、产次、剖宫产史、孕周、体重指数、外科医生以及使用的渗透扩张器数量或时长进行调整后，KCL仍与D&E时长缩短3.5分钟（95%可信区间2.4 - 4.6）相关。使用KCL时子宫收缩乏力比未使用时更常见（分别为3%和0%，p = 0.004），尽管接受KCL的女性预防性使用宫缩剂的频率更高（使用KCL的为82%，未使用KCL的为73%，p = 0.001）。与未接受胎儿安乐死的女性相比，接受KCL的女性在胎儿安乐死至放置扩张器及刮宫期间报告的疼痛更多（分别为49%和25%，p<0.001）。两组中的大多数女性都认为她们的手术非常可接受或可接受（使用KCL的为79%，未使用KCL的为87%，p = 0.2）。
心内注射KCL进行胎儿安乐死可缩短D&E手术时长，但与更多疼痛和子宫收缩乏力相关。有无胎儿安乐死时治疗的可接受性都很高。
在扩张刮宫术前用心内注射氯化钾诱导胎儿死亡可能会缩短手术时间，但似乎并未提高安全性或可接受性。仍需要一级证据来支持在手术流产前使用胎儿安乐死。
