妊娠 6 周前或妊娠 6 周内药物流产和吸宫流产的安全性和有效性：一项回顾性多中心研究。

Safety and effectiveness of medication and aspiration abortion before or during the sixth week of pregnancy: A retrospective multicenter study.

机构信息

Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mailcode UHN 50, Portland, OR 97239, USA.

Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mailcode UHN 50, Portland, OR 97239, USA; Planned Parenthood Columbia Willamette, 3727 NE Martin Luther King Jr Blvd, Portland, OR 97212, USA.

出版信息

Contraception. 2020 Jul;102(1):13-17. doi: 10.1016/j.contraception.2020.04.004. Epub 2020 Apr 13.

DOI:10.1016/j.contraception.2020.04.004

PMID:32298713

Abstract

OBJECTIVE

To compare adverse outcomes of medication and aspiration abortion among those with intrauterine pregnancy <43 days gestation versus abortions performed at 43-48 days.

STUDY DESIGN

We conducted a multicenter retrospective chart review study to review all medication and aspiration abortion of visualized pregnancy <49 days gestation at Planned Parenthood Columbia Willamette (Oregon) and Planned Parenthood of Orange and San Bernardino Counties (California) in 2014-2015. We identified incident cases by billing codes and performed chart review for adverse outcomes (ED visits, incomplete abortion), need for further interventions, or complications (hemorrhage, infection, and uterine perforation), captured up to 90 days post-abortion.

RESULTS

The 3930 abortions during the study period at the two sites included 2914 medication abortions and 1016 aspiration abortions, with 1470 medication abortions and 469 aspiration abortions at <43 days gestation. Composite adverse outcomes did not vary by gestation, for either medication abortion (75/1470; 5.1% for <43 days versus 94/1444; 6.5% at 43-48 days, p = 0.10) or aspiration (12/469; 2.6% for <43 days versus 16/547; 2.9% at 43-48 days, p = 0.72). Fewer incomplete abortions (ongoing pregnancy, symptomatic retained tissue, or retained gestational sac) occurred in the earlier gestational group (3.1% for <43 days versus 4.3% at 43-48 days, p = 0.04). Composite adverse outcomes were higher after medication versus aspiration abortion (169/2914; 5.8% versus 28/1016; 2.7%, p < 0.01).

CONCLUSION

Medication and aspiration abortion performed either before or during the sixth week of ultrasound-confirmed intrauterine pregnancy have low rates of composite adverse outcomes, including complications or incomplete abortion. However, unplanned interventions are more common after medication compared to aspiration abortions.

IMPLICATIONS

Very early medication and aspiration abortion are similarly safe and effective before or during the sixth week of ultrasound-confirmed pregnancy, though subsequent interventions are more likely after medication abortion. Patients with early pregnancy can safely initiate abortion with follow-up to ensure complete abortion.

摘要

目的

比较妊娠<43 天和 43-48 天行药物流产与吸宫流产术的不良结局。

研究设计

我们进行了一项多中心回顾性图表审查研究，对 2014 年至 2015 年在俄勒冈州哥伦比亚普拉特计划生育组织和加利福尼亚州奥兰治县和圣贝纳迪诺县计划生育组织进行的所有可视宫内妊娠<49 天的药物流产和吸宫流产术进行了回顾。我们通过计费代码确定了新发病例，并对不良结局（ED 就诊、不完全流产）、需要进一步干预或并发症（出血、感染和子宫穿孔）进行了图表审查，随访时间长达流产后 90 天。

结果

在这两个地点的研究期间，有 3930 例流产，包括 2914 例药物流产和 1016 例吸宫流产，其中 1470 例药物流产和 469 例吸宫流产在<43 天妊娠。复合不良结局不因妊娠而不同，药物流产（<43 天 75/1470；5.1%，43-48 天 94/1444；6.5%，p=0.10）或吸宫流产（<43 天 12/469；2.6%，43-48 天 16/547；2.9%，p=0.72）。在较早的妊娠组中，不完全流产（持续性妊娠、有症状的残留组织或残留妊娠囊）的发生率较低（<43 天 3.1%，43-48 天 4.3%，p=0.04）。与吸宫流产相比，药物流产的复合不良结局更高（2914 例中 169 例，5.8%，1016 例中 28 例，2.7%，p<0.01）。