J Am Board Fam Pract. 1988 Jan-Mar;1(1):15-23.
The Ambulatory Sentinel Practice Network (ASPN) conducted an observational study of usual primary care of spontaneous abortion (SAB). Forty-nine practices in 18 states and four Canadian provinces reported and audited 171 SABs. Contrary to recommendations in some texts, 40 percent were managed completely in the office and/or at home, and only 51 percent had a dilation and curettage (D&C). SABs occurring later in pregnancy were more likely to be managed in the emergency room/hospital, receive consultation, and have a D&C. Patients managed with D&C had a greater frequency of excessive blood loss at diagnosis, but otherwise they did not differ in terms of complications at diagnosis or follow-up from those who did not. Adverse psychological consequences were subjectively observed by ASPN clinicians in 24 percent of women, exceeding any other category of complications. Management of all SABs in a hospital with D&C, instead of the management observed in this study, could add $145,000,000 per year to health care expenditures in the United States.
门诊哨点实践网络（ASPN）对自然流产（SAB）的常规初级护理进行了一项观察性研究。来自18个州和加拿大4个省的49家医疗机构报告并审核了171例自然流产病例。与一些文献中的建议相反，40%的病例完全在诊所和/或家中处理，只有51%的病例进行了刮宫术（D&C）。妊娠后期发生的自然流产更有可能在急诊室/医院处理、接受会诊并进行刮宫术。接受刮宫术处理的患者在诊断时失血过多的频率更高，但在诊断或随访时的并发症方面与未接受刮宫术的患者并无差异。ASPN临床医生主观观察到24%的女性有不良心理后果，这一比例超过了任何其他并发症类别。在美国，若将所有自然流产病例都在医院进行刮宫术处理，而非采用本研究中观察到的处理方式，每年的医疗保健支出将增加1.45亿美元。
