早期流产诊断后的治疗选择：期待治疗、药物治疗和手术治疗。
Treatment Options After a Diagnosis of Early Miscarriage: Expectant, Medical, and Surgical.
机构信息
Department of Obstetrics & Gynecology at the Medical Center - University of Freiburg, Freiburg, Germany.
出版信息
Dtsch Arztebl Int. 2021 Nov 19;118(46):789-794. doi: 10.3238/arztebl.m2021.0346.
BACKGROUND
Approximately 12% of pregnancies end in an early miscarriage (up to week 12 + 0 of pregnancy). Over the past 10 to 15 years, two alternatives to curettage have appeared in the pertinent international treatment guidelines: expectant treatment and medical (drug) treatment. In this review, we discuss the advantages and disadvantages of each of these therapeutic options.
METHODS
This review is based on pertinent publications (January 2000 to February 2021) retrieved by a selective search in PubMed, as well as on the guidelines of the American College of Obstetrics and Gynecologists, the Association of the Scientific Medical Societies in Germany, the National Institute for Health and Care Excellence/Royal College of Obstetricians and Gynaecologists, and the International Federation of Gynaecology and Obstetrics.
RESULTS
Three effective and safe treatment options are available after a diagnosis of early miscarriage. Expectant treatment yields success rates of 66-91%, depending on the type of miscarriage. Its complications include hemorrhage requiring blood transfusion in 1-2% of cases. If expectant therapy fails, subsequent treatment with misoprostol or curettage is indicated. Drug therapy with misoprostol yields a complete termination in 81-95% of cases and is thus a valid alternative to expectant therapy, with the advantage of better planning capability. The vaginal application of misoprostol is the most effective means of administration, with the fewest side effects. Curettage is needed in 5-20% of cases. Suctional curettage has a success rate of 97-98%, with an associated anesthesia-related risk of 0.2%, a 0.1% risk of perforation, and a 2-3% rate of repeat curettage.
CONCLUSION
If there is no acute indication for the surgical treatment of an early miscarriage, the patient can choose among three treatment options. Expectant and medical treatment can be provided on an outpatient basis. Curettage is the treatment of choice in the presence of infection, marked and persistent bleeding, hemodynamic instability, or a pre-existing coagulopathy.
背景
大约 12%的妊娠以早期流产（妊娠 12 周+0 天之前）结束。在过去的 10 到 15 年中，两种替代刮宫术的方法出现在相关的国际治疗指南中：期待治疗和药物（药物）治疗。在这篇综述中，我们讨论了每种治疗选择的优缺点。
方法
本综述基于通过在 PubMed 中进行选择性搜索检索到的相关出版物（2000 年 1 月至 2021 年 2 月），以及美国妇产科医师学院、德国科学医学协会、英国国家卫生与保健优化研究所/皇家妇产科医师学院和国际妇产科联合会的指南。
结果
在早期流产诊断后，有三种有效且安全的治疗选择。期待疗法的成功率为 66-91%，具体取决于流产类型。其并发症包括 1-2%的病例需要输血的出血。如果期待疗法失败，则需要后续使用米索前列醇或刮宫术治疗。米索前列醇的药物治疗在 81-95%的病例中可完全终止妊娠，因此是期待疗法的有效替代方法，具有更好的计划能力优势。米索前列醇阴道给药是最有效的给药方式，副作用最少。在 5-20%的情况下需要刮宫术。吸引刮宫术的成功率为 97-98%，相关麻醉风险为 0.2%，穿孔风险为 0.1%，重复刮宫术率为 2-3%。
结论
如果不存在早期流产的手术治疗的急性指征，患者可以在三种治疗选择中进行选择。期待疗法和药物治疗可以在门诊进行。如果存在感染、明显和持续出血、血流动力学不稳定或预先存在的凝血障碍，则应选择刮宫术。
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