Lawson H W, Frye A, Atrash H K, Smith J C, Shulman H B, Ramick M
Pregnancy and Infant Health Branch, Centers for Disease Control and Prevention, Atlanta, GA.
Am J Obstet Gynecol. 1994 Nov;171(5):1365-72. doi: 10.1016/0002-9378(94)90162-7.
The aim of our study was to describe risk factors for legal abortion mortality and the characteristics of women who died of legal abortion complications for the period 1972 through 1987.
We reviewed abortion mortality surveillance data collected by the Division of Reproductive Health, Centers for Disease Control and Prevention, and calculated rates by various demographic and reproductive health variables using the Center for Disease Control and Prevention's abortion surveillance data as denominators. Rates are reported as legal abortion deaths per 100,000 abortions.
Between 1972 and 1987, 240 women died as a result of legal induced abortions. The case-fatality rate decreased 90% over time, from 4.1 deaths per 100,000 abortions in 1972 to 0.4 in 1987. Women > or = 40 years old had three times the risk of death as teenagers (relative risk 3.0, 95% confidence interval 1.5 to 6.0), and black women and those of other minority races had 2.5 times the risk of white women (relative risk 2.5, 95% confidence interval 1.9 to 3.2). Abortions at > or = 16 weeks were associated with a risk of death almost 15 times the risk of death from procedures at < or = 12 weeks' gestation. Women undergoing currettage procedures for abortion had a significantly lower risk of death than women undergoing other procedures. Whereas before 1977 infection and hemorrhage were the leading causes of death, during 1977 through 1982 anesthesia complications emerged as one of the leading causes of death and since 1983 have become the most frequent cause.
Although legal induced abortion-related deaths are rare events, our findings suggest that more rigorous efforts are needed to increase the safety of anesthetic methods and anesthetic agents used for abortions and that efforts are still necessary to monitor serious complications of abortion aimed at further reducing risks of death associated with the procedure.
我们研究的目的是描述1972年至1987年期间合法堕胎死亡的危险因素以及死于合法堕胎并发症的女性的特征。
我们回顾了疾病控制和预防中心生殖健康司收集的堕胎死亡率监测数据，并使用疾病控制和预防中心的堕胎监测数据作为分母，按各种人口统计学和生殖健康变量计算比率。比率报告为每10万例堕胎中的合法堕胎死亡数。
1972年至1987年期间，240名女性因合法人工流产死亡。病死率随时间下降了90%，从1972年每10万例堕胎中有4.1人死亡降至1987年的0.4人。40岁及以上的女性死亡风险是青少年的三倍（相对风险3.0，95%置信区间1.5至6.0），黑人女性和其他少数族裔女性的死亡风险是白人女性的2.5倍（相对风险2.5，95%置信区间1.9至3.2）。妊娠16周及以上的堕胎死亡风险几乎是妊娠12周及以下手术死亡风险的15倍。接受刮宫术堕胎的女性死亡风险明显低于接受其他手术的女性。1977年以前，感染和出血是主要死亡原因，1977年至1982年期间，麻醉并发症成为主要死亡原因之一，自1983年以来已成为最常见的原因。
尽管与合法人工流产相关的死亡是罕见事件，但我们的研究结果表明，需要更加严格地努力提高用于堕胎的麻醉方法和麻醉剂的安全性，并且仍有必要监测堕胎的严重并发症，以进一步降低与该手术相关的死亡风险。
