Hern W M, Zen C, Ferguson K A, Hart V, Haseman M V
Boulder Abortion Clinic, Colorado.
Obstet Gynecol. 1993 Feb;81(2):301-6.
To determine the safety of providing outpatient abortion services for women with complicated advanced pregnancies.
During a 10-year period, 124 abortions were performed after 14 menstrual weeks' gestation at an outpatient abortion facility for indications of fetal anomaly, diagnosed genetic disorder, or fetal death. Gestational lengths ranged from 15-34 menstrual weeks. Fetal diagnoses included a variety of chromosomal abnormalities, malformations, and death. Techniques for performing the late abortions included a serial multiple laminaria method of cervical dilation. Abortions performed after 20 menstrual weeks were effected by instillation of intra-amniotic hyperosmolar urea or induction of fetal death by injection of digoxin and/or hyperosmolar urea into the fetus, followed by artificial rupture of membranes, induction of labor, and assisted expulsion or instrumental extraction of the fetus. At less than 20 weeks, dilation and evacuation following serial multiple laminaria treatment of the cervix was the method of choice.
The median gestational age was 23 menstrual weeks. The median procedure time for all cases was 12 minutes and median blood loss was 125 mL. Procedure time increased with length of gestation (P = .00). Blood loss was only slightly increased by gestation length (P = .154) and not by procedure time (P = .299). Complication rates were not significantly related to gestation length (P = .895). There was one major complication in this series. There were no uterine perforations and one cervical laceration.
Outpatient abortion may be performed safely in most cases of fetal disorder, including death, through 34 menstrual weeks under proper conditions.
确定为患有复杂晚期妊娠的女性提供门诊堕胎服务的安全性。
在10年期间，一家门诊堕胎机构对124例妊娠14周后因胎儿异常、确诊的遗传疾病或胎儿死亡迹象而进行了堕胎手术。妊娠时长为15 - 34个月经周。胎儿诊断包括多种染色体异常、畸形和死亡。进行晚期堕胎的技术包括宫颈扩张的连续多次海藻棒法。妊娠20周后进行的堕胎是通过羊膜腔内注入高渗尿素，或向胎儿注射地高辛和/或高渗尿素诱导胎儿死亡，随后人工破膜、引产，并辅助排出或器械取出胎儿。在20周以下，宫颈经连续多次海藻棒处理后进行扩张和刮宫是首选方法。
中位妊娠龄为23个月经周。所有病例的中位手术时间为12分钟，中位失血量为125毫升。手术时间随妊娠时长增加（P = 0.00）。失血量仅随妊娠时长略有增加（P = 0.154），与手术时间无关（P = 0.299）。并发症发生率与妊娠时长无显著相关性（P = 0.895）。本系列中有1例严重并发症。无子宫穿孔，有1例宫颈裂伤。
在适当条件下，对于大多数胎儿疾病（包括胎儿死亡）病例，直至34个月经周，门诊堕胎均可安全进行。
