Krofta L, Calda P, Zizka Z, Parízek A, Hrusková H, Kapras J
II. gynek.-porod. klinika 1, Praha.
Ceska Gynekol. 1998 Oct;63(5):414-7.
The method used to terminate pregnancy on medical grounds during the second trimester must be safe, rapid, psychologically feasible and associated with a minimal risk of long-term sequelae. The objective of the present work was a critical analysis of the author's standard protocol of termination of pregnancy during the second trimester.
For induction of abortion during the second trimester the authors used a synthetic prostaglandin analogue (PG) F2 alpha-Dinoprost which was administered in a single dose of 30 mg by the intraamniotic route. At the time of onset of uterine contractions the authors administered peridural anaesthesia. The authors investigated indications, mean period of induction, correlation between the period of induction of abortion and the indications for termination of pregnancy, the week of pregnancy and parity of the mother. They recorded also the type and number of complications.
From January 1991 till June 1997 179 pregnancies were terminated by intraamniotic PG administration. After a single intraamniotic PG administration 72% women aborted within 24 hours. In 26% women the intraamniotic administration was repeated twice and in 2% women three times. The mean induction period, i.e. the interval between the administration and abortion of the foetus was 22.6 hours. The interval was significantly longer (28 hours) in foetuses where pregnancy was terminated because of a neural tube defect (p < 0.01). The authors did not detect a correlation between the period of induction and the indication, week of gestation and parity of the mother.
once a general reaction to intraamniotic administration, in three patients a major blood loss replaced by transfusion of erythrocyte mass, no uterine rupture.
In all instances the therapeutic effect was achieved and there was no need to perform section minor. The disadvantage of the method is the high price of the preparation and need of repeated intraamniotic administration of PG in 29% of the patients.
孕中期基于医学原因终止妊娠所采用的方法必须安全、迅速、在心理上可行且长期后遗症风险最小。本研究的目的是对作者的孕中期终止妊娠标准方案进行批判性分析。
对于孕中期引产，作者使用了合成前列腺素类似物（PG）F2α - 地诺前列素，通过羊膜腔内途径单剂量给予30毫克。在子宫收缩开始时，作者给予硬膜外麻醉。作者研究了适应症、平均引产时间、引产时间与终止妊娠适应症、孕周及母亲产次之间的相关性。他们还记录了并发症的类型和数量。
从1991年1月至1997年6月，通过羊膜腔内给予PG终止了179例妊娠。单次羊膜腔内给予PG后，72%的女性在24小时内流产。26%的女性羊膜腔内给药重复了两次，2%的女性重复了三次。平均引产时间，即给药至胎儿流产的间隔为22.6小时。因神经管缺陷而终止妊娠的胎儿，该间隔明显更长（28小时）（p < 0.01）。作者未发现引产时间与适应症、孕周及母亲产次之间存在相关性。
一次羊膜腔内给药的一般反应，3例患者出现大量失血，通过输注红细胞制剂纠正，未发生子宫破裂。
在所有情况下均实现了治疗效果，无需进行小剖宫产。该方法的缺点是制剂价格高昂，且29%的患者需要重复进行羊膜腔内给予PG。
