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Does prior ultrasonography affect the safety of induced abortion at or after 13 weeks' gestation? A retrospective study.

既往超声检查是否影响妊娠13周或以后人工流产的安全性?回顾性研究。

  • 影响因子:2.21
  • DOI:10.1111/aogs.14040
  • 作者列表:"Kapp N","Griffin R","Bhattarai N","Dangol DS
  • 发表时间:2021-04-01
Abstract

INTRODUCTION:We aimed to assess whether ultrasonography prior to dilation and evacuation or medical abortion ≥13 weeks was correlated with safety. MATERIAL AND METHODS:We conducted a retrospective chart review of patients undergoing abortion ≥13 weeks at eight sites in Nepal from 2015 to 2019. RESULTS:We included 2294 women undergoing abortion ≥13 weeks (no upper gestational age limit); 593 underwent dilation and evacuation and 1701 had a medical abortion. Demographics differed by procedure for parity (19% vs 33% nulliparous, dilation and evacuation, and medical abortion) and gestational age (90% vs 52% were 13-15 weeks, dilation and evacuation, and medical abortion). Ultrasonography was performed in 81% of cases overall. Complications were rare (<1% of dilations and evacuations, 1.4% of medical abortions). The most common adverse events with dilation and evacuation were hemorrhage and cervical laceration; three women required re-aspiration. Following medical abortion, 13.5% had retained products, 12.9% with prior ultrasound and 16.3% who had not had an ultrasound. Hemorrhage and severe side-effects occurred at similarly low rates regardless of whether ultrasonography was performed. In a logistic regression model where patient characteristics and case clustering within facilities were controlled for, we found a correlation between ultrasonography and complications when retained placenta was included in the model, but there was no correlation between ultrasonography and complications when retained placenta was excluded. CONCLUSIONS:This study confirms low complication rates among women having an abortion ≥13 weeks' gestation in healthcare facilities. Settings without universal availability of ultrasound may still maintain low, comparable complication rates.

摘要

引言: 我们的目的是评估扩张和排空前的超声检查或药物流产 ≥ 13周是否与安全性相关。 材料和方法: 我们对从2015年到2019年在尼泊尔的8个中心接受流产 ≥ 13周的患者进行了回顾性图表审查。 结果: 我们纳入了2294例接受流产 ≥ 13周 (无孕龄上限) 的妇女; 593例接受了扩张和排空术,1701例接受了药物流产。人口统计学因产次 (19% vs 33%,未产,扩张和排空,以及药物流产) 和胎龄 (90% vs 52%,13-15周,扩张和排空,以及药物流产) 而不同。81% 的病例进行了超声检查。并发症罕见 (<1% 的扩张和撤离,1.4% 的药物流产)。扩张和排空最常见的不良事件是出血和宫颈裂伤; 三名妇女需要再次抽吸。药物流产后,13.5% 有保留产品,12.9% 有既往超声检查,16.3% 没有做过超声检查。无论是否进行超声检查,出血和严重副作用的发生率都同样低。在控制设施内患者特征和病例聚类的逻辑回归模型中,我们发现当模型中包括胎盘滞留时,超声检查与并发症之间存在相关性,但当排除胎盘滞留时,超声检查与并发症之间不存在相关性。 结论: 本研究证实了在医疗机构中妊娠 ≥ 13周流产的妇女并发症发生率低。没有超声的普遍可用性的设置仍然可以维持低的、可比较的并发症发生率。

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