Early Abortion in Family Medicine: Clinical Outcomes
Early Abortion in Family Medicine: Clinical Outcomes
复制标题
DOI：
10.1370/afm.1051
复制
发表时间：
2009-11-01
影响因子：
4.4
通讯作者：
Fleischman, Joan
中科院分区：
文献类型：
--
作者：
Bennett, Ian M.;Baylson, Margaret;Fleischman, Joan
临床创新使得将早期流产纳入家庭医学变得更加可行，但在这种情况下早期流产手术的结果还没有得到很好的研究。我们希望评估的结果，早期妊娠药物和吸入流产程序的家庭医生。方法前瞻性观察队列研究进行了从2001年8月至2005年2月的2，在4个家庭医学科临床实践和1个私人诊所/培训点寻求终止妊娠的550名妇女中，药物治疗的成功率为96.5%（95%置信区间[CI]，95.5%-97.0%），抽吸为99.9%（CI，99.3%-1）。药物流产的不良事件和并发症为手术失败（持续妊娠; n = 19，1.45%）;不全流产（n = 16，1.22%）;出血（n = 9，0.69%）;和患者要求抽吸（n = 1，0.08%）。1例（0.08%）异位妊娠漏诊发生在接受药物治疗的患者中。抽吸遇到了四种类型的不良结局：需要再次抽吸的不完全流产（n = 21，1.83%）;术中出血（n = 4，0.35%）;漏诊异位妊娠（n = 3，0.26%）;和轻微子宫内膜炎（n = 1，0.09%）。漏诊异位妊娠在住院环境中得到成功治疗，无死亡（总住院率为0.16/100）。所有其他并发症均在门诊家庭医学中心进行管理。并发症的发生率并不因医生的经验或护理地点（居住与私人执业）而异。结论药物和抽吸程序的并发症发生率低，大多数是轻微的，管理没有发生事故。
PURPOSE Clinical innovations have made it more feasible to incorporate early abortion into family medicine, yet the outcomes of early abortion procedures in this setting have not been well studied. We wished to assess the outcomes of first-trimester medication and aspiration abortion procedures by family physicians.METHODS Prospective observational cohort study conducted from August 2001 to February 2005 of 2,550 women who sought pregnancy termination in 4 clinical practices of family medicine departments and 1 private office/training site.RESULTS The rate of successful uncomplicated procedures for medication was 96.5% (95% confidence interval [CI], 95.5%-97.0%) and for aspiration was 99.9% (CI, 99.3%-1). Adverse events and complications of medication abortions were failed procedure (ongoing pregnancy; n = 19, 1.45%); incomplete abortion (n = 16, 1.22%); hemorrhage (n = 9, 0.69%); and patient request for aspiration (n = 1, 0.08%). One (0.08%) missed ectopic pregnancy was seen among patients receiving medication. Four types of adverse outcomes were encountered with aspiration: incomplete abortion requiring re-aspiration (n = 21, 1.83%); hemorrhage during the procedure (n = 4, 0.35%); missed ectopic pregnancy (n = 3, 0.26%); and minor endometritis (n = 1, 0.09%). Missed ectopic pregnancies were successfully treated in the inpatient setting without mortality (overall hospitalization rate of 0.16 of 100). All other complications were managed within outpatient family medicine sites. Rates of complication did not vary by experience of physician or by site of care (residency vs private practice).CONCLUSIONS Complications of medication and aspiration procedures occurred at a low rate, and most were minor and managed without incident.