Induced abortion
Induced abortion
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DOI：
10.1093/humrep/dex071
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发表时间：
2017-06-01
影响因子：
6.1
通讯作者：
Volpe, A.
中科院分区：
文献类型：
--
作者：
Cameron, S.;Glasier, A.;Volpe, A.
堕胎很常见。关于堕胎率的数据并不准确，但可用于探讨趋势。在全球范围内，2010-2014年期间的估计比率为每1 000名妇女（15-44岁）35例堕胎，比1990-1994年期间的40例低5个百分点。世界各地的堕胎法各不相同，但发展中国家的堕胎法通常更具限制性。限制性法律不一定阻止妇女寻求堕胎，但往往导致不安全的做法，造成严重的死亡率和发病率。虽然堕胎的法律的框架是提供堕胎服务的先决条件，但许多没有证据的法律限制了堕胎服务的提供，并拖延了获得堕胎服务的时间。堕胎应符合公共健康的利益，任何法律的框架都应尽可能允许堕胎，以促进堕胎。在没有法律的准入的情况下，需要采取减少危害战略，以减少与堕胎有关的死亡率和发病率。人工流产可以通过手术（在孕早期，通过手动或电动真空抽吸）或药物进行：两者都是安全有效的。宫颈预充有助于手术并降低不全流产的风险。不全流产的诊断应根据临床而非超声。脓毒性流产是孕产妇死亡的常见原因，几乎总是在不安全流产之后发生，因此在很大程度上是可以预防的。虽然堕胎后的常规随访是不必要的，但所有妇女都应在堕胎后立即提供避孕方法。这一点，再加上改善教育和其他干预措施，可能会成功地减少意外怀孕。
Abortion is common. Data on abortion rates are inexact but can be used to explore trends. Globally, the estimated rate in the period 2010-2014 was 35 abortions per 1000 women ( aged 15-44 years), five points less than the rate of 40 for the period 1990-1994. Abortion laws vary around the world but are generally more restrictive in developing countries. Restrictive laws do not necessarily deter women from seeking abortion but often lead to unsafe practice with significant mortality and morbidity. While a legal framework for abortion is a prerequisite for availability, many laws, which are not evidence based, restrict availability and delay access. Abortion should be available in the interests of public health and any legal framework should be as permissive as possible in order to promote access. In the absence of legal access, harm reduction strategies are needed to reduce abortion-related mortality and morbidity. Abortion can be performed surgically ( in the first trimester, by manual or electric vacuum aspiration) or with medication: both are safe and effective. Cervical priming facilitates surgery and reduces the risk of incomplete abortion. Diagnosis of incomplete abortion should be made on clinical grounds, not by ultrasound. Septic abortion is a common cause of maternal death almost always following unsafe abortion and thus largely preventable. While routine follow-up after abortion is unnecessary, all women should be offered a contraceptive method immediately after the abortion. This, together with improved education and other interventions, may succeed in reducing unintended pregnancy.