药物流产与手术流产对我国未育妇女再次妊娠影响比较的系统综述和Meta分析

The effects of medical abortion and surgical abortion on subsequent pregnancy outcome among nulliparas in China:a systematic review and meta-analysis

目的系统评价药物流产(medical abortion,MA)与手术流产(surgical abortion,SA)对我国未育妇女再次妊娠带来的影响,从而为意外怀孕妇女选择流产时提供一定的参考建议。方法在线检索Pub Med、Cochrane Library、Web of Science、Ovid、Embase、中国知网(China national knowledge infrastructure,CNKI)、中国生物医学文献数据库(Chinese biomedicine literature database,CBM)、万方数据库与重庆维普信息数据库,按照纳入标准纳入文献,并进行文献质量评价。运用Review Manager 5.3软件进行统计分析。结果本研究共纳入7项队列研究,包含2 946例初产妇。结果表明,除MA后再次妊娠的先兆流产(OR=0.38,95%CI:0.28~0.52),产后出血(OR=0.35,95%CI:0.25~0.48)、胎盘前置(OR=0.53,95%CI:0.31~0.90)、胎盘粘连(OR=0.33,95%CI:0.23~0.48)和胎盘残留(OR=0.22,95%CI:0.14~0.35)发生率较SA组低外,其他高危妊娠的发生率差异无统计学意义(均有P>0.05)。结论 MA优于SA,可以作为育龄妇女非意愿妊娠的首选。但流产对再次妊娠仍然存在伤害,对于妇女来说,应当重视首次怀孕,从根本上减少流产对孕妇本身及再次妊娠分娩带来的不良影响。

Objective To evaluate the effects of medical abortion （MA） and surgical abortion （SA） on subsequent pregnancy outcome among nulliparas in China, so as to provide some reference suggestions for the selection of miscarriages for pregnant women. Methods Systematical search was conducted using PubMed, Cochrane Library, Web of Science, Ovid, Embase, CNKI, China biomedical literature database, Wanfang Database and CQVIP Database. Studies were screened according to the predefined inclusion and exclusion criteria. Review Manager 5.3 software was used for statistical analysis. Results Seven cohort studies with 2 946 cases were included. The incidences of miscarriage, postpartum hemorrhage, placental praevia, placental adhesion and placental remnant occurred in MA group were significantly lower than those occurred in SA group, and their OR （ 95 % CI） were 0. 38 （ 0. 284）. 52 ）, 0. 35 （ 0. 25 4）. 48 ）, 0. 53 （ 0. 31 4）. 90 ）, 0. 33 （0. 23 4）. 48 ） and 0. 22 （0. 144）. 35 ） , respectively. No other significant differences were observed between the two artificial abortions groups （ all P 〉 0. 05 ）. Conclusions Although MA is safer than SA on subsequent pregnancy and is considered a preferred option for nulliparas to terminate their unwilling pregnancy, abortion associated injury still existed for nulliparas in regardless of the type of abortion selected. Thus unnecessary abortion should be avoided.