1796例早期妊娠药物流产效果和不良结局分析

Analysis of effect and adverse outcome of 1796 women with the first trimester pregnant termination

目的:分析米非司酮配伍口服米索前列醇药物流产临床效果及不良结局,提高药物流产接受度和安全性。方法:对2013年1月-2017年12月来本院自愿要求药物流产终止早孕的1796例门诊临床资料进行回顾性分析。结果:①5年中药物流产数量较负压吸宫术无明显上升趋势;②1796例中失联161例(8.9%),纳入流产效果分析的1625例中,完全流产1273例(78.3%),不全流产264例(16.3%),失败88例(5.4%)。③严重不良反应包括胃肠反应重改为负压吸宫术10例和阴道出血量过多行急诊清宫术18例,另1例因不全流产行清宫术后发现绒毛水肿,无阴道出血多导致失血性休克和严重过敏及感染病例。结论:临床实践中包括不全流产和失败、严重不良反应及失联等在内的不良结局发生率较高,在临床中需进一步改进。

Objective： To analyze the clinical effect and adverse outcomes of oral mifepristone combined with misoprostol for the first trimester pregnant termination, and to improve the acceptance and safety of medical abortion. Methods：Between January 2013 and December 2017, a retrospective analysis of data of 1796 outpatient patients who voluntarily requested medical abortion to terminate early pregnancy was conducted to explore the adverse outcomes and improvement methods of medical abortion. Result：There was no significant increase in medical abortion rate of Beijing obstetrics and gynecology hospital in 5 years. In the 1796 patients, except 161 cases had followed up lost, the data of total 1635 cases were analyzed. There were 1273 cases had experience complete abortion, and there were 523 cases with adverse outcomes, which included 264 cases of incomplete abortion, 88 cases of abortion failure. There were 10 cases lately experienced surgical abortion suction for severe gastrointestinal reaction, 18 patients with profuse vaginal bleeding had experienced emergency curettage, and there was one case found villous edema after curettage cause of the incomplete abortion. There was no any case with hemorrhagic shock because of vaginal bleeding, and no case with severe allergic or infection. Conclusion：In clinical practice for artificial abortion, the incidence of incomplete abortion and failure abortion, the rate of severe adverse reaction and loss of follow up are high, so further improvement is needed.