初孕行药物流产对再次妊娠的影响

第一次妊娠因不同原因要求终止妊娠者 ,人们常常采用人工流产 ,而近几年来 ,安全、有效的非手术措施 (药物流产 )正在逐渐的、广泛的被人们所接受 ,且在药物流产中 ,初孕妇女有增多的趋势 ,究竟药物流产后对再妊娠和分娩有无影响 ,目前报道较少 ,本研究对初孕药物流产后再妊娠结局进行了调查研究 ,并与同期无流产史的初孕妇女进行了对比分析 ,现将结果报道如下。一、资料和方法1.资料来源 :选自 1999年 1月～ 2 0 0 0年 2月在我院分娩的初产妇 40 0例 ,妊娠 >37周。年龄 2 0～ 36岁 ,平均 2 5 .9岁 ,有药物流产史者 2 0 0例 (均一次药流 ,为…     

影响药物流产的多因素分析

目的分析影响药物流产的各种因素,寻找药物流产的最合适条件。方法对辽宁省妇婴医院2002年1月至2003年8月收治的因非病理性因素要求药物流产终止妊娠的1366例早孕妇女进行回顾性调查,分析成功和失败的原因,运用单因素、多因素研究年龄、孕次、分娩史、分娩方式、流产次数、停经天数、胚囊大小、有无胎芽、子宫位置、是否合并子宫肌瘤及慢性盆腔炎性疾病与流产结局的关系。结果全组对象完全流产者1259例(占92.2%)。单因素分析表明:流产次数越多、停经天数≥50d、胎囊最大径线>25mm、有胎芽、后位子宫、合并慢性盆腔炎性疾病者流产失败率增加,而年龄、孕次、分娩史、分娩方式及合并子宫肌瘤与流产结局无显著相关性;多因素分析表明:子宫位置、胚囊大小、有无胎芽及慢性盆腔炎性疾病是影响药物流产结局的独立因素,停经天数是较重要的影响因素。结论早孕妇女合并有慢性盆腔炎性疾病、后位子宫、胎囊最大径线>25mm、有胎芽及停经天数≥50d者药物流产失败可能性较大。     

初孕药物流产对再妊娠影响的研究

目的 探讨初孕药物流产对再妊娠的影响。方法 采用前瞻性调查方法对１２６例有药物流产史的初孕妇女及２６０例有人工流产史初孕妇女进行比较,随访妊娠分娩结局。结果 因胎盘引起的并发症,药物流产组明显低于人工流产组（Ｐ〈０．０１）;产后出血发生率,药物流产组谱明显低于人工流产组（Ｐ〈０．０５）,结论 初孕妇女药物流产后再次妊娠分娩因胎盘引起的并发症比人工流产后再次妊娠分娩者少,且有较大的安全性。     

米非司酮药物流产与继后妊娠产后出血的研究

目的 评价使用米非司酮进行药物流产对继后妊娠产后出血发生危险的影响.方法 1998年7月至2001年3月在北京、上海和成都产前检查机构同时收集年龄为20～34岁,孕周＜12周的病例资料,分为药流组(4 698例)、术流组(4 582例)和非流组(4 705例)3组,并且在妊娠第28～30周、分娩时及分娩后4～6周进行调查随访.结果 产后出血的总发生率为1.94%,调整可能的混杂因素后,药流组(1.89%)与术流组(2.14%)、非流组(1.79%)产后出血发生率比较差异均无统计学意义(P＞0.05).药流组中有清宫史、妊娠间隔＜6个月或有流产并发症者,发生产后出血的危险略高于非流组,OR分别为1.33、1.44和1.60,但差异亦无统计学意义.随着妊娠间隔的缩短,药流组和术流组相比发生产后出血的相对危险度从妊娠间隔＞1.5年的0.51上升到＜0.5年时的1.47.结论 米非司酮药物流产通常不会增加初产妇女继后妊娠产后出血的发生危险,但如流产时有过清宫史或其他并发症以及妊娠间隔6个月以内,可能会增加产后出血的风险.     

影响药物流产效果的相关因素分析

目的:探讨影响药物流产效果的相关因素,为严格药物流产适应证,减少药物流产副反应及并发症的发生提供科学依据。方法:回顾分析本院近两年来药物流产病例3344例,统计分析患者年龄、孕产次、妊娠时限、子宫位置、孕囊大小、剖宫产史等不同因素与流产结局之间的关系。结果:病例对象的年龄、孕产次、妊娠时限、子宫位置、孕囊大小、剖宫产史等,均与药物流产效果相关。其中孕囊大小、子宫位置、孕产次、剖宫产史是导致药物流产不全或失败的高危因素。结论:严格掌握药物流产适应证,可有效降低不全流产及药物流产失败的发生。     

初孕两种不同流产方式对再次妊娠的影响

目的 探讨初孕妇女药物流产和人工流产对再妊娠的影响。方法 采用回顾性调查方法对226例有药物流产史及260例有人工流产史的初孕妇女进行比较，随访其再妊娠分娩结局。结果 两种流产对新生儿是安全的，但流产造成妊娠期先兆流产、自然流产、前置胎盘发生率，药物流产组明显低于人工流产组，分娩期并发症也是药物流产组明显低于人工流产组。结论 初孕妇女药物流产后缩短阴道出血时间对再妊娠的影响比人工流产明显减小，其安全性较大，值得在临床推广应用。     

药物流产患者的临床观察及护理

目的:探讨药物流产对不同孕周稽留流产的疗效。方法:对160例稽留流产的临床资料进行回顾性分析。结果:药物流产与稽留流产的孕周密切相关:孕周越小,完全流产率越高,排胎时间越短,阴道流血量越少;孕周越大,不全流产及流产失败率越高,排胎时间越长,出血量多的机会明显增加。结论:一旦确诊为稽留流产,如果无药物流产的禁忌症,应尽早行药流术,以提高流产的成功率,减少并发症的发生。     

药物流产后子宫出血与早孕蜕膜和绒毛雌、孕激素受体的关系

米非司酮配伍米索前列醇 (米索 )终止早孕已广泛用于临床 ,但流产后出血已引起人们的关注。本研究为探讨药物流产 (药流 )出血机理 ,从米非司酮抗早孕作用机理入手 ,测定正常早孕人工流产和药流妇女蜕膜、绒毛中雌激素受体(ＥＲ)、孕激素受体 (ＰＲ)水平 ,探讨药流出血与ＥＲ、ＰＲ的关系 ,为防治流产后出血提供理论依据。一、资料与方法1 研究对象 :为 1996年 8月至 12月在我科接受药流的早孕妇女 ,140例 ,年龄 2 0～ 30岁 ,身体健康 ,既往月经规则 ,停经 5～ 7周 ,1年内无哺乳 ,无人工流产史 ,无应用甾体避孕药及宫内节育器史。其中人工流…     

米非司酮配伍前列腺素终止妊娠8～12周的流产问题

米非司酮配伍米索前列醇终止早期妊娠已在全国广泛应用。由于痛苦小、简便 ,选择药物流产者众多。按照我国药政审批规定 ,药物流产主要适用于停经 49天以内 ,可以得到较高的流产成功率及降低并发症 ,保障妇女的安全。在欧洲如英国 ,早孕期药物流产仅批准用于停经 6 3天以内 ;>孕 9周只能手术终止 ,不得使用药物流产 ;而中期妊娠的药物流产又属合法。在较大孕周使用药物流产的目的 ,主要是为了避免手术的并发症。对于终止 >8周的妊娠 ,尤其是早孕晚期 (10～ 12周 )的妊娠 ,常给临床医生带来难题。此时胎儿较大 ,负压吸宫术难以吸出 ;而又因羊…     

药物流产对再次妊娠孕产期及新生儿的影响

目的:探讨药物流产对再次妊娠的影响。方法:采用回顾性研究,分析年龄在23-33岁有药流史再次妊娠的健康妇女138例和无流产史的健康妊娠妇女91例,对孕期(妊娠反应、妊娠贫血、前置胎盘、胎盘早剥、妊高症、胎儿窘迫、羊水异常)、产时(产后出血、第三产程>15min、产钳、剖腹产)以及新生儿的各种情况进行比较。结果:药物流产组与无流产组孕产期及新生儿各项情况均无显著性差异(P>0.05)。结论:药物流产对再次妊娠孕产期及新生儿无明显不良影响,是一种安全、方便、有效的避孕失败补救措施。     

Side effects of induced abortion: results from a population-based survey

OBJECTIVES: This study compares the gynaecological symptoms of women who have undergone an induced abortion to those who have not. We also compare the gynaecological side effects, in particular the infectious symptoms, following an induced abortion, according to the abortion technique, medical and surgical, in the year after the abortion. PATIENTS AND METHODS: A representative sample of 2863 women, aged 18 to 44, was interviewed by telephone between September 2000 and January 2001. Of these women, 401 declared an abortion in the last 5 years. Analysis of the gynaecological side effects according to the abortion technique was performed among the 199 women who terminated their pregnancy before the 8th week of amenorrhoea. RESULTS: Women with a history of induced abortion had a higher sexual risk profile than those with no such history. They also more frequently reported genital infectious symptoms. The comparison between medical and surgical abortions shows that women who had a medical abortion were more likely to report heavy and prolonged bleeding. On the contrary, we found no difference of infectious symptoms between the two techniques. DISCUSSION AND CONCLUSION: Our study does not support the idea of a reduction of infectious complications related to medical as opposed to surgical abortions. However, given the rapid diffusion of medical abortion, it seems important to carry on the investigations on the side effects related to medical abortions, in order to prevent them if necessary.     

Risks of preterm delivery and small-for-gestational age infants following abortion: a population study

We examined hospital discharge records in 1980-81 for singleton third trimester deliveries in Scotland. We compared 3000 women who had previously experienced induced termination of pregnancy, and 4000 who had experienced spontaneous abortion with primigravidae and with women in their second pregnancy, their first having resulted in a livebirth. Two aspects of low birthweight were examined: delivery before the 37th completed week of gestation, and low birthweight for gestational age. Our comparisons were further controlled for maternal height, age, sex of infant, marital status and social class. Women with previous spontaneous abortions experienced significantly increased risk of preterm delivery but not of low birthweight for gestational age. Women with a history of induced abortion also experienced increased risk of preterm delivery, but for women aged 18-24 years, risk of low birthweight for gestational age was significantly reduced compared with primigravidae.     

Risks of preterm delivery and small-for-gestational age infants following abortion: a population study

Summary. We examined hospital discharge records in 1980–81 for singleton third trimester deliveries in Scotland. We compared 3000 women who had previously experienced induced termination of pregnancy, and 4000 who had experienced spontaneous abortion with primigravidae and with women in their second pregnancy, their first having resulted in a litebirth. Two aspects of low birthweight were examined: delivery before the 37th completed week of gestation, and low hirth weight for gestational age. Our comparisons were further controlled for maternal height, age, sex of infant, marital status and social class. Women with previous spontaneous abortions experienced significantly increased risk of preterm delivery but not of low birthweight for gestational age. Women with a history of induced abortion also experienced increased risk of preterm delivery, but for women aged 18–24 years, risk of low birth weight for gestational a ge was significantly reduced compared with primigravidae.     

Women's decision making regarding choice of second trimester termination method for pregnancy complications

ObjectiveTo describe how women terminating a pregnancy for fetal or maternal complications decide between surgical (dilation and evacuation [D&;E]) and medical abortion.MethodsA qualitative study was conducted among women who underwent D&;E or medical abortion before 24 weeks of gestation for fetal anomalies or pregnancy complications at an academic medical center where both methods are offered. Women were interviewed by phone 1 week after the procedure about their counseling experiences and reasons for choosing a particular method. Data were analyzed by 3 researchers using a grounded theory approach, and interviews were stopped upon thematic saturation.ResultsOf the 21 women, 13 (62%) chose D&;E and 8 (38%) chose medical abortion. Key themes that emerged from the interviews were valuing the ability to choose the method, and the importance of religious beliefs, abortion attitudes, and emotional coping style. Women's preferences for a method were largely based on their individual emotional coping styles.ConclusionDecisions to undergo D&;E or medical abortion are highly personal and could affect how women recover after ending a desired pregnancy. Women should be offered counseling about and access to both methods. Understanding these decision processes may help when counseling women faced with these diagnoses and decisions.     

Health, sociodemographic data, and pregnancy outcome in women with antepartum depressive symptoms

OBJECTIVE: To study whether women with antepartum depression have an increased risk for adverse perinatal outcome. METHODS: From a sample of 1,489 women, an index group (n = 259) of all women with depressive symptoms on the Edinburgh Postnatal Depression Scale in gestational week 35-36 was selected. Two hundred fifty-nine women with no depressive symptoms on the Edinburgh Postnatal Depression Scale antepartum or postpartum were randomly chosen as the reference group. Medical, gynecologic, and obstetric history, socioeconomic status, pregnancy, and perinatal data were collected from standardized medical records for all women. RESULTS: Women with antepartum depressive symptoms were more often multiparas with a history of earlier obstetric complications. Complications during the present pregnancy were more frequent in the antepartum-depressed group of women. There were no differences concerning outcome of delivery, puerperium, and neonatal health between the index and reference groups. Forty-six percent of the women with antepartum depressive symptoms had depressive symptoms at 6-8 weeks or 6 months postpartum or both. CONCLUSION: Women depressed during pregnancy constitute a group without an increased risk for adverse obstetric or neonatal outcome but with a high risk for postpartum depressive symptoms.     

The effect of induced abortion on subsequent pregnancy outcome.

OBJECTIVE--To investigate the effect of induced abortion on the outcome of the next pregnancy. DESIGN--Long-term prospective controlled cohort study. SETTING--Joint Royal College of General Practitioners/Royal College of Obstetricians and Gynaecologists study based in general practice in England, Scotland and Wales. SUBJECTS--1311 women whose recruitment pregnancy had ended in induced abortion (the abortion group) and 2131 women whose recruitment pregnancy had a natural conclusion (the non-abortion group). MAIN OUTCOME MEASURES--Non-viable outcome (spontaneous or missed miscarriage, ectopic pregnancy or stillbirth), birthweight, length of gestation. RESULTS--Induced abortion was not materially associated with any of the three measures of adverse outcome. Compared with the non-abortion group the relative risk of a non-viable outcome in the abortion group was 1.01 (95% CI 0.81 to 1.27). In the abortion group birthweight was an average 23 g lighter (95% CI -76 g to + 30 g) and length of gestation an average 0.9 days shorter (95% CI -2.2 days to + 0.4 days) than in the non-abortion group. Women who had their abortions in NHS premises had an increased risk of a non-viable outcome (RR 2.55, 95% CI 1.31 to 4.94) and had babies with significantly lower mean birthweight (-119 g, 95% CI -233 g to +5 g) compared with those who obtained their operations in the private sector. Women whose abortion had been carried out by a consultant had the lowest risk of non-viable outcome. Although these differences remained after adjustment for a number of important variables, it is possible that factors not measured in the present study, such as economic status and occupation, played a contributory role. CONCLUSION--Overall, induced abortion was not associated with any important effect on the three measures of adverse outcome in the subsequent pregnancy.     

Characteristics of women who considered or obtained tubal reanastomosis: results from a prospective study of tubal sterilization

The Collaborative Review of Sterilization is a prospective study of women undergoing tubal sterilization at selected medical centers in the United States. This analysis examined 5817 study participants who were asked whether they had sought information on tubal reanastomosis after their sterilizations and whether they had actually obtained reanastomosis surgery. Characteristics that predicted the likelihood of seeking reanastomosis information were examined in multivariate, logistic regression models that included age, race, number of living children, history of abortion, education, timing of sterilization in relation to pregnancy, initial marital status, and change in marital status. Among the women studied, 6.2% reported that they had sought information on reanastomosis. Women who were younger than 30 years old at the time of sterilization were twice as likely to seek such information as women aged 30-34, and women who had experienced changes in martial status after sterilization were 2.8 times as likely to seek information as women with unchanged marital status. Thirteen women had actually obtained reanastomosis. Compared with the overall study population, these women were more likely to be white, to have lower gravidity, to be younger, and to have experienced changes in marital status.     

Ectopic pregnancy and medical abortion

OBJECTIVE: Medical abortion regimens have become more widely used to terminate early pregnancies. Medical abortion providers are concerned to diagnose and exclude women with ectopic pregnancy before initiating treatment, as with any early pregnancy termination. Yet, there is little information about whether the various pretreatment screening methods used are adequate. We reviewed published literature to determine the overall success of screening for ectopic pregnancy before medical abortion treatment. DATA SOURCES: We searched MEDLINE for articles on medical abortion regimens published before July 2003. METHODS OF STUDY SELECTION: We selected English language articles of studies of medical abortion with sample sizes greater than 100, which reported on ectopic pregnancy diagnosed after medical abortion treatment. Fifty-seven of 85 prospective studies and randomized trials (69%) met these inclusion criteria. We also included data from 2 unpublished studies because they were large and well-controlled and because they included serious adverse events known to us, which we did not deem fair to exclude from our analysis. TABULATION, INTEGRATION, AND RESULTS: Each article was reviewed by one author. Data from selected studies were compiled, and the frequency of ectopic pregnancy diagnosed after medical abortion treatment was calculated. Ectopic pregnancy was diagnosed very infrequently following medical abortion procedures, occurring in only 10 of 44,789 (0.02%) women. CONCLUSION: The very low frequency of ectopic pregnancies diagnosed after medical abortion treatment demonstrates that the various pretreatment screening methods that providers use to exclude patients with ectopic pregnancies are successful. Further, there is no evidence to suggest that medical abortion treatment leads to unusual complications for women with ectopic pregnancies.     

Prediction of spontaneous abortion by vaginal cytologic smears (author's transl)i1]

Vaginal smears were obtained from 175 women during the first four months of pregnancy weekly and the Karyopycnotic Index and the Eosinophilic Index encountered by phase contrast microscopy. The normal values were listed our by percentils. The development of KPI and Eo I during early pregnancy were compaired in three groups of patients: 1, 120 women with normal early pregnancy, 2.20 women with threatened abortion but good following up of later pregnancy, and 3. 35 women with spontaneous abortion. Even 4 weeks before abortion vaginal smears changed to pathological values in about 40% of all patients with spontaneous abortion. Women with threatened abortion but good outcome of pregnancy used to have normal KPI and Eo I.     

Pregnancy course and outcome following blunt trauma

Objective: To investigate short- and long-term outcome following blunt trauma in pregnancy, and to identify risk factors for adverse pregnancy outcome in these cases. Methods: A retrospective cohort study of all pregnant women who were admitted following blunt trauma (N?=?411). Women who experienced immediate complications (N?=?13) were compared with those who did not (N?=?398). Pregnancy outcome of women who experienced trauma during pregnancy and did not deliver during the trauma admission (N?=?303) were compared with a control group of women matched to by maternal age and parity in a 3:1 ratio (N?=?909). Results: The overall rate of immediate complications was 3.2%, with the most common complications being preterm labor (2.0%) and placental abruption (1.7%). Independent risk factors for immediate complications were higher severity of trauma, multiple gestation, vaginal bleeding and uterine contractions at admission. Patients who experienced trauma were at increased risk for long-term adverse outcome including preterm labor, placental abruption, and perinatal morbidity. Increased trauma severity (ISS ≥ 5) and the need for laparotomy during the trauma hospitalization were independently associated with long-term adverse pregnancy outcome. Conclusion: Trauma during pregnancy is associated with both immediate and long-term adverse pregnancy outcome. Women who experience trauma should be followed more closely throughout pregnancy.