药物流产后清宫与继后妊娠分娩时并发症关系的临床研究

目的:探讨药物流产后清宫与继后妊娠分娩时并发症的关系。方法:1998年7月~2001年3月在北京、上海和成都3个中心招收仅有1次药物流产史、妊娠16周以内的妇女4 661例进行队列研究,研究对象根据药物流产后有无清宫分为清宫组(1 181例)和无清宫组(3 480例),随访观察其继后妊娠分娩时情况。结果:与无清宫组相比,清宫组分娩时第三产程延长的发生率较高,调整相关因素后OR值为2.05(95%C I:1.27~3.30);两组间胎盘早剥、粘连或植入和产后出血的发生率差异均无统计学意义(P>0.05)。按流产时的孕龄分层分析后,孕龄<7周时清宫组胎盘早剥、粘连或植入、第三产程延长和产后出血的发生率均高于无清宫组,调整后OR值分别为3.38(95%C I:1.08~10.61)、1.51(95%C I:0.99~2.53)、2.37(95%C I:1.35~4.16)和1.77(95%C I:1.01~3.09);孕龄≥7周时,两组上述并发症的发生率差异无统计学意义(P>0.05)。结论:药物流产(尤其是孕龄<7周时)后的清宫可能会对继后妊娠的分娩产生一定的不良影响。

Clinical Study on the Relationship between Curettage after Medical Abortion and Labor Complications of Subsequent Pregnancy

Objective: To study the relationship between curettage after medical abortion and the labor complications of subsequent pregnancy.Methods: Cohort study was adopted,and 4,661 pregnant women with gestational age less than 16 weeks and only one medical abortion were recruited in this study,from July 1998 to March 2001,in Beijing,Shanghai,and Chengdu.According to the presence of curettage after medical abortion,eligible women were divided into the curettage group(1,181 cases) and the no-curettage group(3,480 cases).Follow-ups were made to observe the process of subsequent pregnancy and delivery.Results: Compared with the no-curettage group,the incidence of prolonged third stage of labor was significantly higher in the curettage group(adjusted OR: 2.05,95%CI: 1.27-3.30).The incidences of placenta abruption,placenta accrete or increta and postpartum hemorrhage were respectively 0.68%,3.30% and 2.37% in the curettage group,and respectively 0.37%,1.84% and 1.70% in the no-curettage group,but there was no statistical difference between the two groups(P>0.05).After stratified by gestational week at abortion,increased ORs of each complication mentioned above in comparison with the no-curettage group were found only in women who experienced a medical abortion earlier than 7 weeks of gestation,with the adjusted ORs were 3.38(95%CI: 1.08-10.61),1.51(95%CI: 0.99-2.53),2.37(95%CI: 1.35-4.16),and 1.77(95%CI: 1.01-3.09),respectively.The differences of the incidences of the complications mentioned above showed no statistical significance between the two groups(P>0.05),when the gestation age was no less than 7 weeks.Conclusion: The curettage after medical abortion may have adverse effects on subsequent pregnancy and delivery,especially at gestational age of less than 7 weeks.