米非司酮药物流产与继后妊娠产后出血的研究  

The association between mifepristone-induced abortion and postpartum hemorrhage of subsequent pregnancy

作　　者：张艳[1] 高尔生[2] 朱虔兮[2] 程怡民 罗琳 吴尚纯 陈爱民[2] 周利锋[2] 丁吟秋[2] 袁伟[2] 

机构地区：[1]复旦大学,上海200032 [2]上海市计划生育科学研究所,上海200032 [3]国家人口与计划生育委员会科学技术研究所,北京100088 [4]四川省计划生育科学技术研究所,四川成都610041

出　　处：《中国实用妇科与产科杂志》2008年第5期351-353,共3页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：世界卫生组织资助(WHO97823)

摘　　要：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（4698例）、术流组（4582例）和非流组（4705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。Objective To evaluate the effect of mifepristone-indueed abortion on postpartum hemorrhage of subsequent wanted pregnancy. Methods Pregnant women aged 20 ～ 34 years at gestational age ≤ 12 weeeks were enrolled in prenatal care centers of Beijing, Shanghai and Chengdu from 1998 to 2001. Equal numbers of subjects were enrolled respectively into three comparative groups based on their induced abortion history： one mifepristone-indueed abortion （ MA）, one surgical abortion（SA） , or no induced abortion（NA）. Follow-ups were made at 28 ～ 30 weeks of pregnancy, at delivery, and 4-6 weeks after delivery. Results The incidence rate of postpartum hemorrhage was 1.94%, and the rate in group MA, SA and NA was 1.89%, 2. 14% and 1.79%, respectively. There was no significant difference in postpartum hemorrhage between MA and SA（ P 〉 0. 05 ） , neither between MA and NA（ P 〉 0. 05 ） after adjusting possible confoundings. The risk for postpartum hemorrhage, however, in MA,who had undergone an uterine curettage, had a interpregnancy interval less than half a year, or had abortion-related complications,was slightly higher than that in NA （ OR： 1.33, 1.44 and 1.60, respectively）, although they were not statistically significant. Similarly, comparison between MA and SA stratifying interpregnancy interval showed that OR arose from 0. 51 in MA with an interval 〉 1.5 years to 1.47 in MA with an interval 〈 0. 5 years. Conclusion Mifepristone-indueed abortion usually doesn＇ t increase the risk of postpartum hemorrhage of subsequent wanted pregnancy. It might, however, increase the risk of postpartum hemorrhage such as an abortion-related curettage or other complications, and a interpregnaney interval less than half a year.

关 键 词：米非司酮 药物流产 产后出血 队列研究 

分 类 号：R71[医药卫生—妇产科学]