Surgical methods of abortion

被引:8
作者
Linet, T. [1 ]
机构
[1] Ctr Hosp Loire Vendee Ocean, Gynecol Serv, Blvd Guerin, F-85300 Challans, France
来源
JOURNAL DE GYNECOLOGIE OBSTETRIQUE ET BIOLOGIE DE LA REPRODUCTION | 2016年 / 45卷 / 10期
关键词
Practice guidelines; abortion; induced; Abortion; induced/instrumentation; induced/methods; Anesthetics; local/administration and dosage; Antibiotic prophylaxis/methods; Mifepristone; Misoprostol; Pain/prevention and control; Patient safety; Vacuum curettage/adverse effects; Vacuum curettage/methods; RANDOMIZED CONTROLLED-TRIAL; 1ST TRIMESTER ABORTION; PELVIC-INFLAMMATORY-DISEASE; ELECTRIC VACUUM ASPIRATION; CERVICAL DILATATION PRIOR; THAN; 6; WEEKS; VAGINAL MISOPROSTOL; PARACERVICAL-BLOCK; 1ST-TRIMESTER ABORTION; DOUBLE-BLIND;
D O I
10.1016/j.jgyn.2016.09.026
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Objective. A state of the art of surgical method of abortion focusing on safety and practical aspects. Material and methods. A systematic review of French-speaking or English-speaking evidence based literature about surgical methods of abortion was performed using Pubmed, Cochrane and international recommendations. Results. Surgical abortion is efficient and safe regardless of gestational age, even before 7 weeks gestation (EL2). A systematic prophylactic antibiotics should be preferred to a targeted antibiotic prophylaxis (grade A). In women under 25 years, doxycycline is preferred (grade C) due to the high prevalence of Chlamydia trachomatis. Systematic cervical preparation is recommended for reducing the incidence of complications from vacuum aspiration (grade A). Misoprostol is a first-line agent (grade A). When misoprostol is used before a vacuum aspiration, a dose of 400 mcg is recommended. The choice of vaginal route or sublingual administration should be left to the woman: (i) the vaginal route 3 hours before the procedure has a good efficiency/safety ratio (grade A); (ii) the sublingual administration 1 to 3 hours before the procedure has a higher efficiency (ELI). The patient should be warned of more common gastrointestinal side effects. The addition of mifepristone 200 mg 24 to 48 hours before the procedure is interesting for pregnancies between 12 and 14 weeks gestations (EL2). The systematic use of nonsteroidal anti-inflammatory drugs is recommended for limiting the operative and postoperative pain (grade B). Routine vaginal application of an antiseptic prior to the procedure cannot be recommended (grade B). The type of anesthesia (general or local) should be left up to the woman after explanation of the benefit-risk ratio (grade B). Paracervical local anesthesia (PLA) is recommended before performing a vacuum aspiration under local anesthesia (grade A). The electric or manual vacuum methods are very effective, safe and acceptable to women (grade A). Before 9 weeks gestation, the manual vacuum aspiration could have a subjective interest (grade B). The electric vacuum aspiration is recommended after 9 weeks gestation (best practice agreement). For a pregnancy of unknown location, the success of the procedure can reasonably be determined if hCG drops more than 50 % on day 5 an 80 % on day 7 (NP3). After a surgical abortion, paracetamol or addition of paracetamol and codeine is not recommended (grade B). (C) 2016 Published by Elsevier Masson SAS.
引用
收藏
页码:1515 / 1535
页数:21
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