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1. Cochrane Database Syst Rev. 2010 Aug 4;(8):CD007310.

Cervical preparation for second trimester dilation and evacuation. 第二產程子宮頸的準備擴張與吸取

醫學名詞

1.antiprogesterone 黃體激素
2.prostaglandin 前列腺素
3.medical 醫療
4.cervical 子宮頸
5.surgical 手術
6.abortion 流產
7.gestation 妊娠
8.Osmotic dilators 擴張性滲透
9.Mifepristone 墮胎藥物：黃體素拮抗劑
10.misoprostol 胃藥：但用在懷孕婦女可能造成胎兒死亡

11. Dilation and evacuation (D&E) 擴張及吸取

Newmann SJ, Dalve-Endres A, Diedrich JT, Steinauer JE, Meckstroth K, Drey EA.

Obstetrics and Gynecology and Reproductive Sciences, University of California, San Francisco General Hospital,

1001 Potrero Avenue

Ward 6D, San Francisco, California, USA, CA 94110.

婦產科和生殖科學,加州大學舊金山總醫院,1001波特羅雷大街渥德6D條,舊金山,加州,美國,加州94110

Abstract

摘要

BACKGROUND: Abortion during the second trimester of pregnancy accounts for 10-15% of abortions performed worldwide.

背景:在懷孕的第二期,全世界因為流產墮胎佔10-15%,

Dilation and evacuation (D&E) is the preferred method of second-trimester abortion in most parts of the developed world.

大部分地區的發達國家,在孕期中首選的方法其擴張及吸取,

Cervical preparation is recommended for dilation and curettage (D&C) after 12 weeks gestation and is standard practice for D&E beyond 14 weeks gestation. Prostaglandins, osmotic dilators, and Foley balloon catheters have been used and studied as cervical preparation prior to second-trimester D&E.

做準備擴張括除數在孕期12週之後,超過14週標準做法擴張及吸取,前列腺素,擴張器,和尿管,是第二產子宮頸重要準備

However, no consensus exists as to which cervical preparation method is superior with regards to safety, procedure time, need for additional dilation, ability to perform the procedure, or patient and provider acceptability.然而，沒有共識的存在，以子宮頸準備方法優於與安全方面手術時間需要額外的擴張，有能力執行的程序或病人和提供者的接受程度。

Despite the fact that the advent of osmotic dilation has improved the safety of the D&E procedure during the second trimester, it is unclear whether a certain type of osmotic dilator is superior to another or whether osmotic dilation with adjuvant prostaglandin is superior to osmotic dilation alone or to prostaglandins alone.

儘管現在出現滲透擴張器，提高了安全性擴張及吸取的過程，在第二產程，

目前還不清楚是否有某種類型的滲透擴張器優於另一個，還是滲透擴張與輔助前列腺素是優於滲透擴張單獨或前列腺素孤單。

 

OBJECTIVES: This review evaluates cervical preparation methods for second-trimester surgical abortion with respect to differences in procedure time, dilation achieved, need for additional dilation, complications, ability to complete the procedure, patient pain scores, and patient and provider acceptability and satisfaction.

目標：本審查評估子宮頸準備方法孕中期流產手術方面的差異，手術時間，擴張程度，需要額外的擴張，併發症，有能力完成的程序，病人疼痛評分，病人和提供者的接受程度和滿意度。

SEARCH STRATEGY: We searched for trials of cervical preparation prior to second-trimester D&E.

搜索策略：我們尋找試驗的子宮頸前準備孕中期的擴張及吸取。

SELECTION CRITERIA: We included all randomized controlled trials that compared osmotic, mechanical, antiprogesterone, prostaglandin, or other medical agents of cervical preparation for second-trimester surgical abortion from 14-24 weeks of gestation.

標準選擇：
在其孕期第三個月到六個月做流產手術，從妊娠第14~24週妊娠時。我們利用黃體激素， 前列腺素,或其他醫療媒介來做隨機試驗在孕中期時於子宮頸準備流產手術,

DATA COLLECTION AND ANALYSIS: Data were abstracted by two authors and data entry was verified by a third author. Mean difference and Peto Odds Ratio were calculated.

數據收集與分析：
兩位作者數據資料輸入是抽象的.以第三位作者而驗證了三分之一的數據。平均差是以皮托比數比做計算。  authors勝算比  真陰性 委楊姓

MAIN RESULTS: Osmotic dilators were found to be superior to prostaglandins with respect to cervical dilation throughout the second trimester and with respect to procedure time within the early second trimester. Addition of prostaglandins to osmotic dilators was not found to increase cervical dilation, except after 19 weeks gestation, however, no impact was seen on procedure time. Addition of Mifepristone to misoprostol was found to improve cervical dilation, yet increase procedure time and frequency of pre-procedural expulsions. 主要結果：
滲透擴張器被認為優於前列腺素對子宮頸擴張，而整個孕中期程序的時間內在懷孕早期的第二個三個月。除了前列腺素對子宮頸擴張沒有發現增加，除妊娠19週後，子宮頸擴張增加，然而，在手術時間就已經沒有影響。除了Mifepristone(墮胎藥物)對misoprostol (胃藥：但用在懷孕婦女可能造成胎兒死亡)兩種藥發現會達到子宮頸擴張但會增加手術時間和頻率。

Two-day cervical preparation was found to produce greater cervical preparation than one-day, but had no impact on procedure time. Serious complication rates or ability to complete the procedure did not differ significantly between any of the preparation methods reviewed.

為期兩天的子宮頸準備比一天來的更多，但並沒有影響手術時間。嚴重併發症的發生率及能力完成過程並沒有顯著差異的準備方法的任何審查。

AUTHORS' CONCLUSIONS: Cervical preparation with osmotic dilators and/or misoprostol before second-trimester D&E is safe and effective. Osmotic dilators appear to provide superior cervical dilation when compared to prostaglandins alone or when combined with prostaglandins, however this difference in cervical dilation does not appear to result in differences in procedure time or complication rates.

作者的結論：在孕中期的擴張及吸取,子宮頸準備與滲透擴張器和Mifepristone(墮胎藥物)是安全有效的。似乎滲透擴張器擴張提供子宮頸上前列腺素相比，單獨或合併時，前列腺素，但這種差異在子宮頸擴張不會出現差異導致手術時間或並發症的發生率

There does not appear to be clear clinical benefit from two days of cervical preparation compared to one-day prior to second-trimester D&E below 19 weeks gestational duration. Mifepristone plus misoprostol was associated with high rates of pre-procedural expulsions and does not appear to be a useful method of cervical preparation before second-trimester dilation and evacuation. 

似乎沒有被明確的臨床受益於兩天相比，子宮頸準備為期一天前孕中期D及E低於妊娠19週的時間。Mifepristone(墮胎藥物)對misoprostol (胃藥：但用在懷孕婦女可能造成胎兒死亡)與提高手程序驅逐並沒有出現是一個有用的方法子宮頸準備工作孕中期擴張及吸取。
Same-day procedures appear to be a safe and reasonable option in the early second trimester, however, more research is needed to assess the effectiveness and safety of same-day procedures in the later second trimester.
在第二孕期的剛開始，同一天的程序似乎是一個較安全、合理的選擇，然而，在第二期的結尾，需要做更多研究評估同一天程序的效果和安全。