(精选)【医学课件课件】人工流產的臨床考量教学课件.pptVIP

人工流產的臨床考量 　　　　何師竹 台中榮民醫院婦產部 人工流產的母體合併症（官方手術說明書） 感染：極少數感染會造成子宮內膜炎、輸卵管炎、骨盆腔炎症或流產後敗血症，甚至會因而感染造成休克死亡。 ? 不完全流產：容易發炎或造成大量出血。 ? 出血：嚴重失血以致造成肺栓塞、腦部受損、心臟停止甚至死亡。 ? 組織傷害：極少數，但情況嚴重時甚至須緊急施以腹腔鏡或剖腹手術探查： 1. 子宮頸裂傷：可能造成日後受孕困難、子宮頸閉鎖不全甚至早產。 2. 子宮內膜受損：少數會因子宮內膜腔沾黏造成阿休曼式症候群，術後子宮腔積血、經血量少、甚至無月經；或日後造成不孕症及復發性流產。 人工流產的母體合併症（官方手術說明書） 3. 子宮穿孔：造成腸道損傷併發腹膜炎、腹腔膿瘍或併發腹內出血，嚴重可至休克死亡。 4. 子宮破裂 5. 神經損傷 ? 嚴重出血時需要輸血，伴隨輸血的危險包括： 1. 感染 2. 溶血性輸血反應 3. 血量負荷過大、鬱血性心衰竭、肺水腫、輸血性抗宿主反應等合併症。 ? 與麻醉有關之併發症：藥物過敏反應、神經作用、心跳過緩或停止，休克。 人工流產對長期身心健康上的後果 Long-Term Physical and Psychological Health Consequences of Induced Abortion:Review of the Evidence OBSTETRICAL AND GYNCOLOGICAL SURVEY 2007 V58:67 One can presume that abortion is most often chosen as a response to a crisis or unintended pregnancy. The high prevalence of history of induced abortion means that even small positive or negative effects on long-term health could influence the lives of many women and their families. Abortion rate ? 1996 U.S.A. 23/1000＃ ? Women Age 15 to 44 ＃ 26% all recognized pregnancy 1995 Canada 16/1000 England 15/1000 Sweden 18/1000 Netherland 6/1000 Obstetric Ethics：(the fetus as a patient)胎兒也是產科醫師的病人 ? The pregnant women has beneficence-based obligations to the fetus because she is its moral fiduciary. She is expected to protect and promote the best interests of her fetus. 孕婦是胎兒的法定代理人，有嘉惠胎兒的義務，被預期會保護及促進胎兒的權益。 Obstetric Ethics：(the fetus as a patient)胎兒也是產科醫師的病人 The physician also has beneficence-based obligation to the fetus, to protect and promote its interests. 醫師也有嘉惠胎兒的義務，會保護及促進胎兒的權益。