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Medical abortion in the community setting

机译：社区环境中的医疗堕胎

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In France, women are entitled to request a termination of their pregnancy. Medical abortion is permitted in a hospital setting until 9 weeks of gestation, i.e. 9 weeks after the first day of the last menstrual period. In a community setting, it is permitted until 5 weeks after conception (7 weeks of gestation). It is carried out by a doctor or midwife, in their office or a health centre. How effective is medical abortion and what are its adverse effects? How is it undertaken in the community setting in France? We reviewed the available evidence using the standard Prescrire methodology.Medical abortion is based on sequential administration of two oral drngs: first the progesterone antagonist mifepristone, followed 24 to 48 hours later by the prostaglandin analogue misoprostol. Before 7 weeks of gestation, medical abortion is effective (complete abortion with no need for an additional procedure) in about 96% of cases. Incomplete abortion sometimes requires surgical evacuation.Vaginal bleeding starts within hours after taking misoprostol and sometimes even before it is taken. It is accompanied by potentially intense abdominal or pelvic pain.These symptoms are an inherent part of induced abortion. Ibuprofen is the first-choice analgesic.The abortifacient drugs used have mainly gastrointestinal adverse effects. Genital tract, haemor-rhagic or infectious complications are rare. Abortion has no known long-term adverse effects.There have been few studies on its psychological effects.In 0.5% of cases, the pregnancy remains viable. When this occurs, the fact that the woman has taken misoprostol carries a risk of severe fetal malformations.Some situations preclude the use of medical abortion, in particular when these abortifacient drugs must be avoided or when the woman cannot safely undergo this method of abortion.In France, the law requires 1 or 2 consultations before medical abortion, 2 consultations for administration of the drugs, and 1 follow-up consultation. In practice, some of these consultations are often combined.
机译：在法国，妇女有权要求终止怀孕。在医院环境中允许医疗流产，直到妊娠9周，即最后一次月经期间的第一天后9周。在社区环境中，允许在受孕后5周（妊娠7周）至5周。它由医生或助产士，办公室或健康中心进行。医疗流产有多效果，其不利影响是什么？如何在法国的社区环境中进行？我们使用标准的预征收法审查了可用的证据。医学堕胎是基于两种口服DRNG的连续施用：首先是前列腺素类似物米索前列醇后24至48小时后的24至48小时。在妊娠7周之前，医疗流产有效（完全堕胎，不需要额外程序），约96％的病例。堕胎有时需要外科疏散。幼儿司醇后几小时开始出血，有时甚至在拍摄之前。它伴有潜在的腹部或盆腔疼痛。这些症状是诱导流产的固有部分。布洛芬是第一选择镇痛。使用的含热剂主要具有胃肠不良影响。生殖道，炎性流氓或传染性并发​​症很少见。堕胎没有已知的长期不利影响。对其心理作用的研究很少。0.5％的病例，怀孕仍然可行。当发生这种情况时，女性服用误毒醇的事实患有严重的胎儿畸形的风险。一些情况妨碍了使用医用流产的使用，特别是当必须避免这些牵引药物或当女性不能安全地进行这种堕胎方法时。在法国，法律需要在医疗堕胎之前进行1或2次磋商，2次咨询药物，以及1个后续磋商。在实践中，这些咨询通常会组合。

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    《Prescrire international》 |2017年第187期|共5页
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