蔚來
2021-12-23 22:09:50
20wk 前,唔洗feticide, 基本唔viable at birth
20wk+, 好似你講咁
「有d係染色體唔正常,媽媽唔捨得好遲先決定人工流產,20週後都要做引產先生到出黎,唔通人地遲決定就唔俾佢做流產?」
6.7 Feticide
RECOMMENDATION 6.21
Feticide should be performed before medical abortion after 21 weeks and 6 days of gestation
to ensure that there is no risk of a live birth.
Evidence supporting recommendation 6.21
Inducing fetal death before medical abortion may have beneficial emotional, ethical and legal
consequences.260 The RCOG guidance on termination of pregnancy for fetal abnormality (published
in 2010) clearly explains the legal situation around late-stage abortions (see Chapter 2).7 Where a
decision to abort a pregnancy after 21 weeks and 6 days is taken, feticide should be routinely
offered. In abortions where the fetal abnormality is not compatible with life, abortion without
feticide may be preferred. However, in cases where the fetal abnormality is not lethal or the
abortion is not for fetal abnormality and is being undertaken after 21 weeks and 6 days of gestation,
failure to perform feticide could result in a live birth and survival, which contradicts the intention
of the abortion.261 Regarding fetal pain and awareness, the RCOG has published guidance and
concluded that ‘In reviewing the neuroanatomical and physiological evidence in the fetus, it was
apparent that connections from the periphery to the cortex are not intact before 24 weeks of
gestation and, as most neuroscientists believe that the cortex is necessary for pain perception, it can
be concluded that the fetus cannot experience pain in any sense prior to this gestation.’262
Very few abortions on grounds C or D are undertaken at late gestations. Only 9% of abortions occur
after 13 weeks and only 1.5% occur after 20 weeks of gestation.3 In Great Britain, those few are, for
the most part, undertaken within the specialist independent sector. When the method of abortion
chosen by a specialist practitioner is surgical (D&E), the nature of the procedure ensures that there
is no risk of a live birth, although in one study 91% of women indicated a preference that the fetus
was dead.263 When medical abortion is chosen, special steps are required to ensure that the fetus is
dead at the time of abortion. The RCOG recommends feticide for abortions over 21 weeks and 6
days of gestation, except in the case of lethal fetal abnormality, and that feticide should always be
performed by an appropriately trained practitioner (under consultant supervision) using aseptic
conditions and with continuous ultrasound.7
The RCOG recommends intracardiac potassium chloride (KCl) 2–3 ml strong (15%) injection into
a cardiac ventricle. A repeat injection may be required if asystole has not occurred after 30–60
seconds. Asystole should be observed for at least 2 minutes and fetal demise should be confirmed
by ultrasound scan after 30–60 minutes.7
Fetal demise may also be induced by intra-amniotic or intrathoracic injection of digoxin (up to 1
mg) and by umbilical venous or intracardiac injection of 1% lidocaine (up to 30 ml); however,
neither procedure consistently induces fetal demise.7
A dose of digoxin 1 mg given either intra-amniotically or intrafetally will cause fetal death in 87%
of cases; the latter method is much more rapid.264 A dose of digoxin 1.5 mg given intra-amniotically
caused death within 20 hours (in most cases there was still fetal cardiac activity at 4 hours).265 In a
large retrospective review, Molaei et al. (2008) concluded that the overall failure rate with digoxin
was 7%, although there were no failures with an intrafetal dose of 1 mg.266 Importantly, in this
review there were no adverse effects at any of the doses used.
邊間公立無做? 大西北第三世界龍頭醫院?