剖宫产后早孕药流及重复药流213例临床分析

研究目的 :研究停经 70 d以内的剖宫产后早孕药流及重复药流的安全性、有效性。对象和方法 :剖宫产后早孕对象 2 1 3例 ,其中 6 3例为剖宫产后第 2次要求药流的早孕对象 ,停经 34～ 6 9d,口服米非司酮 2 5 mg q1 2 h× 5次 ,首次计量 5 0 mg(总量 1 5 0 mg) ,d3上午来院加服米索前列醇 6 0 0μg。结果 :完全流产率 92 .5 % ,不全流产率 4.7% ,失败率2 .8%。结论 :口服米非司酮合并米索前列醇能有效地终止剖宫产后早孕包括重复药流对象的早孕 ,其效果与一般人群药流效果相似 ,其安全性、有效性令人满意。此外 ,由于用药后宫颈软化 ,宫口扩张 ,即使药流失败 ,也易于吸宫术的施行 ,减轻受术者的痛苦     

复方米非司酮配伍米索前列醇终止早孕临床验证

目的:验证复方米非司酮配伍米索前列醇终止早孕的效果及安全性。方法:征集100例要求终止妊娠的健康早孕(7周内)妇女,口服复方米非司酮片(米非司酮30mg、双炔失碳酯5mg)1片/d×2d;d3口服米索前列醇0．6mg。观察流产过程、孕囊排出情况、出血情况、复经情况及不良反应等。结果:验证了复方米非司酮并用米索前列醇终止早孕成功率达96％。结论:复方米非司酮配伍米索前列醇终止早孕无论从不良反应程度、出血量,还是出血时间、复经情况评论都符合药物流产要求。     

米非司酮配伍米索前列醇终止子宫肌瘤患者早孕的探讨

目的 :探讨米非司酮配伍米索前列醇终止子宫肌瘤患者早孕的可行性、有效性。方法 :92例早孕合并子宫肌瘤的健康妇女给予米非司酮 1 5 0 mg配伍米索前列醇 1 0 0 0 μg终止妊娠。结果 :完全流产率为 89.1 % ,出血时间平均为 1 1 .89± 6.87d。多因素分析提示肌瘤大小对孕囊排出时间、出血时间有影响 ,孕囊大小对出血时间有影响。但肌瘤位置、个数对药流结局、出血时间和转经时间均无明显影响。结论 :米非司酮配伍米索前列醇终止子宫肌瘤患者早孕是可行、有效、安全的     

米非司酮配伍前列腺素抗早孕效果影响因素的探讨

目的:探讨国产米非司酮配伍前列腺素抗早孕效果的影响因素。方法:将500例分为两组,一组用米非司酮25mg,每日2次,连服3d,第4天上午阴道塞卡前列腺素栓(15-甲基PGF_(2a)酸)1mg(简称卡前列素栓组)。另一组米非司酮的用法及剂量与前一组同,第4天上午口服米索前列醇0.6mg(简称米索组)。结果:米索组完全流产率为93.2%,明显高于卡前列素栓组的88.4%(P<0.05)。米索组的流产效果受服药者年龄、既往人工流产次数、用药前胚囊平均直径与血β-hCG水平的影响较卡前列素栓组小。结论:米非司酮配伍米索前列醇是方便、有效、副作用小的抗早孕方法。用药后2w测定β-hCG值结合B超检查可用于监测药物流产效果,有实用价值。     

米非司酮配伍米索前列醇用作黄体晚期生育调节的临床研究

目的 :探讨米非司酮配伍米索前列醇黄体晚期用作生育调节的有效性、安全性和可接受性。方法 :预期月经来潮前 5日～月经来潮当日开始口服米非司酮 ,2 5 mg,q1 2 h× 4次 ,并于首次用药后48h口服米索前列醇 40 0μg。结果 :共接纳了 61名对象 ,服药周期为 2 67个。共有 1 3个周期妊娠 ,其中 7个周期完全流产 ,6个周期继续妊娠 ,故总妊娠率为 4.87% ( 1 3 / 2 67) ,服药后继续妊娠率为2 .2 5 % ( 6/ 2 67) ,妊娠周期的服药失败率为 46.1 5 % ( 6/ 1 3 )。用药期间 ,月经周期与经期长度均无明显变化。2 67个服药周期中有 1 94个周期按照科研设计服药 ,占 72 .66%。结论 :米非司酮配伍米索前列醇黄体晚期用作生育调节有一定效果 ,但有效性、依从性与可接受性有待进一步提高     

早孕6～8周药物流产的临床观察

在早孕米非司酮配伍米索前列醇(米索)药物流产中,孕囊平均直径是影响完全流产率的一个重要因素。我们发现孕囊平均直径与完全流产率呈负相关[1],上海15个单位多中心临床试验也发现孕囊直径<15mm组的完全流产率显著高于≥15mm组[2]。为了提高早孕药流中孕囊>15mm者的完全流产率,我们设想在米非司酮配伍米索前列醇的基础上,再加辅助药物,以加强对滋养叶细胞或蜕膜细胞的杀伤作用。本文选用紫草和达那唑,比较它们的临床疗效,以选出较好的辅助药物及合理的给药剂量。对象及方法一.对象及分组健康早孕妇女,年龄18～40岁,停经6～8周,无药流禁忌症…     

复方米非司酮与米非司酮贯序用米索前列醇的药流效果比较研究

目的:比较新型抗早孕药物复方米非司酮和米非司酮的药流效果。方法:将妊娠49d的早孕妇女随机分组:①复方米非司酮组50例,口服复方米非司酮1片/24h×2(米非司酮共60mg),首次服药后48h后米索前列醇600μg。②米非司酮组50例,口服米非司酮25mg/12h×5次,首次加倍(米非司酮共150mg),末次服米非司酮后1-2h续服米索前列醇600μg。结果:复方米非司酮组和米非司酮组完全流产率分别为96%和92%;出血时间为11.00±3.35d和14.64±3.98d;转经时间为31.7±4.5d和34.6±6.5d;排出孕囊时间为3.59±1.98和3.65±1.47。两药比较,复方米非司酮组完全流产率和孕囊自行排出率明显高于米非司酮组。结论:复方米非司酮加速孕囊排出,提高完全流产率,有减少出血量的趋势,减少米索用量,且服药方法简便,时间短,剂量小,副作用减少,临床效果优于米非司酮。     

低剂量米福配伍米索前列醇终止早孕804例临床分析

近年,米非司酮配伍米索前列醇终止早孕广泛用于临床,临床成功率95%以上[1],有的完全流产率甚至可达95%~98%[2]。为确定低剂量米福(50mg)配伍米索前列醇终止早孕的效果,2005年9月至2006年3月我们对比研究了804例米非司酮片剂(150mg)及米福(50mg)配伍米索前列醇的抗早孕效果,现报     

米非司酮配伍米索前列醇终止畸形子宫早孕63例临床分析

目的 :探讨米非司酮配伍米索前列醇终止畸形子宫早孕的临床疗效。方法 :对 6 3例早孕合并畸形的流产病例均采用药物流产方法 ,即 :米非司酮 75mg× 2 (早 50 mg,晚 2 5mg)口服 ,d 3晨空腹服米索前列醇 6 0 0μg。结果 :完全流产率 44 /6 3(6 9.8% ) ,不全流产率 1 7/6 3(2 7.6 % ) ,失败 2 /6 3(3.2 % )。对 1 7例不全流产、2例失败者行刮宫及吸宫术 ,手术操作容易 ,穿孔率及漏吸率为 0。B超用于诊断畸形子宫正确率高。结论 :米非司酮配伍米索前列醇终止畸形子宫早孕的方法较理想 ,B超是诊断子宫畸形较理想的手段     

米非司酮配伍米索前列醇终止10～14周妊娠临床多中心研究

近10多年来,国内外大量临床研究已经证明米非司酮配伍前列腺素类似物能有效终止早孕,不仅用于停经49d以内,也用于停经56d及63d以内的妊娠[1]。近年来,国内外虽然已陆续有应用米非司酮配伍米索前列醇口服用于终止10～16周妊娠的报道,但两种药物配伍的剂量大小和给药方案,均不尽相同。本研究选择孕10～14周健康妇女作为试验对象,进行多中心临床研究,目的为在不同地区、不同条件下,应用同样给药方案,观察米非司酮配伍米索前列醇口服给药,对该阶段妊娠的引产效果、副反应、转经情况及其可接受性,提供临床参考。材料和方法一、对象选择停经70～98…     

Acceptability of suction curettage and mifepristone abortion in the United States: a prospective comparison study

OBJECTIVE: We sought to compare the acceptability of suction curettage abortion with that of medical abortion with mifepristone and misoprostol in American women. STUDY DESIGN: We performed a prospective, serially enrolled, cohort analysis. The study population consisted of 152 subjects receiving mifepristone and misoprostol and 174 subjects undergoing suction curettage abortion aged > or =18 years with intrauterine pregnancies of up to 63 days' estimated gestation. Questionnaires regarding expectations and experiences were administered before the abortion and at the 2-week follow-up visit. RESULTS: Subjects undergoing medical abortions reported significantly greater satisfaction than those undergoing surgical abortions (mean rank, 121 vs 149; P <.01) but were no more likely to recommend the method they had just experienced to a friend (97% vs 93.3%). If a future abortion was required, however, 41.7% of subjects undergoing surgical abortions indicated they would opt for a medical abortion, whereas only 8.6% of subjects receiving medical abortions would choose a surgical abortion (P <.001). Failure of the abortion decreased satisfaction in the medical group and increased the likelihood of choosing a surgical abortion for a subsequent procedure (P <.001). Surgical subjects who experienced more anxiety than expected during the abortion were more likely to choose a medical procedure for a subsequent abortion (P <.01). CONCLUSION: Women receiving mifepristone and misoprostol were more satisfied with their method and more likely to choose the same method again than were subjects undergoing surgical abortion. Failure of a medical abortion and increased anxiety during surgical abortion were associated with preference for the alternative technique in a future procedure.     

Systematic Review of the Effectiveness,Safety, and Acceptability of Mifepristone and Misoprostol for Medical Abortion in Low- and Middle-Income Countries

ObjectiveAbortion-related complications remain one of the leading causes of maternal morbidity and mortality worldwide. Nearly half of all abortions are unsafe, and the vast majority of these occur in low- and middle-income countries. The use of mifepristone with misoprostol for medical abortion has been proposed and implemented to improve abortion safety.Data SourcesA systematic review of the literature was conducted in PubMed, Embase, Cochrane, and CINAHL.Study SelectionCriteria for study inclusion were first-trimester abortion, use of mifepristone with misoprostol, and low- or middle-income country status as designated by the World Health Organization.Data ExtractionResults for effectiveness, safety, acceptability, and qualitative information were assessed.Data SynthesisThe literature search resulted in 181 eligible articles, 52 of which met our criteria for inclusion. A total of 34 publications reported effectiveness data on 25 385 medical abortions. The average effectiveness rate with mifepristone 200 mg and misoprostol 800 µg was 95% up to 63 days gestation. A sensitivity analysis was performed to assume that all women lost to follow-up failed treatment, and the recalculated effectiveness rate remained high at 93%. The average continuing pregnancy rate was 0.6%. A total of 22 publications reported safety and acceptability data on 17 381 medical abortions. Only 0.8% abortions required presentation to hospital, and 87% of patients found the side effects of treatment acceptable. Overall, 95% of women were satisfied with their medical abortion, 94% would choose the method again, and 94% would recommend this method to a friend. A total of 16 publications reported qualitative results and the majority supported positive patient experiences with medical abortion.ConclusionsMifepristone and misoprostol is highly effective, safe, and acceptable to women in low- and middle-income countries, making it a feasible option for reducing maternal morbidity and mortality worldwide.     

Risk factors for unsuccessful medical abortion with mifepristone and misoprostol

BACKGROUND: The aim of this study was to determine the effectiveness of medical abortions with mifepristone and misoprostol following the approval of medical abortion in Israel. METHODS: A retrospective review of 377 consecutive medical records at an ambulatory care unit of a university medical centre was performed, screening all women undergoing medical abortion with mifepristone and misoprostol. Transvaginal ultrasonographic study and serum beta hCG measurement were performed 14-20 days after the procedure. The clinical outcome was defined as complete expulsion of intrauterine contents with (failed group) or without (successful group) surgical intervention. RESULTS: Surgical intervention was performed in 7.4% of patients. Residual products of conception were confirmed in 89%. Older age, previous spontaneous abortions, multigravidity, and earlier follow-up visit were independently associated with unsuccessful medical abortion. Significant differences were found in mean serum beta hCG and mean endometrial thickness in the successful versus failed procedure groups. CONCLUSIONS: Medical termination of pregnancy with mifepristone and misoprostol is >90% effective. High risk group for failure of the procedure can be characterised. An algorithm of follow up using follow-up visit date, serum beta hCG and sonographic endometrial stripe is suggested to define high risk patients for failed medical abortion.     

Outcomes During Early Implementation of Mifepristone-Buccal Misoprostol Abortions up to 63 Days of Gestation in a Canadian Clinical Setting

ObjectiveIn January 2017, mifepristone became available in Canada. The goal of this study was to determine the effectiveness and safety of mifepristone-misoprostol abortion during its early implementation in a Canadian setting.MethodsThis retrospective chart review included the first 477 patients who had a mifepristone-misoprostol abortion from March 13 to October 31, 2017, in an urban sexual health clinic. Women with pregnancies up to 63days of gestation had an initial dating ultrasound and β-human chorionic gonadotropin determination. They were provided mifepristone 200 mg orally in clinic, followed 24–48hours later with misoprostol 800 µg buccally at home. Follow-up, 7–14days later, in clinic or by telephone, used symptom review and follow-up β-human chorionic gonadotropin or ultrasound. The primary outcome was successful abortion, defined as expulsion of pregnancy without uterine aspiration.ResultsOf 477 consecutive mifepristone abortions, 422 women (88.5%) had documented follow-up, with 408 (96.7%) successful abortions, including eight in women who had a repeat dose of misoprostol. Fourteen (3.3%) unsuccessful abortions required uterine aspiration, two (0.5%) for ongoing pregnancy and 12 (2.8%) for incomplete abortion or persistent bleeding. Seventeen women (4.0%) had emergency department visits, one (0.2%) of whom was hospitalized and three (0.7%) of whom received blood transfusion. Four women (1.0%) were treated for infection.ConclusionMifepristone-misoprostol medical abortion was safe and effective during early implementation in Canada, comparable to previously published outcomes.     

Vaginal misoprostol for abortion at 10-13 weeks' gestation.

OBJECTIVE: The effectiveness and safety of misoprostol have been reported for abortion up to 22 weeks' gestation. The objective of this study was to demonstrate the effectiveness and safety of self-administration of misoprostol every 12 h, without the need of postexpulsion systematic curettage, in late first-trimester abortions (10-13 weeks' gestation). METHODS: A group of 180 women with gestations from 64 to 91 days, self-administered 800 micrograms of vaginal misoprostol every 12 h for a maximum of three doses without performing postexpulsion systematic preventive curettage. Outcome measures included successful abortion (complete and incomplete abortion without requiring a surgical procedure), side-effects, mean expulsion time and vaginal bleeding. RESULTS: Successful abortion occurred in 153/180 (85%) subjects (95% confidence interval (CI) 79-90). The decrease of hemoglobin was statistically significant (p = 0.0001) but clinically unimportant: 12.1 mg/dl (SD 1.1) before treatment and 11.7 mg/dl (SD 1.1) afterwards. The mean expulsion time for patients who aborted after the first dose was 8.3 +/- 3.6 h (median 8 h, range 2-12 h). Vaginal bleeding lasted 6 +/- 3 days, spotting 7 +/- 3 days and total bleeding 13 +/- 4 days. The median dose of misoprostol administered was 1780 micrograms (range 1400-3000 micrograms). CONCLUSIONS: The high degree of acceptability, its efficacy and the fact that postabortion systematic curettage was not needed make misoprostol a suitable alternative to the currently available methods for termination of pregnancy at 10-13 weeks' gestation.     

Mifepristone medical abortion in Albania: results from a pilot clinical research study.

OBJECTIVE: To explore the acceptability and feasibility of introducing mifepristone-misoprostol for early medical abortion in home and clinic settings in Albania. METHODS: This was a prospective study testing a simplified mifepristone-misoprostol regimen in two tertiary-level government health facilities in Tirana, Albania. Women (n = 409) with amenorrhea of 8 weeks or less received 200 mg mifepristone in the clinic and then chose whether to take 400 microg of oral misoprostol 2 days later either at home or in the clinic. RESULTS: Nearly 97% of women successfully terminated their pregnancies using the simplified regimen. Almost all women found the method either satisfactory (49.4%) or highly satisfactory (41.1%). Almost all women who were given the option selected the home use protocol. Women choosing home administration of misoprostol were able to manage the medical abortion process on their own. CONCLUSION: A reduced dose mifepristone medical abortion regimen with home administration of misoprostol is feasible for introduction into healthcare facilities in Albania.     

Efficacy of mifepristone followed on the same day by misoprostol for early termination of pregnancy: report of a randomised trial

Objective To examine the clinical efficacy of mifepristone 600 mg followed on the same day or two days later by misoprostol 400μg orally in women undergoing medical termination of pregnancy whose pregnancies have a gestational age up to 49 days.
Design Prospective, randomised trial.
Setting Clinical research office.
Participants Eighty-six women, requesting elective termination of a pregnancy which has a gestational age of  ≤ 49  days.
Methods After administration of mifepristone 600 mg, participants were randomised to take misoprostol six to eight hours later (Group 1) or 48 hours later (Group 2). Women returned for a follow up evaluation  24±1  hours after taking the misoprostol. Participants in Group 1 who had not aborted received a second dose of misoprostol to take 48 hours after the mifepristone. All women returned approximately two weeks after receiving mifepristone. If termination of pregnancy had still not occurred and the pregnancy was non-viable, the woman returned again in three weeks.
Main outcome measures Rate of complete abortion 24 hours after administration of misoprostol.
Results At 24 hours after receiving misoprostol, 21/42 (50%, 95% CI 35%, 65%) women in Group 1 and 40/44 (91%, 95% CI 82%, 99%) women in Group 2 had complete abortions. By follow up two weeks later after the administration of mifepristone, 40/42 (95%, 95% CI 89%, 100%) women in Group 1 and 43/44 (98%, 95% CI 93%, 99%) women in Group 2 were known to have complete abortions. Nausea, vomiting or diarrhoea in women using the standard regimen (Group 2) occurred in 68%, 36%, and 20%, respectively.
Conclusions After treatment with mifepristone 600 mg, administration of misoprostol  400 μg  orally on the same day is not as effective at causing abortion within the first 24 hours compared with the standard time interval of 48 hours between medications.     

Early pregnancy termination with mifepristone and misoprostol in Norway.

OBJECTIVES: Medical abortion was first introduced in Norway in April 1998. The aims of this study were to assess the efficacy, side effects, and acceptability of medical abortion using mifepristone orally and misoprostol vaginally in a Norwegian population. DESIGN: The study included the first 226 pregnant women with gestational age of <63 days who requested nonsurgical abortion during the first year in the first Norwegian hospital using this regimen. METHODS: All women received a single dose of mifepristone 600 mg orally, followed at 48 hours by 800 microg misoprostol vaginally. Treatment outcome and complications were the principal outcome measures. We also measured the rates of side effects such as abdominal pain and bleeding and the women's acceptability of treatment. RESULTS: Abortion was successful in 95%, surgical evacuation became necessary in 4%, and the pregnancy continued in one woman. During the study period the method was chosen by 23% of those requesting abortion before 63 days amenorrhea; 80% would use the method again; 81% would recommend it to a friend; in retrospect, 69% would not have been willing to be randomly allocated to either a medical or a surgical method. CONCLUSIONS: The combination of orally administrated mifepristone and vaginally administrated misoprostol is an abortion method that is both effective and safe, has few side effects and is well accepted by Norwegian women.     

Mifepristone and misoprostol and methotrexate/misoprostol in clinical practice for abortion

OBJECTIVE: The purpose of this study was to evaluate the efficacy, side-effect profile, and follow-up rates in women who obtain a medical abortion in a nonresearch setting. STUDY DESIGN: From December 1, 2000, to June 30, 2001, we prospectively followed 218 women who had been evaluated in our private office for medical abortion. Women received either mifepristone 200 mg orally followed 1 to 2 days later by self-administered misoprostol 800 microg vaginally or methotrexate 50 mg/m(2) intramuscularly followed 3 to 7 days later by self-administered misoprostol 800 microg vaginally. RESULTS: Of the 174 women who had a medical abortion, 148 women (85%) chose mifepristone/misoprostol, and 26 women (15%) chose methotrexate/misoprostol. In women up to 49 days of gestation, complete abortion occurred by the first follow-up visit in 82 of 86 women (95%; 95% CI, 89-99) and in 21 of 25 women (84%; 95% CI, 64-95) women, respectively. In women who used mifepristone/misoprostol from 50 to 63 days of gestation, complete abortions occurred in 56 of 59 women (95%; 95% CI, 86-99) women. Four women (2%; 95% CI, 1-6) were lost to follow-up. CONCLUSION: Medical abortion with mifepristone/misoprostol and with methotrexate/misoprostol can be provided in a nonresearch setting with efficacy similar to that reported in the medical literature for research protocols.