米索前列醇联合依沙吖啶在中晚期妊娠引产中的临床应用

目的 探讨米索前列醇联合依沙吖啶在中晚期妊娠引产中的应用效果。方法 选取西安交通大学附属3201医院2012年1月—2017年12月收治的138例中晚期妊娠引产患者，按引产方式分为对照组、观察组，各69例。对照组使用乳酸依沙吖啶注射液进行引产，观察组在对照组的基础上联合使用米索前列醇进行引产。比较两组引产效果、胎儿娩出时间、阴道出血量及不良反应的发生情况。结果 观察组引产有效率是100%，显著高于对照组的91.75%（P<0.05）。观察组胎儿娩出时间<35 h的人数占比显著高于对照组（P<0.05）。观察组患者阴道出血量显著低于对照组（P<0.05），两组不良反应的发生率间差异不显著。结论 米索前列醇联合依沙吖啶在中晚期妊娠引产中的效果较好，可显著提高引产有效率、缩短胎儿娩出时间，值得临床应用。     

双针刺疗法联合米索前列醇在118例孕足月产妇催产中的应用及对产妇宫颈成熟的影响＊

目的 研究118例孕足月产妇催产中采用双针刺疗法联合米索前列醇的效果对其宫颈成熟的影响。方法 选取2019年6月-2020年6月在我院就诊的足月催产患者118例，按照随机数字分配法分为米索前列醇治疗组和联合治疗组，各59例。米索前列醇治疗组给予米索前列醇片进行治疗，联合治疗组在米索前列醇治疗组的基础上给予双针刺疗法针刺双侧合谷、三阴交穴位。统计两组患者宫颈成熟、子宫活动力、宫口扩张速度、出血量、产程、分娩方式、新生儿情况及催产效率。结果 联合治疗组宫颈口扩张、宫颈管消退、先露位置、宫颈硬度、宫口位置指标均大于米索前列醇治疗组，有统计学差异（P < 0.05）。联合治疗组子宫活动力、宫口扩张速度均大于米索前列醇治疗组，产时出血量、产后2 h出血量均低于米索前列醇治疗组，有统计学差异（P < 0.05）。联合治疗组第一产程、第二产程、第三产程、总产程均小于米索前列醇治疗组，有统计学差异（P < 0.05）。联合治疗组阴道分娩患者例数多于米索前列醇治疗组，剖宫产患者例数少于米索前列醇治疗组，有统计学差异（P < 0.05）。联合治疗组催产效率高于米索前列醇治疗组，有统计学差异（P < 0.05）。结论 双针刺疗法联合米索前列醇在足月产妇催产中应用能促进患者宫颈成熟，减少产后出血量，缩短产程，促进阴道分娩，催产效率高。     

Self-managed abortion: A systematic scoping review

Self-managed abortion, when a person performs their own abortion without clinical supervision, is a model of abortion care used across a range of settings. To provide a comprehensive synthesis of the available literature on self-managed abortion, we conducted a systematic search for peer-reviewed research in April 2019 in PubMed, Embase, Web of Science, Popline, PsycINFO, Google Scholar, Scielo, and Redalyc. We included studies that had a research question focused on self-managed abortion; and were published in English or Spanish. The combined search returned 7167 studies; after screening, 99 studies were included in the analysis. Included studies reported on methods, procurement, characteristics of those who self-managed, effectiveness, safety, reasons for self-managed abortion, and emotional and physical experiences. Numerous abortion methods were reported, most frequently abortion with pills and herbs. Studies reporting on self-managed medication abortion reported high-levels of effectiveness. We identify gaps in the research, and make recommendations to address those gaps.     

2017–19 governmental decisions to allow home use of misoprostol for early medical abortion in the UK

Home use of misoprostol for early medical abortion has long been an established practice in several countries. It is a safe, effective, and dignified means of obtaining a legal abortion, with a low risk of complications. In the UK, however, the practice has only recently been permitted. Prior to the change, women were required to attend a clinic to be observed taking the drug, before being discharged to go home and see through the process. The requirement to attend a clinic was a result of political rather than medical reasoning; a desire not to provoke pro-life groups. It also highlighted an inconsistency whereby misoprostol was prescribed for home use to women who had suffered an incomplete miscarriage. Failure to permit home use of misoprostol for early medical abortion has caused women to suffer trauma when experiencing the effects of the drug when returning home from clinics, in addition to acting as an obstacle to access for women living in remote areas with no nearby clinic. Through an overview of recent developments in UK abortion policy, I demonstrate the lack of good, medical reasons for the delayed change. Further, I suggest appropriate future steps to be taken by policymakers.     

Misoprostol as an adjunct to overnight osmotic dilators prior to second trimester dilation and evacuation: A systematic review and meta-analysis,

ObjectiveTo understand effect of adjunct misoprostol on cervical preparation with overnight osmotic dilators for dilation and evacuation after 16 weeks gestation.MethodsWe searched on-line reference databases using search terms for second trimester, abortion, misoprostol, and dilators. Randomized controlled trials of cervical preparation for second trimester D&E using overnight osmotic dilators comparing adjunct misoprostol to placebo were included. Weighted mean with standard deviation (SD) and pooled binary outcomes were compared.ResultsAmong 84 articles identified, three met inclusion criteria (n = 457 subjects) adjunct misoprostol did not significantly decrease mean procedure times (8.5 ± 4.6 vs 9.6 ± 5.8 min, p = 0.78) or manual dilation (18% vs 28%, p = 0.23) when compared to placebo. There was no difference in total complications (p = 0.61), major complications (p = 0.44), or cervical lacerations (p = 0.87).ConclusionCurrent limited evidence suggests adjunct misoprostol with osmotic dilators after 16 weeks does not affect procedure time or need for manual dilation.ImplicationsFurther research is needed to determine the effect of adjunct misoprostol on major complications and blood loss.     

Online access to abortion medications: a review of utilization and clinical outcomes

We performed a search in PubMed and Web of Science on the self-use of abortion medication after online access. Studies published between January 1, 1995, and March 31, 2019, were considered. We included studies of online services that were (i) led by healthcare staff (n = 14), (ii) led by non-healthcare staff (n = 4), and (iii) providing noninteractive access (n = 17). Our outcomes were utilization (frequency and demand for services), acceptability for women, safety, and success rate. Key findings: Women are increasingly using the Internet to access abortion medication. Available services are of varying quality. Women accessing noninteractive services report feelings of distress related to the lack of medical guidance, and the demand for interactive guidance through the abortion process is high. Women using services led by healthcare staff report high rates of satisfaction and similar rates of clinical outcomes as those of in-person abortion care.     

Efficacy of medical abortion prior to 6 gestational weeks: a systematic review

Objective

The objective was to describe the efficacy of medical abortion using mifepristone and misoprostol for gestations less than 6 weeks.

“It is just like having a period with back pain”: exploring women’s experiences with community-based distribution of misoprostol for early abortion on the Thailand–Burma border

Introduction

The lack of economic development and longstanding conflict in Burma have led to mass population displacement. Unintended pregnancy and unsafe abortion are common and contribute to maternal death and disability. In 2011, stakeholders operating along the Thailand-Burma border established a community-based distribution program of misoprostol for early abortion, with the aim of providing safe and free abortion care in this low-resource and legally restricted setting.

Accompaniment of second-trimester abortions: the model of the feminist Socorrista network of Argentina

Objective

Legal restrictions on abortion access impact the safety and timing of abortion. Women affected by these laws face barriers to safe care that often result in abortion being delayed. Second-trimester abortion affects vulnerable groups of women disproportionately and is often more difficult to access. In Argentina, where abortion is legally restricted except in cases of rape or threat to the health of the woman, the Socorristas en Red, a feminist network, offers a model of accompaniment wherein they provide information and support to women seeking second-trimester abortions. This qualitative analysis aimed to understand Socorristas' experiences supporting women who have second-trimester medication abortion outside the formal health care system.

依沙吖啶联合米非司酮和米索前列醇治疗中期妊娠引产的疗效观察

目的探讨乳酸依沙吖啶注射液联合米非司酮片和米索前列醇片治疗中期妊娠引产的临床疗效。方法选取2013年9月—2017年3月安阳市人民医院妇产科收治的中期妊娠引产患者132例为研究对象,将所有患者分为依沙吖啶组(A组,44例)、米非司酮联合米索前列醇组(B组,41例)和依沙吖啶联合米非司酮和米索前列醇组(C组,47例)。A组腹部注射位点采用腰穿针行羊膜腔穿刺,注入乳酸依沙吖啶注射液100 mg。B组口服米非司酮片,50 mg/次,2次/d,连续3 d,第4天阴道后穹窿放置米索前列醇片0.4 mg。C组口服米非司酮片100 mg/次,1 h后采用腰穿针行羊膜腔穿刺,注入乳酸依沙吖啶注射液100 mg,12 h后阴道后穹窿放置米索前列醇片0.4 mg。观察各组患者的引产效果,比较术中及术后情况。结果3组引产成功率比较差异无统计学意义。A、B、C组清宫率分别为36.36%、29.27%、12.77%,C组清宫率明显低于A、B组,3组比较差异具有统计学意义(P0.05)。C组用药至宫缩时间、引产时间、产后2 h出血量、产后出血天数、胎盘残留率显著低于A、B组,3组比较差异具有统计学意义(P0.05)。C组1级疼痛程度明显高于A、B组,3、4级疼痛程度明显低于A、B组,3组比较差异具有统计学意义(P0.05)。3组患者复潮时间、经期持续时间相当,没有统计学差异。结论乳酸依沙吖啶注射液联合米非司酮片和米索前列醇片治疗中期妊娠引产具有较好的临床效果,可降低清宫率和胎盘残留率,缩短用药至宫缩时间、引产时间,减少出现量和出血天数,具有一定临床推广应用价值。