米索前列醇在人工流产术中扩张宫颈的临床观察

<正>为了探索米索前列醇(以下简称米索)在人工流产术中扩张宫颈的临床效果,我们对198例要求行人工流产的孕6～13周健康妇女给予口服米索行药物扩宫,观察结果如下.     

笑气吸入人工流产术前直肠给药米索前列醇扩张宫颈的剂量观察

目的 探讨早孕妇女在笑气无痛人流术前直肠给药米索前列醇扩张宫颈口的适宜剂量，了解用药后扩宫效果及不良反应。方法 选择900例未经阴道分娩，自愿行笑气无痛人工流产、无禁忌证、孕40～60天的妇女，随机分为3组。每组在笑气吸入无痛人流术前直肠给药米索前列醇分别为200μg、400μg、600μg，观察不同剂量给药后孕妇腹痛、阴道流血、流产、术中宫颈口扩张程度、镇痛效果及术中出血情况。结果 米索前列醇用量越大，宫颈口扩张越好，但术前腹痛、阴道流血、流产等不良反应越重，各组术中疼痛及出血量无明显差异。400μg组宫颈扩张效果满意、并发症少、安全。结论 笑气吸入人工流产术前2～3h直肠给药米索前列醇400μg，扩宫满意，镇痛效果好，并发症少，受术者易接受，设备及方法简单。安全可靠，价格便宜，稳定性好，值得推广。     

米索前列醇与宫术安栓人流术前扩张宫颈比较性研究

米索前列醇与宫术安栓人流术前扩张宫颈比较性研究张丽霞，朱龙凤，姚梅影（上海第二医科大学附属瑞金医院妇产科，上海，２０００２５）吸宫止孕前均需作机械性扩张宫颈，可能造成宫颈、子宫或邻近组织损伤。在扩宫颈过程中会产生酸、胀、痛的感觉，有的孕妇难以忍受。国...     

米索前列醇不同给药途径在人工流产中的临床效果

目的:探讨米索前列醇不同的给药途径在人工流产中的临床价值和作用。方法:将患者随机划分为空腹口服、舌下含服和阴道给药途径的治疗组,比较不同给药途径对人工流产疗效的影响。结果:米索前列醇的舌下含服方法在软化宫颈、扩大张力、减缓疼痛、出血记忆不良反应等方面具有明显显著的优势作用。结论:舌下含服途径具有较多优点,在临床中具有显著的优势和作用。     

钳刮术前口服米索前列醇临床观察

1999年 6～ 11月我院采用术前 1～ 2小时口服米索前列醇片 6 0 0 μｇ方法 ,对 5 0例孕 11～ 15周者进行钳刮术 ,并随机选择同样条件 5 0例宫颈插管后行钳刮术为对照组 ,进行对比研究。1　资料与方法1.1　对象　 10 0例孕 11～ 15周的健康妇女 ,自愿要求终止妊娠 ,无药物过敏史及前列腺素应用禁忌证 ,经妇科检查及Ｂ超证实为宫内妊娠且胎儿大小与孕周相符 (胎儿头臀长 <7ｃｍ) ,各项常规检查正常 ,年龄 19～ 30岁 ,初孕 4 5例 ,经孕未产 4 0例 ,经产 15例 ,未婚先孕 6 1例 ,随机分为研究组 (5 0例 )和对照组 (5 0例 ) ,两组年龄、孕产次及孕…     

米索前列醇阴道给药用于足月妊娠引产的临床观察

米索前列醇（Ｍｉｓｏ）既保存前列腺素Ｅ１（ＰＧＥ１）的活性,又克服了天然ＰＧＥ１的缺点,其作用较ＰＧ０５即卡波前列甲醇（ｃɑｒｂｏｐｒｏｓｔｍｅｔｈｙｌ）弱（１）。配伍米非司酮（Ｍｉｆｅ）用于早、中孕药物流产,临床效果满意。Ｒｅｆɑｅｙ等报道阴道给药...     

曲马朵配伍米索前列醇用于人工流产临床观察

人工流产时需用扩棒强行扩张宫颈。有可能导致宫颈裂伤、人流综合反应等并发症。我们运用曲马朵注射液静注配伍米索前列醇阴道放药的方法行人工流产术，取得了满意的效果，现报告如下。     

间苯三酚与米索前列醇用于妇科术前患者宫颈扩张的效果

目的 观察在妇科术前患者宫颈扩张处理中实施间苯三酚与米索前列醇的效果。方法 选取120例妇科术前宫颈扩张患者,根据随机数字表法分组,各60例。对照组实施米索前列醇扩张宫颈,观察组实施间苯三酚扩张宫颈。比较两组临床疗效。结果 观察组不良反应发生率低于对照组（P<0.05）。观察组术中出血量少于对照组,宫颈扩张时间短于对照组,宫颈扩张程度高于对照组（P<0.05）。观察组宫颈扩张率高于对照组（P<0.05）。观察组治疗总有效率96.67%高于对照组的86.67%(P<0.05)。结论 在妇科术前宫颈扩张患者治疗中,间苯三酚的治疗效果明显优于米索前列醇,可优化患者的手术指标,宫颈扩张程度显著,且具有安全性。     

米索前列醇在早期人工流产术中的应用

本文前瞻性地于人流术前口服米索前列醇作药物扩宫共５１例，与对照组５０例结果相对照。确诊早孕后口服米索前列醇２００μｇ，每日４次，共２天，服完末次药后１～３小时作吸宫人流术，研究组人流时宫颈变软，松弛可入６～７．５号宫颈扩张器者共４３例，总有效率为８４．３１％，对照组占３８％，Ｘ＾２检验Ｐ〈０．０１，差异非常显著，结果认为口服米索前列醇，可使宫颈变软，宫口松弛，是一种简便，安全，有效的药物扩宫法。     

A randomized controlled comparison of sublingual and vaginal administration of misoprostol for cervical priming before first-trimester surgical abortion

OBJECTIVE: The purpose of this study was to compare the effectiveness of the sublingual and vaginal administration of misoprostol for cervical priming before surgical termination of pregnancy. STUDY DESIGN: In a randomized controlled trial, 74 primigravid women who were undergoing surgical abortion were assigned randomly to receive misoprostol (400 microg) sublingually or vaginally. RESULTS: There was no statistically significant difference in the cumulative force that was required to dilate the cervix to 9 mm, for baseline cervical dilatation, for priming to abortion interval, for operating time, or for intraoperative blood loss between the two groups. Women in the sublingual group had more nausea (P=.008), vomiting (P=.01), diarrhea (P=.01), and unpleasant mouth taste (P=.0001) compared with the women in the vaginal group. In the sublingual group, 65% of women were satisfied with the route of misoprostol administration compared with 78% in the vaginal group (P=.11). Most of the staff members (84%) said that they would recommend the sublingual administration of misoprostol (P=.0001). CONCLUSION: The sublingual administration of misoprostol is an effective alternative to vaginal administration for cervical priming before surgical abortion; despite a higher incidence of side effects, there was high patient and staff acceptability.     

Vaginal misoprostol for cervical priming before dilatation and curettage in postmenopausal women: a randomized controlled trial

AIM: To investigate the efficacy of vaginal misoprostol for cervical priming before dilatation and curettage in postmenopausal women. METHODS: Forty-four postmenopausal women with indication for dilatation and curettage were randomly assigned to receive either 400 micro g of misoprostol or placebo vaginally 6 h before dilatation and curettage. The main outcome measures were the number of women who required cervical dilatation, cervical width, time taken to dilate to Hegar 6 and other complications. RESULTS: The mean cervical diameter (4.59 millimeters in the misoprostol group vs 4.41 millimeters in the placebo group) was comparable between the two groups. A similar number of women in the misoprostol group and in the placebo group required cervical dilatation (12 vs 16, P = 0.35). The operative times for both groups were similar. The incidence of side-effects was comparable in both groups. There were two uterine perforations in the misoprostol group (2 vs 0). CONCLUSION: There was no significant benefit from applying 400 micro g vaginal misoprostol 6 h prior to dilatation and curettage in postmenopausal women.     

Cervical priming with misoprostol before manual vacuum aspiration versus electric vacuum aspiration for first-trimester surgical abortion

Objective

To compare the efficacy of manual vacuum aspiration (MVA) with electric vacuum aspiration (EVA) and to evaluate whether cervical priming with misoprostol facilitates cervical dilation and reduces complications associated with first-trimester medical abortion performed up to 10 weeks of pregnancy.

Methods

A total of 600 women who requested termination of pregnancy were randomized into 4 groups (150 women in each group). Group I and II received a vaginal placebo 3 hours before MVA or EVA, respectively. Group III and IV received 400 μg of vaginal misoprostol 3 hours before MVA or EVA, respectively.

Results

Complete abortion rates after MVA and EVA were both 97.9%; after cervical priming with misoprostol complete abortion rates were 98.6% versus 97.3% after cervical priming with placebo (P > 0.05). Administration of misoprostol into the vagina before MVA resulted in 99.3% complete abortions (P = 0.40), and the least operative blood loss, operating time, and need for cervical dilation (P < 0.05). Overall complications and adverse effects were similar in all groups (P > 0.05).

Conclusion

For surgical evacuation, EVA and MVA did not differ in efficacy. Cervical priming 3 hours before MVA for termination of pregnancy significantly reduced the need for cervical dilation and the operative time, and improved the efficacy of the procedure. Pretreatment with vaginal misoprostol before MVA is a safe and effective method for terminating pregnancies of up to 10 weeks of gestation.Clinical Trials Registry: CTRI/2009/091/000008     

Spontaneous abortion: a randomized, controlled trial comparing surgical evacuation with conservative management using misoprostol

Objective: To compare the efficacy of surgical evacuation of the uterus with medical evacuation using misoprostol in cases of spontaneous abortion.

Design: A prospective, randomized, controlled trial.

Setting: A university teaching hospital.

Patient(s): Six hundred thirty-five women who aborted spontaneously and who consented to pretreatment randomization.

Intervention(s): Routine surgical evacuation or medical evacuation of the uterus using misoprostol.

Main Outcome Measure(s): Immediate, short-term (2–3 weeks), and medium-term (6 months) medical complications.

Result(s): There was a significantly lower incidence of immediate and short-term complications in the group treated with misoprostol compared with the surgically treated group. There were also fewer major complications in the 6 months after treatment in the medically treated group. Approximately 50% of the medically treated group subsequently required surgical evacuation, and these subjects required significantly more analgesia.

Conclusion(s): Treatment with misoprostol can reduce the demand for surgical evacuation in cases of spontaneous abortion, and its use is associated with fewer medical complications.     

氧化亚氮联合米索前列醇在基层医院人工流产术中的临床应用

目的 观察用氧化亚氮（笑气）吸入性镇痛加米索前列醇做术前预处理对人工流产术的疗效。方法 将同期门诊924例早孕初产妇要求人工流产术而无手术禁忌证者随机分为两组，一组为氧化亚氮吸入组，另一组为宫旁利多卡因注射组，分别观察镇痛效果、综合反应程度及出血情况。结果 两组镇痛效果及出血量比较差异有非常显著性（P〈0．01），人工流产综合征出现程度有统计学意义。结论 氧化亚氮吸入镇痛加米索前列醇软化宫颈术前预处理用于人工流产术镇痛效果好，综合反应少，适合基层医院开展手术的需要。     

Regimens of misoprostol with mifepristone for early medical abortion: a randomised trial

OBJECTIVE: To compare the efficacy, adverse effects and acceptability of the three most common misoprostol regimens used with mifepristone for medical abortion. DESIGN: Randomised nonblinded trial. SETTING: Three clinics associated with major research universities in Canada; two in major urban areas and one in a periurban area. POPULATION: Women of reproductive age. METHODS: Consenting women presenting for abortion services with gestations less than 56 days and who met inclusion criteria were given 200 mg mifepristone orally and then randomised into three misoprostol study groups: (group I) 400 micrograms of oral misoprostol, (group II) 600 micrograms of oral misoprostol, and (group III) 800 micrograms of vaginal misoprostol. Misoprostol was self-administered at home 24-48 hours following mifepristone, and participants were instructed to take a second similar misoprostol dose at 24 hours after the initial dose if bleeding was less than a normal menstrual period. MAIN OUTCOME MEASURES: Successful abortion without surgery was 94.1%, with no significant differences across the three study groups (94.7% in group I, 93.4% in group II, and 94.3% in group III; P= 0.975). RESULTS: Efficacy and adverse effects did not differ significantly across the three study groups. Pain increased significantly across the study and the gestational age groups and was associated with lower acceptability. CONCLUSIONS: There appears to be a range of safe and effective options for early medical abortion with mifepristone including a choice between oral and vaginal administration of misoprostol.     

米索前列醇联合杜冷丁异丙嗪用于712例人工流产的疗效观察

目的:探讨米索前列醇联合杜冷丁和异丙嗪在人工流产术中应用的临床效果。方法:选择我院2008年12月至2011年01月901例自愿要求做无痛流产的妇女,均为未生育的初孕女性,随机分为两组,试验组(n=712)术前2小时口服米索前列醇600ug,术中静脉推注杜冷丁和异丙嗪后行手术。对照组(n=189)不用任何药物直接进行手术。结果:试验组镇痛效果优于对照组,降低了人工流产综合征,并且缩短了手术时间,不增加阴道流血。结论:杜冷丁和异丙嗪联合米索前列醇在人工流产术中镇痛效果好,应用方便,值得临床推广使用。     

Comparison of oral and vaginal misoprostol for induction of labor at term: a randomized controlled trial

OBJECTIVE: To compare the efficacy of oral with vaginal misoprostol for induction of labor at term. METHODS: One hundred and fifty-three pregnant women at term with indications for induction of labor and Bishop score < or = 6 were randomly assigned to receive misoprostol either 100 microg orally or 50 microg vaginally every 6 h for 48 h. Repeated doses were given until Bishop score > or = 8 was achieved or spontaneous rupture of membranes occurred. Those who were not in labor after 48 h had labor induced with amniotomy and oxytocin. The main outcome measure was induction to delivery time. RESULTS: The median induction to vaginal delivery time in the oral group (14.3 h) was not significantly different from that of the vaginal group (15.8 h). The median number of doses was also not significantly different in the oral group compared with the vaginal group. There was a significant higher incidence of uterine tachysystole in the vaginal group compared to the oral group (17.1% vs 5.3%, P = 0.032). There was no hyperstimulation in either group. There were no significant differences between the groups with respect to oxytocin augmentation, cesarean section rate, analgesic requirement, and neonatal outcomes. CONCLUSION: Oral administration of 100 microg misoprostol has similar efficacy to intravaginal administration of 50 microg misoprostol for labor induction with less frequent abnormal uterine contractility. 100 microg of misoprostol orally can be used as an alternative to the vaginal route for labor induction.     

Cervical priming with sublingual misoprostol vs. 15-methyl-prostaglandin F2alpha prior to surgical abortion.

OBJECTIVE: To compare the efficacy and tolerability of sublingual misoprostol with those of intramuscular 15-methyl-prostaglandin F2alpha (15-M-PG F2alpha) for cervical dilation prior to vacuum aspiration (VA) in first-trimester pregnancy termination. METHODS: Sixty pregnant women requesting pregnancy termination between the 9th and 12th week were randomized to receive 400 microg of sublingual misoprostol or an intramuscular injection of 125 microg of 15-M-PG F2alpha 2 h prior to vacuum aspiration. Baseline cervical dilation prior to vacuum aspiration was measured using Hegar's dilators. Other variables assessed included procedure duration, intraoperative blood loss, and associated adverse effects. Patient acceptability was assessed by questionnaires completed at the time of discharge from the hospital. RESULTS: Mean cervical dilation at vacuum aspiration was significantly greater in the misoprostol group than in the 15-M-PG F2alpha group (8.8 vs. 7.6 mm; P<0.01), and preoperative adverse effects were significantly less frequent in the sublingual misoprostol group (P<0.05). However, procedure duration and intraoperative blood loss were similar in both groups. The acceptability rates were 93.3% in the sublingual misoprostol group and 76.6% in the 15-M-PG F2alpha group, respectively; however, 6.6% patients in the sublingual misoprostol group thought that the tablets had an unpleasant taste. CONCLUSION: Sublingual misoprostol appears to be an effective alternative to intramuscular 15-M-PG F2alpha for cervical dilation prior to vacuum aspiration in first trimester pregnancy. In addition, misoprostol is inexpensive and convenient to use and has higher patient acceptability rates.     

氧化亚氮并用米索前列醇镇痛在人工流产术中的应用

目的　探讨氧化亚氮与米索前列醇并用镇痛在人工流产术中的临床应用价值。方法　将 4 4 0例未产早孕妇女 ,随机分为笑气组、米索组、联合组、对照组 ,观察各组术中镇痛效果、宫颈扩张程度、手术时间、术中及术后出血量、人工流产不良反应发生率。结果　联合组及笑气组镇痛效果显著 ,联合组效果最佳 ,四组间两两比较差异显著 (P <0 0 5 )。联合组无痛人工流产率及 6号宫颈扩张器通过率最高 ,手术时间最短 ,与其他各组比差别均有显著性 (P <0 0 5 ) ,人工流产不良反应发生率最低。结论　氧化亚氮用于人工流产有较好的镇痛作用 ,加用米索前列醇镇痛效果更为理想