药物流产的可接受性及影响因素分析

目的:了解药物流产可接受性及其影响因素。方法:采用分层整群随机抽样方法,在三级医院、二级医院、计划生育服务站共调查要求人工流产的妇女1342人,有效问卷1305份,以药物流产组331人作为观察组,手术流产组974人作为对照组进行分析。采用视觉模拟表格做可接受性的评估。结果:药物流产组20～39岁年龄比例(98.5%)高于手术流产组,大专及以上学历(60.4%)、月收入>3000元者(38.1%)、管理营销和自由职业(76.4%)均高于手术流产组。多因素分析显示年龄、文化程度是流产方式选择的影响因素。医护人员和乡(村)计生人员等渠道获取流产知识不利于药物流产的选择。对既有药物流产史又有手术流产史的108人进行分析,结果显示该人群对两种流产方式的满意度无差异。结论:药物流产更易被教育水平高的人群接受,有人工流产经历的妇女对药物流产的可接受性与手术流产相似,应尊重妇女流产方式的知情选择,更好地开展流产后计划生育服务。     

药物流产可接受性及影响因素的原因分析

药物流产是治疗意外妊娠的有效手段,属于非侵入性操作,具有良好的私密性,但同时也存在出血多、失败率高、伴有副作用等缺点.因此,如何选择流产方式,成为临床治疗的关键.本文首先概述了药物流产的应用现状,然后分别对药物流产的可接受性、影响因素进行探究.     

未婚妇女药物流产与手术流产心理健康状况比较的meta分析

目的:对比分析药物流产与手术流产后未婚妇女的心理健康状况。方法:检索MEDLINE、EMBASE、Cochrane Library、CMCC/CMAC、CBM、CNKI、VIP、万方等8个医学数据库,手工检索12种相关杂志,并追查参考文献。由2位评价员独立筛选、评价文献和提取数据。应用RevMan 5.0.1软件对2011年以前发表的符合纳入标准的相关文献进行汇总分析。结果:未婚妇女使用药物流产与手术流产,在躯体化因子得分、总分、阳性总均分、阳性症状均分以及阳性项目数等方面均有统计学差异(P<0.05),其他各因子得分两组妇女无统计学差异。结论:与手术流产相比,药物流产对未婚妇女心理健康的影响较小。     

药物流产和手术流产对输卵管通畅性的影响

目的:探讨药物流产和手术流产对输卵管通畅性的影响。方法:将542例行子宫输卵管造影术的不孕妇女分成药物流产组(药物组)、手术流产组(手术组),以及无流产组(原发组),并将流产组再分为停经≤6周和>6周两组进行对比分析。结果:药物组、手术组、原发组的输卵管阻塞的发生率分别为51.38％,39.88％,30.74％。药物组、手术组的输卵管阻塞的发生率高于原发组,有显著性差异(P<0.001,P<0.05)。药物组输卵管阻塞高于手术组(P<0.05)。>6周药物组的输卵管阻塞率高于≤6周的药物组和>6周的手术组(P<0.05,P<0.01)。而≤6周的药物组与≤6周的手术组、>6周的手术组与≤6周之间无显著性差异(P>0.05)。结论:流产是引起输卵管阻塞的原因,药物流产比手术流产的输卵管阻塞率高。而妊娠6周以上的药物流产妇女输卵管阻塞发生的可能性比手术流产及妊娠6周以内的药物流产者增加。     

药物流产和手术流产后对卵巢功能的影响

在妊娠3个月内人为地采取措施终止妊娠称为人工流产.药物流产和手术流产就是最常使用的两种人工流产方法,在临床上普遍应用.非自然流产,会带来很多并发症,比如不孕症和感染等疾病,所以不值得提倡;不同的流产方式对女性的健康影响不同.对流产后卵巢功能的影响进行研究,现报道如下.     

药物流产与吸宫术流产的效果比较

人工流产是避孕失败后的补救措施 ,目前终止早孕的方法有两种 ,一种是传统的负压吸宫术 ,另一种是使用药物———米非司酮配伍前列腺素终止妊娠。上述两种方法均对受术者带来某些创伤。本文就目前常用的两种终止早孕方法的效果、出现的副反应及可接受性进行比较研究 ,以期能选择适合于个体的流产方式。材料与方法1　对象　选择 1996～ 1999年在本院终止早孕的妇女共 936例 ,年龄 18～ 4 2岁 ,停经 38～ 75天 ,身体健康 ,按就诊要求自愿选择药物流产或吸宫术。早孕妇女均经Ｂ超检查 ,孕囊与停经时间基本相符 ,并为正常宫内孕者。2　方法2 1…     

药物及手术流产史与早产关联的出生队列研究

目的 探讨既往药物及手术流产史与早产的关联。方法 参与马鞍山市优生优育队列的3 474名孕妇于孕14周前收集一般人口学资料、既往药物及手术流产史资料,以单胎活产儿3 256人为分析样本。根据是否有药物及手术流产史以及流产次数进行分组,采用logistic回归分析既往药物及手术流产史对随后妊娠早产发生率的影响。结果 早产发生率为4.12%（n=134）,自发性早产发生率为2.49%（n=81）。控制可能的混杂因素后,有过1次药物流产史（RR=2.00,95%CI：1.04～3.85）或2次及以上药物流产史（RR=3.58,95%CI：1.04～12.30）会增加总早产发生风险,药物流产史（RR=2.51,95%CI：1.23～5.15）亦会增加自发性早产风险。有过1次手术流产史（RR=0.67,95%CI：0.42～1.01）或2次及以上手术流产史（RR=0.97,95%CI：0.51～1.85）与总早产或自发性早产（RR=0.72,95%CI：0.43～1.22）关联无统计学意义。结论 既往药物流产史是早产或自发性早产的独立危险因素。     

药物流产次数与药物流产成功率关系的探讨

目的探讨药物流产次数与药物流产成功率关系。方法对要求药物流产孕妇200例临床资料进行分析,观察孕周、年龄、孕囊直径、子宫位置、药物流产次数和药物流产成功率的关系。结果孕周>7周年龄≥35岁、孕囊直径≥2.0、子宫后倾后屈、多次药物流产是影响孕妇流产成功率的重要因素,P<0.05,差异有统计学意义。结论药物流产成功不良影响因素较复杂,同时难以完全避免。     

孕产妇复发性流产与胰岛素抵抗相关性Meta分析

目的：对国内外发表的随机病例对照研究文章进行Meta分析,力图探明胰岛素抵抗( IR)是否增加孕产妇复发性流产( RSA)的风险。方法使用计算机检索PubMed、Embase、Springer Link、中国生物医学文献数据库等数据库及手工检索相关期刊内自1996年1月至2014年1月之间发表的有关于RSA与IR关系的病例对照研究类国内外文献,按既定标准筛选后对入组文献进行质量评分,并使用Meta分析探究两者间关系。结果分析中共计6篇国内外文献选入研究范围,RSA组共计432例孕产妇,对照组共计383例(均未见不良孕产史)。分析提示,两组孕产妇在空腹血糖水平差异无统计学意义的前提下,出现了RSA组患者空腹胰岛素数值相对升高及RSA组患者的胰岛β细胞功能受损较对照组严重;且RSA组患者的IR指数较对照组高,即IR指数>4.5的患者大多来自RSA组,差异具有统计学意义(OR=3.16,95%CI为1.7~6.8,I2=1.157,P<0.05)。结论 IR与RSA间存在一定相关性,其可能为RSA的原因之一。     

药物流产与人工流产终止早孕的比较

药物流产就是使用药物达到终止早孕的方法。目前最常用的药物是米非司酮配伍米索前列醇口服。人流是采用传统的负压吸宫术来终止早孕的方法。药物流产和人工流产是当前临床应用最广泛的两种终止早孕的方法,其安全性和有效性已得到充分的肯定,但在临床应用中各有利弊。本文将5年来我院妇科行人流、药流患者各80例进行分析报道,旨在对比两种终止早孕方法的临床效果,可接受性,对患者心理状态的影响。1资料与方法1·1一般资料随机选取1999-08~2004-08因非意愿妊娠来我院要求终止早孕的健康妇女160名,分为人流、药流两组各80名行对照观察。选取对…     

Users' perspectives on medical abortion in Finland

The objective of this study was to determine the reasons for choosing the medical instead of surgical method for the termination of early pregnancy, and to evaluate the experience and the level of satisfaction with the medical method among women in Helsinki who participated in a multinational efficacy study of medical abortion. The study respondents consisted of 123 women with less than 9 weeks gestation, undergoing medical abortion with mifepristone 200 mg orally followed 36 h to 48 h later by misoprostol 0.8 mg orally or vaginally. By using structured questionnaires, the reasons for choosing the medical method were assessed before the abortion, whereas the experience of medical abortion was evaluated at follow-up visits 2 weeks and 6 weeks later. The three most important reasons for choosing medical abortion instead of surgical abortion were ‘avoidance of surgery,’ ‘avoidance of general anesthesia,’ and ‘the method being more natural.’ At the 6-week evaluation, most women (92%) were satisfied or highly satisfied with the method, and 103 (88%) women said that the method met their expectations. The majority of all women, 105 (89%), would opt for the same method in the future should the need arise, and 102 (88%) patients would recommend the medical method to a friend. The length of pregnancy had an effect on acceptability; the shorter the gestational age, the more acceptable the medical abortion. Medical abortion was perceived as an acceptable method for termination of early pregnancy among the Finnish women studied.     

影响早孕药物流产结局的多因素分析

目的:探讨影响米非司酮配伍米索前列醇药物终止早孕结局的相关因素,为选择合适的终止早孕方法提供思路。方法:以药物流产后因不全流产或失败行手术干预者为病例组,以药物流产后完全流产者为对照组,采用病例-对照研究的方法,按1:4比例匹配对照组,分析药物流产时手术干预的相关影响因素。结果:经单因素分析,药物流产后需手术干预的相关影响因素为孕次(OR=2.051,P<0.001)、流产次数(OR=2.677,P<0.001)、有分娩史(OR=2.328,P<0.001)、孕囊直径(OR=2.115,P<0.001)、子宫前倾前屈位和后倾后屈位(OR=2.031,P<0.001;OR=2.384,P<0.001)。经多因素分析,药物流产后需手术干预的危险因素为孕次(OR=2.317,P<0.001)、流产次数(OR=1.897,P<0.001)、孕囊直径(OR=1.196,P<0.001)和子宫位置(OR=1.494,P>0.05)。结论:妊娠次数多(≥3次)、流产次数多(≥3次)、孕囊直径大(>25mm)、屈位子宫(前倾前屈或后倾后屈)的早孕妇女选择药物流产时需要手术干预的可能性较大,而剖宫产史与药物流产结局无明显相关性。     

Acceptability of home-use of misoprostol in medical abortion

INTRODUCTION: Home-use of misoprostol would reduce the number of visits and improve access to medical abortion. We evaluated acceptance of home-use of misoprostol among women and their partners. MATERIALS AND METHODS: One hundred women with up to 49 days of amenorrhea were given mifepristone, followed by misoprostol taken at home. RESULTS: Women chose home-use of misoprostol because it felt more natural, private and allowed the presence of a partner/friend. Two women had a vacuum aspiration due to incomplete abortion. Five unscheduled visits occurred. Ninety-six women were satisfied with their choice of home-use. The male partners were generally satisfied with their partner's choice of home-use and felt that their presence and support had been valuable. DISCUSSION: Our study shows a high acceptability among women and their partners and confirms the safety and efficacy of home-use of misoprostol. Women should be offered this choice to allow more flexibility and privacy in their abortions.     

Safety and acceptability with the use of a contraceptive vaginal ring after surgical or medical abortion

OBJECTIVE: The study was conducted to determine if a contraceptive vaginal ring (CVR) is a safe and acceptable method of contraception when used in the proximate postabortion period following first-trimester surgical or medical abortion. METHODS: A CVR was inserted within 1 week following a medical or surgical abortion. Participants were followed up for 3 months to determine safety and acceptability. Safety was measured by the absence of signs of infection or serious adverse events. Acceptability was assessed by the CVR satisfaction survey, completed at the 3-month follow-up visit. RESULTS: Of 81 participants enrolled in the study, 69 (85%) completed the first-month follow-up visit, and 54 (67%) completed the final 3-month follow-up visit. There were no serious adverse events and no signs of infection on physical exam. Most adverse events were mild and not specifically related to the CVR. Related adverse events were those commonly associated with hormonal contraception use. Eighty-nine percent of participants chose to continue the CVR as their birth control method. CONCLUSION: The CVR is potentially safe and has high acceptability when used in the proximate postabortion period following a first-trimester abortion.     

Medical vs. surgical abortion: the importance of women's choice

Background

Using a large national sample of women undergoing an abortion in France, we explore the factors associated with medical or surgical abortion. We draw particular attention to the influence of women's preferences in the decision-making process.

Study Design

The data are drawn from a nationally representative survey of 8245 women undergoing an elective abortion in France in 2007. Analyses of factors associated with the type of abortion technique were performed among the 4650 women who were identified as being eligible for the two techniques.

Results

Sixty-eight percent of all abortions were medical procedures among women eligible for both techniques. The type of abortion technique was not dependent on women's age, parity, cohabitation status, socioeconomic circumstances nor on the type of facility providing the abortion (private or public). Conversely, women's participation in the decision-making process was strongly associated with the type of abortion method. Among the 50% of women who reported they had been given a choice, 84% underwent a medical procedure vs. 52% of those who were not offered a choice. Among the 2286 women who were not involved in the decision, 35% indicated they trusted their doctor to make the best choice for them, while 44% were told it was too late for a medical procedure, although they had consulted before 8 weeks of amenorrhea.

Conclusion

In this sample of French women who participated in a national survey on abortion, those who were involved in the decision-making process as to whether to have a medical or surgical procedure showed a strong preference for the medical procedure.     

Patient preference in a randomized study comparing medical and surgical abortion at 10-13 weeks gestation

The aim of this study was to assess women's preferences and acceptability of medical (MA) and surgical abortion (SA) at 10-13 weeks gestation. This was a partially randomized patient preference trial. Women were offered to enter the randomized arm of the trial. Those who expressed a strong preference for a method were entered into the preference arm. A total of 368 women were randomized (188 medical and 180 surgical) while 77 entered the preference arm (15 medical and 62 surgical). Prior to abortion, 253 women (72%) indicated a preference for MA while 98 (28%) showed a preference for surgery (p < .0001). Despite having a preference for a particular method, women were content with alternatives. Women were more likely to choose the same abortion method again if they had shown a preference for that method prior to abortion (p = .002 and .01 for MA and SA, respectively). The availability of MA is an important option for many women who wish to avoid surgery or anesthesia and should now be offered routinely in the late first trimester.     

Women's perceptions on medical abortion

The reasons why women choose medical abortion vary in different countries. In most countries, the most common reasons for choosing medical abortion are as follows: (a) avoidance of surgery or general anesthesia; (b) perception that it is safer; and (c) perception that it is more natural than a surgical procedure. In most studies, over 80% of women who chose medical abortion found it acceptable and would choose the same method again if they needed another abortion in the future. They would also recommend this procedure to other women who need an abortion. In selected women, the administration of misoprostol at home was also acceptable. The acceptability of medical abortion may decrease with increasing gestational age of pregnancy, failure of medical abortion, prolonged bleeding and high levels of discomfort and anxiety during the abortion procedure. There was no significant difference in the emotional responses or incidences of psychiatric morbidity between women undergoing medical and women undergoing surgical abortion.     

Efficacy, acceptability and safety of medication abortion in low-income, urban Latina women

Background

Health care providers may be reluctant to offer medication abortion to low-income, non-English-speaking populations. Concerns include lack of patient interest, incorrect use of misoprostol at home, missing mandatory follow-up visits and inappropriate use of emergency services. We describe the appeal, acceptability, safety and follow-up rates of medication abortion in a low-income Latina population in New York City.

Study Design

Nested analysis of 270 subjects up to 63 days' gestation enrolled in a multicenter trial of medication abortion comparing different mifepristone-misoprostol intervals. After receiving mifepristone, subjects were instructed on home use of misoprostol, what to do in an emergency and when to return.

Results

This population was predominantly Spanish-speaking, unmarried, poor and publicly insured. Ninety-six percent took the misoprostol at home correctly, 90% returned as scheduled without reminders and 2% were lost to follow-up. Ninety-six percent described the experience as positive or neutral and 94% would recommend medication abortion to a friend. Three serious adverse events occurred and women accessed emergency services appropriately.

Conclusion

Medication abortion can be a very appealing, safe and effective option in low-income, non-English-speaking populations.     

药流后阴道持续出血的声像学分析及临床评价

目的:探讨一种超声学参照体系以评价药物流产的临床效果。方法:对100例早孕妇女药物流产后采用B型超声波检查,前瞻性动态观察宫腔声像学变化,分析和总结药流后不同结局(完全流产vs.不全流产)的声像学规律。结果:100例对象中完全流产92例(92%),不全流产8例(8%),无1例继续妊娠。胚囊排出后依B超下宫内残留组织的形态及回声将声像图分为3型:A、B和C型。第10天有残留组织声像图存在对出血持续时间无显著性影响(P>0.05);若第15天仍有残留组织征象存在时,将对出血持续时间有显著性影响(P<0.01)。第15天完全流产者和不全流产者子宫内膜平均厚度分别为(9.5±5.0)mm和(15.7±3.1)mm,统计学上有极显著性意义(P<0.0001)。结论:B超作为1种无创伤性方法,其对药物流产的动态监测而获得的声像学规律对临床工作有着重要的指导意义。