三种不同中期妊娠引产方式的比较

目的 比较中期妊娠引产中米非司酮联合米索前列醇,水囊引产,利凡诺引产的疗效,副作用以及预后等.方法 回顾性分析我院2007.6-2009.9中期妊娠引产264例,将其分成米非司酮联合米索前列醇组,水囊引产组,利凡诺引产组,进行临床疗效对比.结果:米非司酮联合米索前列醇组引产成功率94.84%.显著高于水囊组(88.09%)和利凡诺组(92.00%).引产时间12.71±7.15h),显著短于水囊组(26.83±8.18h)和利凡诺引产组(31.16±11.51h).结论 米非司嗣联合米索前列醇用于中期妊娠引产安全,效果好,引产时间短,大大降低住院费用,尤其适用于当前社区及基层医院的应用.     

三种不同中期妊娠引产方式的比较

目的比较中期妊娠引产中米非司酮联合米索前列醇,水囊引产,利凡诺引产的疗效,副作用以及预后等。方法回顾性分析我院2007.6-2009.9中期妊娠引产264例,将其分成米非司酮联合米索前列醇组,水囊引产组,利凡诺引产组,进行临床疗效对比。结果：米非司酮联合米索前列醇组引产成功率94.84%,显著高于水囊组（88.09%）和利凡诺组（92.00%）。引产时间12.71±7.15h）,显著短于水囊组（26.83±8.18h）和利凡诺引产组（31.16±11.51h）。结论米非司酮联合米索前列醇用于中期妊娠引产安全,效果好,引产时间短,大大降低住院费用,尤其适用于当前社区及基层医院的应用。     

中期妊娠两种引产方法疗效比较

目的：比较利凡诺与米非司酮联合米索前列醇应用在中期妊娠引产中的临床效果。方法：将100例要求终止妊娠的中期妊娠（16～24周）孕妇随机分为两组。A组50例,采用利凡诺经腹羊膜腔注射引产;B组50例,采用口服米非司酮联合米索前列醇引产。结果：两组引产成功率差异无统计学意义（P〉0．05）,但A组的产后出血量、引产时间、清宫率均大于B组（P〈0．05）。结论：米非司酮联合米索前列醇应用于中期妊娠引产安全、有效,作用优于传统的利凡诺,值得临床推广应用。     

三种药物引产方法在中期妊娠中的应用

目的 为探讨药物在中期妊娠引产中的疗效.方法 将96例中期妊娠引产患者随机分为3组,米非司酮与米索前列醇组(A组)、米非司酮与利凡诺组(B组)、利凡诺组(C组),各组患者32例.A组口服米非司酮及米索前列醇;B组口服米非司酮后即行利凡诺羊膜腔注射;C组只行利凡诺羊膜腔注射.结果 A组与B组引产成功率高,出血量少,流产时间短,胎盘胎膜残留需刮宫处置的都少于单纯利凡诺引产组.结论 中期妊娠引产口服米非司酮、米索前列醇与口服米非司酮后即行利凡诺羊膜腔注射,优于利凡诺引产,具有重要临床意义     

米非司酮联合米索前列醇用于中孕引产的临床观察

目的探讨米非司酮顿服联合米索前列醇阴道后穹窿放置用于中孕引产的疗效。方法选取我院2006年10～2008年10月孕16～24周要求终止妊娠者100例,随机分为两组,观察组50例,米非司酮片150mg顿服,隔日晨米索前列醇片0．4mg阴道后穹窿放置;对照组50例,利凡诺针100mg羊膜腔内注射。结果观察组流产时间短、清宫率低、产后出血量少、宫缩痛轻,与对照组比较差异有显著性（P〈0．05）;观察组引产成功率与对照组比较差异无显著性（P〉0．05）。结论米非司酮顿服联合米索前列醇阴道后穹窿放置用于中孕引产是一种安全、有效的引产方法,明显优于利凡诺羊膜腔内注射法。     

米非司酮配伍米索前列醇用于利凡诺中期妊娠引产10例疗效观察

目的旨在评价利用米非司酮配伍米索前列醇用于利凡诺中期妊娠引产较传统的单纯应用利凡诺引产在产程发动、分娩时间的长短、病人承受的痛苦和有效地避免生殖道感染以及对病人身心健康方面存在的一系列优缺点进行了阐述。结果提示利凡诺配伍米非司酮引产优点多,疗效满意     

瘢痕子宫中期妊娠引产方法的比较与分析

目的观察三种方法用于瘢痕子宫中期妊娠引产的疗效及安全性。方法选择瘢痕子宫孕妇120例,孕周14-24周,随机分为三组：A组：米非司酮配伍米索前列醇片;B组：米非司酮联合羊膜腔内注入利凡诺100mg;C组：单用利凡诺100mg羊膜腔内注入法引产。结果用药至宫缩开始时间,总产程,产时产后出血量,胎盘胎膜残留率,引产成功率等;A组,B组无明显差异,但与C组间差异有显著性意义（P〈0.05）。结论瘢痕子宫中期妊娠引产在排除了禁忌症后,联合米非司酮应用方法简单,安全可靠。     

即墨地区米非司酮配伍米索前列醇终止早期妊娠的临床观察

本地区９８例孕１４－１６周的妇女，要求终止妊娠者，给予米非司酮５０ｍｇｑ４ｈ口服共３次，末次服药１２小时后给予米索前列醇６００－１２００μｇ分次口服，进行临床观察，成功９５例，成功率９６．９３％。以７２例常规利凡诺引产做为对照组，成功４２例，成功率５８．３３％。前者平均引产时间为２８．０４±１，４４小时，后者为４３．５２±４．３３小时。证明米非司酮配伍米索前列醇用于１４－１６周妊娠引产，成功率高，时间短，为一种安全可靠的引产方法。     

米非司酮配伍米索前列醇终止中期妊娠引产110例临床观察

目的探讨对14~27周妊娠两种不同引产方法的效果。方法将110例妊娠14~27周自愿要求终止妊娠者随机分成雷佛努尔组、米非司酮联合米索前列醇组,观察两组的总产程时间,产后2h出血量,胎盘、胎膜残留情况,产伤情况,引产成功例数等情况。结果对于14~27周中期妊娠者,米非司酮联合米索前列醇,较单独用雷佛努尔引产总产程时间短,产后2h出血量少,胎盘、胎膜残留率低,两种引产引产成功率差异无显著性。结论对于14~27周中期妊娠者,使用米非司酮配伍米索前列醇引产,可缩短引产时间,减少产后出血量,降低胎盘、胎膜残留率,临床上值得推广。     

米索前列醇在利凡诺中期妊娠引产中的应用

米索前列醇在利凡诺中期妊娠引产中的应用万有连，韩芳江苏省兴化市妇幼保健所我们１９９４年１月～１９９５年２月采用利凡诺中期妊娠引产５１５例，其中４３例加用米索前列醇，以软化宫颈，加强宫缩，缩短产程，减少并发症，提高引产成功率，取得满意疗效，现总结分析如...     

Randomized comparison of vaginal (200 microg every 3 h) and oral (400 microg every 3 h) misoprostol when combined with mifepristone in termination of second trimester pregnancy

It is known that when misoprostol is given at 200 microg every 3 h after mifepristone pretreatment, the vaginal route is more effective than the oral route. However, women prefer the oral route. This randomized study was to test our hypothesis that oral misoprostol 400 microg is as effective as vaginal misoprostol 200 microg when given every 3 h in termination of second trimester pregnancy after priming with mifepristone. A total of 142 patients was randomly assigned to group 1 (200 mg mifepristone + 400 microg oral misoprostol every 3 h up to five doses) or group 2 (200 mg mifepristone + 200 microg vaginal misoprostol every 3 h up to five doses). The incidence of side-effects and the preference study were assessed through a standardized questionnaire during and after the abortion. For the oral group, both the incidence of diarrhoea (40.0 versus 23.2%, P = 0.03) and the amount of drug used (1734 compared with 812 microg, P < 0.0001) were significantly higher than that of the vaginal group but the incidence of fever appeared to be lower (not significant). There was no significant difference in complete abortion rate: 81.4% in the oral group and 75.4% in the vaginal group. The median induction-abortion interval was similar in the two groups (10.4 versus 10.0 h). The percentage of women who aborted in 24 h was also similar: 57/70 (81.4%) in the oral group and 58/69 (87.0%) in the vaginal group. Overall, 82.0% of women preferred the oral route. Oral misoprostol (400 microg) given every 3 h up to five doses, when combined with mifepristone, was as effective as the vaginal (200 microg) route in second trimester termination of pregnancy. This regimen could also be offered to those women who found repeated vaginal administration unacceptable.     

A prospective, randomized, placebo-controlled trial on the use of mifepristone with sublingual or vaginal misoprostol for medical abortions of less than 9 weeks gestation

BACKGROUND: A combination of mifepristone and misoprostol provides an effective method of medical abortion for early pregnancy. This is the first randomized trial comparing the use of sublingual misoprostol with vaginal misoprostol in combination with mifepristone for termination of early pregnancies up to 63 days. METHODS: A total of 224 women who requested legal termination of pregnancy up to 63 days were randomized by computer- generated list into two groups and given 200 mg of oral mifepristone followed 48 h later by either 800 micro g of sublingual (n = 112) or vaginal (n = 112) misoprostol. RESULTS: Complete abortion occurred in 98.2% (95% CI: 93-99) of women in the sublingual group and 93.8% (95% CI: 88-97) in the vaginal group. There were three ongoing pregnancies in the vaginal group but none in the sublingual group. The median duration of vaginal bleeding was 17 days. There was no serious complication. Fever, chills and gastrointestinal side-effects (nausea, vomiting and diarrhoea) were significantly more common in the sublingual group. CONCLUSIONS: The combination of mifepristone and misoprostol is effective for medical abortion up to 63 days. Both the sublingual and vaginal are effective routes of administration. Further randomized trials are required to find out the optimal dose of sublingual misoprostol that can give the highest complete abortion rate and lowest incidence of side-effects.     

A prospective randomized,double-blinded,placebo-controlled trial comparing mifepristone and vaginal misoprostol to vaginal misoprostol alone for elective termination of early pregnancy

BACKGROUND: Vaginal misoprostol has been shown to be an effective single agent for medical abortion. This randomized, double-blinded, placebo-controlled trial compared a regimen of mifepristone and misoprostol with misoprostol alone for termination of early pregnancy. METHODS: 250 women with gestations < or = 56 days were randomized by a random number table to receive either 200 mg mifepristone orally or placebo followed 48 h later by 800 microg vaginal misoprostol. Administration of misoprostol was repeated every 24 h up to three doses if abortion failed to occur. Abortion success was defined as complete abortion without the use of surgical aspiration. RESULTS: Successful medical abortions occurred in 114 out of 119 subjects (95.7%) after mifepristone followed by vaginal misoprostol. In all, 110 out of 125 subjects (88.0%) successfully aborted after placebo and vaginal misoprostol. The higher success rate of complete abortion with the mifepristone and misoprostol regimen was statistically significant compared with the placebo and misoprostol regimen (P < 0.05). CONCLUSIONS: A regimen of mifepristone and misoprostol was significantly more effective for termination of pregnancies < or = 56 days than misoprostol alone. The 88% efficacy obtained with vaginal misoprostol alone may be clinically acceptable when mifepristone is not available.     

Pilot study on the use of sublingual misoprostol with mifepristone in termination of first trimester pregnancy up to 9 weeks gestation

BACKGROUND: A combination of mifepristone and misoprostol provides an effective method of medical abortion for early pregnancy. A new route of administration of misoprostol, the sublingual route, was investigated in this study. METHODS: One hundred women who requested legal termination of pregnancy up to 63 days were given 200 mg of oral mifepristone followed 48 h later by 800 microg (4 x 200 microg tablets) of sublingual misoprostol. RESULTS: Ninety-four women (94%) had a complete abortion with this regimen. There was one ongoing pregnancy. The median duration of vaginal bleeding was 15 days. There were no serious complications. However, lower abdominal pain, diarrhoea, chills and fever were the commonest side-effects with incidences of 89, 42, 38 and 79% respectively. CONCLUSIONS: The combination of mifepristone and sublingual misoprostol is effective for medical abortion up to 63 days gestation. Randomized trials are required to compare its efficacy and side-effect profile with vaginal misoprostol.     

Medical termination of pregnancy

This review focuses on advances in the medical termination of pregnancy during the early period of the first trimester, when most abortions are performed. The drugs are used to terminate pregnancy act by inhibiting the synthesis of progesterone, inducing myometrial contractions, antagonizing the action of progesterone, or inhibiting trophoblast development. Among the drugs used in medical abortion are epostane, prostaglandins (including misoprostol and gameprost), combined methotrexate and misoprostol, tamoxifen-misoprostol regimen, mifepristone and prostaglandin, and antiprogestin and prostaglandins. The efficacy, side effects, and contraindications of these drugs in the medical termination of pregnancy are discussed. In general, medical abortion is associated with higher rates of prolonged bleeding, nausea, vomiting, and pain as compared to surgical abortion. However, medical termination of pregnancy has a high rate of efficacy in women with early pregnancies. In addition, medical abortion is safe and acceptable to women, and it does not require anesthesia. Lastly, women who choose medical abortion must have access to a center where suction curettage is available, should heavy bleeding occur and blood transfusion is required.     

Double-blind randomized trial of mifepristone in combination with vaginal gemeprost or misoprostol for induction of abortion up to 63 days gestation

BACKGROUND: Gemeprost and misoprostol are two of the most widely used prostaglandins in combination with mifepristone for medical abortion in early pregnancy. However, the efficacy and side-effects of those two drugs given vaginally have not been assessed in a randomized trial. METHODS: Randomized double-blind controlled trial involving 999 women undergoing an abortion at gestational age < or =63 days who received either 0.5 mg gemeprost (group I, n = 499) or 800 microg misoprostol (group II, n = 500) vaginally approximately 48 h after taking 200 mg mifepristone by mouth. The rate of complete abortion and the side-effects were compared between the groups. RESULTS: A total of 89 cases was excluded from full analysis of outcome because either they aborted after mifepristone alone (n = 2), had an ectopic pregnancy (n = 1), or because the outcome was uncertain as they failed to attend their follow-up appointment (n = 86). The rate of complete abortion was very high (>95%) in both groups but significantly higher after treatment with misoprostol than with gemeprost [436/453 (98.7%) versus 451/457 (96.2%), P = 0.019, difference 2.5%, confidence interval 0.4-4.7%] and there were fewer ongoing pregnancies (n = 1 versus n = 8, P < 0.018). Surgical intervention rose significantly with gestation in women who received gemeprost (P < 0.03) but not with misoprostol. The incidence of side-effects such as diarrhoea (13.7 versus 16.4%) and vomiting (27.8 versus 29.7%) was similar in women who received misoprostol or gemeprost respectively, as was the duration and amount of bleeding. CONCLUSIONS: (i) Both regimens using a reduced dose of mifepristone are highly effective methods of inducing abortion in early pregnancy; (ii) vaginal misoprostol is the preferred prostaglandin because it is it is associated with fewer failures than low-dose gemeprost, particularly at gestation > or =49 days.     

阴道放置米索前列醇在终止6~10周妊娠负压吸宫术前的应用

目的 探讨米索前列醇在终止6~10周妊娠负压吸宫术前的应用效果。方法 选取2018年5月~2019年5月我院收治的终止6~10周妊娠患者129例,按照随机数字表法分为对照1组、对照2组和研究组,每组43例。对照1组术前不使用药物干预,对照2组术前口服米索前列醇片联合米非司酮进行干预,研究组术前3 h阴道放置米索前列醇干预,比较三组宫颈软化程度、手术情况、出血量、人流综合征、术后疼痛、宫颈粘连及感染发生情况。结果 研究组宫颈软化有效率高于对照1组、对照2组（P＜0.05）;对照2组宫颈软化有效率高于对照1组（P＜0.05）;研究组手术时间、出血量、疼痛以及人流综合征发生低于对照1组、对照2组,且对照2组低于对照1组（P＜0.05）;研究组并发症发生率低于对照1组、对照2组,且对照2组并发症发生率低于对照组1组（P＜0.05）。结论 对于接受负压吸宫术治疗的妊娠10周内患者,术前3 h阴道置入米索前列醇进行治疗,可以有效提高患者宫颈软化效果,缩短手术时间,减少出血量,降低术后疼痛以及人流综合征的发生,提高负压吸宫术的治疗安全性,可在临床中进一步应用。     

The kinetics of serum hCG and progesterone in response to oral and vaginal administration of misoprostol during medical termination of early pregnancy

BACKGROUND: Misoprostol is widely used in combination with mifepristone for medical termination of pregnancy. We studied the endocrine parameters of trophoblast function during medical termination of early pregnancy using mifepristone in combination with oral or vaginal misoprostol. The effect of prolonged misoprostol administration was also examined. METHODS: Thirty-four women, requesting termination of pregnancy and with 相似文献   

A comparative study of surgical and medical procedures: 932 pregnancy terminations up to 63 days gestation

The aim of this retrospective study was to compare the efficacy and complications associated with early medical and surgical pregnancy termination. The study population comprised 932 consecutive women undergoing pregnancy termination at gestations of 63 days or less. There were no age or parity differences between the study groups. Medical termination was performed with mifepristone 200 mg orally and misoprostol 800 microgram vaginally; surgical aspiration termination was performed under general anaesthesia. Outcome measures were: surgical curettage for presumed retained products of conception; ongoing pregnancy; and planned and emergency review in the unit. Early medical and surgical termination were associated with a 90.2 and 94.5% complete abortion rate respectively (P = 0.025). The complete abortion rate with medical termination decreased significantly with increasing parity; no such relationship with surgical abortion was found. Women of parity three or more were less likely to have a complete abortion following a medical (83.3%) compared to surgical procedure (97.7%) (P = 0.028). The ongoing pregnancy rate was 0.9% with medical and 0.5% with surgical termination (P = NS). Medical termination was associated with a lower complete abortion rate than surgical termination, particularly for women of higher parity. However, early medical termination allows over 90% of women to avoid the risks of surgical instrumentation of the uterus and anaesthesia.     

A comparison of two regimens of intravaginal misoprostol for termination of second trimester pregnancy: a randomized comparative trial

A prospective randomized trial was conducted in 148 women to compare the efficacy of two regimens of vaginal misoprostol for termination of second trimester pregnancy. Women aged 16-40 years requesting termination of second trimester pregnancy were randomized into two groups. Women in group 1 were given vaginal misoprostol 400 microg every 3 h for a maximum of five doses in 24 h. Women in group 2 were given vaginal misoprostol 400 microg every 6 h for a maximum of three doses in 24 h. If women did not abort in 24 h, the same regimen was repeated. The median induction-abortion interval in group 1 (15.2 h) was significantly shorter (P < 0.01) than that in the group 2 (19.0 h). The percentage of women who achieved successful abortion within 48 h in group 1 (90.5%) was also significantly higher (P < 0.02) than that in group 2 (75.7%). The incidence of fever was more common in group 1 (P = 0.01). It is concluded that the regimen of vaginal misoprostol 400 microg every 3 h with maximum of five doses in 24 h was more effective than the regimen of misoprostol every 6 h in termination of second trimester pregnancy.