黄体晚期服用米非司酮作为每月一次避孕药的研究

目的 :探讨黄体晚期应用小剂量米非司酮作为每月一次避孕药的有效性、可行性、安全性。方法 :1 50例育龄妇女随机分为 5组 ,每组 3 0例 ,A、B、C组于预期月经来潮前 2 d开始口服米非司酮 ,总量分别为 75mg、50 mg、75mg,其中 A、B组首次服米非司酮后 48h加服米索前列醇 (米索 ) 4 0 0 μg;D、E组预期月经来潮前 4d开始口服米非司酮 ,总量均为 75mg,其中 E组首次服米非司酮后 48h加服米索 40 0 μg。所有对象服药前查血 β-h CG。观察期内监测基础体温 ( BBT)、尿 L H试纸检测 L H峰及 B超监测卵泡发育。观察各组服药后的妊娠率、月经变化。结果 :5组对象黄体晚期应用米非司酮对月经周期均无影响 ,5组对象继续妊娠率分别为 6 .2 5%、3 6 .4%、55.6 %、8.3 %、1 0 %。结论 :预期月经来潮前 2 d或 4d服用为 75mg米非司酮配伍米索 ,均能有效地达到避孕目的。     

米非司酮配伍米索前列醇用于黄体期避孕的研究

目的　探讨在黄体期无保护性生活后 ,使用米非司酮配伍米索前列醇避孕的效果、副反应和对月经的影响。方法　对因多次无保护性生活或无保护性生活结束超过 12 0h要求紧急避孕的69 9例妇女 ,于预期月经来潮前 10d内服用米非司酮 10 0mg ,并于服用米非司酮 48h后加服米索前列醇 40 0 μg。观察是否妊娠和下次月经的情况。 结果　 699例妇女中失访 1例 ,妊娠 2 5例 ,妊娠率 (即失败率 )为 3 6%。妊娠危险性随性生活次数的增多而增加。 673例妇女月经来潮 ,其中 3 81例( 56 6% )在预期月经日± 3d来潮 ,月经提前或延迟超过 7d者分别占 2 2 %和 8 5%。服药后 1周内的主要副反应为腹泻、腹痛 ( 3 1 1% )和恶心、呕吐 ( 2 0 4% )。结论　在黄体期使用米非司酮配伍米索前列醇 ,是一种可选择的避孕补救方法     

复方米非司酮配伍米索前列醇终止10-16周妊娠的临床疗效比较研究

目的:比较复方米非司酮和米非司酮配伍米索前列醇终止10-16周妊娠的临床疗效。方法:将152例妊娠10-16周因非意愿妊娠要求药物流产的妇女随机分成2个不同的治疗组:单方组76例,米非司酮晨服50mg,晚服25mg,连服2d。d3晨服米索600μg。复方组76例,晨服复方米非司酮片1片(米非司酮30mg/片,双炔失碳酯5mg/片),连服2d,米索服法同单方组。结果:复方组和单方组流产成功率分别为92.10%和89.48%;完全流产率分别为82.89%和78.95%。结论:复方米非司酮配伍米索前列醇口服能安全有效地终止10-16周的妊娠,疗效好,有减少流产后子宫出血量的趋势。且有服药方法简便,米非司酮剂量小等优点。     

米非司酮合并米索前列醇催经止孕的临床研究

米非司酮合并米索前列醇催经止孕的临床研究钱美玲，陶承洁，周美蓉（上海市卢湾区妇幼保健院，上海，２０００２０）本研究旨在了解小剂量米非司酮配伍米索前列醉于预期月经来潮前４天至预期月经来潮日及月经延期４天之内口服，用于催经止孕的临床效果及副反应。对象与方...     

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早孕流产200例效果观察

目的:了解米非司酮配伍米索前列醇用于早孕流产的临床效果。方法:对200例B超检查确诊为宫内妊娠的患者米非司酮配伍米索前列醇引产。结果:200例服药患者中,完全流产185例,占92.5%,不全流产13例,占6.5%,失败2例,占1%。结论:米非司酮配伍米索前列醇用于早孕流产是一种比较理想的药物流产方法,具有疗效高,使用方便,不良反应少,痛苦轻,损伤小的优点。     

两种紧急避孕方法比较性研究

目的 :比较不同低剂量米非司酮配伍米索前列醇与单服米非司酮用于紧急避孕的效果及其副反应。方法 :运用随机双盲多中心临床比较 ,研究 899例健康妇女在无保护性性交后 1 2 0 h内 ,随机分为 3组。组 (3 0 0例 ) :口服 2 5 mg米非司酮 ,2 4 h后口服 0 .2 mg米索前列醇 ;组 (2 99例 ) :口服 1 0 mg米非司酮 ,2 4 h后口服 0 .2 mg米索前列醇 ;组 (3 0 0例 ) :单服米非司酮 1 0 mg。按 Dixon法推算避孕有效率。结果 :899例妇女中总妊娠数 1 1例 :组 2例 ,组 2例 ,组 7例 ;方法失败 :组 1例 ,组 0例 ,组 5例 ;避孕有效率分别为 95 .5 %、1 0 0 %、76 .9%。组 加组 与组 相比有极显著差异 (P<0 .0 1 )。副反应较轻均可耐受 ,无严重副反应。米非司酮配伍米索前列醇与单服米非司酮组间副反应也无显著差异。结论 :应用低剂量米非司酮和米索前列醇作为紧急避孕是有效安全的紧急避孕方案 ,且对月经周期无明显干扰。     

复方米非司酮配伍米索前列醇治疗稽留流产不同给药方法比较

目的:探讨复方米非司酮配伍米索前列醇治疗稽留流产2种方法的可行性和副反应。方法:将82例稽留流产患者随机分为A组和B组,所有患者均为口服复方米非司酮1片/d,qd×2d,然后于第1次服药48h后A组口服米索前列醇片0.4mg,B组阴道塞入米索前列醇片0.4mg。观察妊娠物排出情况、阴道出血量及治疗后的副反应。结果:A组与B组流产率分别为73.17%和80.48%,B组成功率高于A组;组间阴道流血量相似;但B组胃肠道反应明显轻,腹泻发生率12.91%、寒战发生率2.44%、皮肤瘙痒发生率(2.44%)均低于A组(分别为26.83%、9.76%和12.20%。总副反应发生率有明显差异。结论:复方米非司酮配伍米索前列醇治疗稽留流产2种方法均可行,但阴道给药副反应明显下降。     

复方米非司酮配伍米索前列醇终止8-12周妊娠的临床疗效比较研究

目的:探讨复方米非司酮配伍米索前列醇终止8-12周妊娠的临床疗效。方法:将要求终止105例孕8-12周正常或合并高危因素妊娠的早孕妇女随机分为两组:复方组53例,晨服复方米非司酮片1片,qd×2次(总量:米非司酮60mg,双炔失碳酯10mg);单方组52例,口服米非司酮2片,bid×3次(总量:米非司酮150mg),两组均首次服药后48h加服米索前列醇。结果:复方组和单方组流产成功率分别为90.57%(48/53)和86.54%(45/52);完全流产率分别为81.13%(43/53)和75%(39/52)。结论:复方米非司酮配伍喜克馈能安全有效终止8-12周正常或合并高危因素的妊娠,疗效较好,具有米非司酮剂量小,服药简便等优点。     

复方米非司酮与米非司酮配伍米索治疗稽留流产的临床研究

目的:初步探讨复方米非司酮配伍米索前列醇治疗稽留流产的效果和可行性。方法:将80例稽留流产妇女随机分为观察组和对照组,观察组口服复方米非司酮1片/d×2d,48h后口服米索前列醇,对照组口服米非司酮75mg/d×2d,余同观察组。观察妊娠物排出情况、流产时间、阴道流血量、术前术后血红蛋白变化及服药后副反应。结果:观察组和对照组流产率分别为60.53%和47.22%,观察组流产时间及阴道流血量小于对照组。观察组和对照组分别有2例及4例因阴道流血量≥100ml立即行钳刮术终止试验。结论:复方米非司酮配伍米索可以有效治疗稽留流产,其流产时间短,出血量少,是治疗稽留流产安全、有效、简便的新方法。     

Are two doses of misoprostol after mifepristone for early abortion better than one?

OBJECTIVE: The objective of this study was to determine if a repeat dose of misoprostol following mifepristone or a single dose of misoprostol increases the efficacy of medical termination of pregnancy. DESIGN: Randomised, placebo controlled trial. SETTING: K.E.M. Hospital, Pune, India, and the Health Centre, Larsen and Toubro Limited, Mumbai, India. SAMPLE: A total of 300 women seeking an abortion with amenorrhoea of 8 weeks or less. Methods Women were randomised to receive one or two doses of 400 microgram oral misoprostol at the clinic 48 hours after administration of 200 mg mifepristone. Main outcome measure Complete abortion without surgical intervention. Results The repeat administration of misoprostol 400 microgram improved the complete abortion rate from 86 to 92% and significantly reduced the rate of continuing pregnancy from 7 to 1%. Almost all the women who were administered the additional dose of misoprostol were either very satisfied (58%) or satisfied (37%) with the method. Conclusion While an additional oral dose of 400 microgram misoprostol did not significantly increase the rate of complete abortion without surgical intervention, the additional dose did significantly reduce the rate of continuing pregnancies without compromising the acceptability and ease of use of the method.     

Randomised controlled trial comparing the efficacy of same-day administration of mifepristone and misoprostol for termination of pregnancy with the standard 36 to 48 hour protocol

OBJECTIVE: To determine the efficacy of oral mifepristone followed by vaginal misoprostol 6 hours later compared with the standard 36- to 48-hour regimen for medical termination of pregnancy. DESIGN: Single centre, two arm, parallel, open randomised controlled trial. SETTING: Medical termination service at a teaching hospital. SAMPLE: Four hundred and fifty women undergoing medical termination of pregnancy at up to 63 days of gestation. METHODS: Eligible women were randomised to receive mifepristone 200 mg orally followed by vaginal misoprostol 800 micrograms either 6 hours (n=225) or 36-48 hours (n=225) later. All participants were invited to attend for a follow-up pelvic ultrasound scan within 7 days following the misoprostol administration. For those women in whom products of conception remained at the follow-up ultrasound scan, expectant management ensued with weekly follow-up ultrasound scans until the termination was complete. They could elect to undergo an evacuation of uterus at any stage following the scan. Those women with a nonviable gestation sac at the follow-up scan were offered a further dose of vaginal misoprostol 800 micrograms or suction termination of pregnancy. Women with a continuing pregnancy were managed with surgical termination. MAIN OUTCOME MEASURE: Successful medical abortion defined as no requirement for medical or surgical intervention beyond the initial dose of misoprostol. RESULTS: One hundred and sixty-five women (79%) in the 6-hour group and 197 women (92%) in the 36- to 48-hour group had a successful termination at first follow-up ultrasound or presumed on the basis of other considerations (those not seen for ultrasound but deemed successful by negative pregnancy test, products passed on ward or long-term assessment of notes). Twenty-two women (10%) in the 6-hour regimen required up to three further ultrasound scans after 7 days following the mifepristone administration in order to ensure that the termination process was complete. None of these women required a suction evacuation of uterus. In the 36- to 48-hour regimen, ten (5%) women had up to two further ultrasound scans to confirm a complete termination without the need for a surgical evacuation of uterus. Therefore, the overall successful termination rate in the 6-hour regimen was 89% (187/210) compared with 96% (207/215) in the 36- to 48-hour regimen (relative risk=0.92, 95% CI 0.84-0.98). Repeat administration of misoprostol or surgical treatment was required in 23 women (11%) in the 6-hour group and 8 women (4%) in the 36- to 48-hour group. A viable pregnancy was found in five women (2%) in the 6-hour group and in three women (1%) in the 36- to 48-hour group. CONCLUSIONS: Oral mifepristone 200 mg followed by vaginal misoprostol 800 micrograms after 6 hours is not as effective at achieving a complete abortion compared with the 36- to 48-hour protocol.     

Factors affecting the outcome of early medical abortion: a review of 4132 consecutive cases

Objective To assess the outcome of a regimen of a reduced dose of mifepristone followed by one or two doses of vaginal misoprostol as a non-surgical method for termination of pregnancy.
Design Prospective observational study.
Setting Aberdeen Royal Infirmary, Aberdeen, Scotland.
Population Women seeking abortion under the 1967 Abortion Act.
Methods Factors influencing the outcome in a consecutive series of 4132 women undergoing early medical abortion in one Scottish teaching hospital since 1994.
Main outcome measures Complete abortion rates following one or two doses of misoprostol. The effect of age, gestation, previous pregnancy and previous termination on complete abortion rates following the medical regimen.
Results Of the 4132 women, 95 (2.3%) aborted within 48 hours of mifepristone and a further 3942 (95.4%) achieved complete abortion following administration of one or two doses of misoprostol. Thus, the overall complete abortion rate was 97.7% (4037/4131). A total of 94 (2.3%) women required surgical intervention of whom 13 (0.3%) had a continuing pregnancy. Following change of the regimen to include the possibility of two doses of misoprostol the continuing pregnancy rates were significantly reduced (  OR = 5.88  ) and gestation ceased to have an effect on overall efficacy. Women who had a previous abortion were more likely to have a failed medical abortion (  OR = 2.09  ), while women with no previous termination, but a previous live birth were more likely to have a failed abortion (  OR = 2.03  ).
Conclusion Mifepristone in combination with one to two doses of vaginal misoprostol is an effective regimen for early medical abortion. The option of administering two doses of misoprostol significantly reduced the ongoing pregnancy rates and abolished the effect of gestation on overall efficacy. Previous termination was the strongest predictor of failed medical abortion.     

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     

Mifepristone 100 mg in abortion regimens

OBJECTIVE: To examine the clinical efficacy of mifepristone 100 mg followed 2 days later by misoprostol 400 microg orally or 800 microg vaginally in women at up to 49 days' gestation. METHODS: Eighty participants received mifepristone 100 mg and then were randomized to misoprostol, administered 48 hours later, at a dose of 400 microg orally (group 1) or 800 microg vaginally (group 2). Women returned for follow-up evaluations 24 +/- 1 hour after using the misoprostol and then 2-3 weeks later. If abortion still had not occurred and the pregnancy was nonviable, the subject returned again after an additional 3 weeks. RESULTS: Twenty-four hours after receiving misoprostol, 34 (85%; 95% confidence interval [CI] 71%, 94%) of the 40 women in group 1 and 38 (95%; 95% CI 85%, 99%) of the 40 women in group 2 had complete abortions. Overall, complete abortion without surgical intervention occurred in 34 women in group 1 (85%; 95% CI 71%, 94%) and 40 women in group 2 (100%; 95% CI 91%, 100%; P =.03). Four women in group 1 required suction aspiration for continuing pregnancy at the second follow-up, compared with none in group 2 (P =.12). Side effects occurred with similar frequency in both treatment groups. CONCLUSION: Low-dose mifepristone (100 mg) combined with vaginal misoprostol 800 microg may be an effective alternative to regimens using 200 or 600 mg of mifepristone with misoprostol.     

Medical abortion with mifepristone and misoprostol: a clinical trial in Taiwanese women.

BACKGROUND AND PURPOSE: Medical abortion was not officially approved in Taiwan until the end of 2001. We investigated the efficacy of combination mifepristone and misoprostol therapy for medical abortion (which has now been approved) in early pregnant Taiwanese women and whether the attitudes of women who received this treatment affected the clinical outcome of medical abortion. METHODS: Eighty healthy women in early pregnancy (< 49 d of gestation) were enrolled into two studies of medical abortion using mifepristone and misoprostol regimens. The outcomes were evaluated based on complete expulsion of intrauterine contents, with or without surgical intervention. Study 1 used treatment with mifepristone (200 mg or 600 mg) and misoprostol (400 micrograms), and the decision to perform surgical intervention was made mainly on the basis of the patient's request. Study 2 used treatment with mifepristone (200 mg or 600 mg) and misoprostol (600 micrograms) where the decision to perform surgical intervention was made exclusively by the physician. Serum or urinary human chorionic gonadotropin (hCG) concentration was measured serially after abortion. RESULTS: In general, the success rate was 95% as judged by complete expulsion of intrauterine contents without surgical intervention. However, the success rate in Study 1 was only 62.5%. The mean duration of bleeding after abortion was 16.7 to 21.7 days. Serum or urinary hCG concentration remained positive in one woman (1.2%) studied during 43 to 60 days after abortion. CONCLUSION: A combination of mifepristone and misoprostol for medical abortion in Taiwanese women during early pregnancy can achieve a high success rate. Our study showed that a mifepristone dose of 200 mg and a misoprostol dose of 400 micrograms were most effective. Our results suggest that sufficient physician and patient communication regarding medical abortion affects the clinical outcome.     

Curettage after mifepristone-induced abortion: frequency, timing, and indications.

OBJECTIVE:To characterize women who underwent curettage after medical abortion with mifepristone and vaginal misoprostol, to describe when curettage occurred and the reasons for the intervention, and to categorize the indications for curettage according to a simple classification schema. METHODS: These analyses used data from two multisite, randomized controlled trials sponsored by Abortion Rights Mobilization. In the first study, women pregnant less than 63 days received 200 mg of mifepristone and 800 microg of vaginal misoprostol to use 48 hours after taking mifepristone. In the second study, women pregnant less than 56 days were randomly assigned to insert vaginal misoprostol at 1, 2, or 3 days after mifepristone administration. Case report forms and clinical case notes of all women who underwent curettage were examined. RESULTS: Of the 4393 women enrolled in both studies, 116 (2.6%, 95% confidence interval 2.1%, 3.1%) curettages were identified. The gestational age and a history of prior elective abortion were associated with the rate of curettage. The distribution of indications for curettage included bleeding, 61 (53%); continuing pregnancy, 17 (15%); patient request, 36 (31%); and indeterminate, 2 (1.7%). The timing of curettage differed by the indication and scheduled interval between study visits. The distribution of the timing was bimodal. One subset of women, 44 (38%), underwent curettage in the first study week and another subset, 43 (37%), during weeks 3-5. CONCLUSION: Curettage after medical abortion with mifepristone and vaginal misoprostol is rare. At least one half of the curettages were performed for persistent bleeding several weeks after treatment. Both acute heavy bleeding and continuing pregnancy are extremely rare.     

A randomized comparison of mifepristone and self-administered oral or vaginal misoprostol for early abortion

In France, mifepristone in association with orally administered misoprostol is widely used for the early termination of pregnancy (up to 49 days' gestation). In other centers, mifepristone in association with vaginally administered misoprostol has also been used. The aim of the present study was to compare the efficacy and tolerance of mifepristone in association with misoprostol administered orally or vaginally for the termination of pregnancy of up to 49 days' gestation.

A total of 237 women were enrolled in the study. All women received 600 mg mifepristone administered orally and 400 μg misoprostol administered either orally (n = 119) or vaginally (n = 118). A second dose of 400 μg misoprostol was administered if women had not expelled the pregnancy within 3 h. Women were randomized into treatment groups according to the day of their admission.

The overall success rate was 98.7% and there was no significant difference in efficacy between the two groups. There was one treatment failure in the group in which misoprostol was administered orally. Of those women who aborted within 3 h of administration of the first dose of misoprostol, the route of administration of misoprostol did not influence the time to abortion. Of the women who received a second dose of misoprostol, the time to abortion was shorter in those who received misoprostol orally (52 min versus 77 min).

Tolerance was assessed by visual analog scales and was similar for both groups. In both groups, women preferred the oral route of administration.     

A randomized comparison of mifepristone and self-administered oral or vaginal misoprostol for early abortion.

In France, mifepristone in association with orally administered misoprostol is widely used for the early termination of pregnancy (up to 49 days' gestation). In other centers, mifepristone in association with vaginally administered misoprostol has also been used. The aim of the present study was to compare the efficacy and tolerance of mifepristone in association with misoprostol administered orally or vaginally for the termination of pregnancy of up to 49 days' gestation. A total of 237 women were enrolled in the study. All women received 600 mg mifepristone administered orally and 400 microg misoprostol administered either orally (n = 119) or vaginally (n = 118). A second dose of 400 microg misoprostol was administered if women had not expelled the pregnancy within 3 h. Women were randomized into treatment groups according to the day of their admission. The overall success rate was 98.7% and there was no significant difference in efficacy between the two groups. There was one treatment failure in the group in which misoprostol was administered orally. Of those women who aborted within 3 h of administration of the first dose ofmisoprostol, the route of administration ofmisoprostol did not influence the time to abortion. Of the women who received a second dose ofmisoprostol, the time to abortion was shorter in those who received misoprostol orally (52 min versus 77 min). Tolerance was assessed by visual analog scales and was similar for both groups. In both groups, women preferred the oral route of administration.     

Évaluation de l’association mifépristone–misoprostol pour la prise en charge médicale des fausses couches retardées

ObjectivesA retrospective monocentric clinical trial was performed to evaluate the efficacy of the association of mifepristone and misoprostol for the management of early pregnancy failure.Patients and methodsNinety-two women with early pregnancy failure or anembryonic pregnancy were first treated with 600 mg of mifepristone and 48 hours later with 400 μg of misoprostol by oral administration. Successful treatment, defined as an empty uterus, was searched at day 3, with the association of misoprostol–mifepristone alone or with complementary medical treatment, prostaglandins or ocytocine.ResultsThe overall treatment success was 82% (75 of 92 women) with 69 successful cases at day 3 (75%). Six of 92 women (7%) needed a second-line medical treatment. For the last 17 women (18%), the failure of the associated tested medical treatment lead to a secondary surgery. No prognostic factor for the successful medical treatment has been highlighted.Discussion and conclusionA high efficacy for the management of early pregnancy failure is demonstrated for the mifepristone and misoprostol medical treatment. The specific contribution of mifepristone, although proven in the cases of termination of evolutive pregnancies, should be further evaluated in the future for the specific management of early pregnancy failure. Nevertheless, no prognostic factor for the success of the propose treatment can be determined, as the amount of patients enrolled in this study was not sufficient.