生化汤辅助早期妊娠药物流产100例临床观察

目的探讨生化汤对早期妊娠药物流产效果的影响。方法将200例妊娠38~49d的妇女随机分成两组,分别采用米非司酮配伍米索前列醇药物流产及药物流产加用生化汤,对两组流产效果、出血时间、不良反应及月经恢复时间进行比较。结果加用生化汤组完全流产率为95%,显著高于单用药物流产组84%,P<0.05;出血时间(10.2±5.5)d,显著低于单用药物流产组(12.3±4.6)d,P<0.05;两组不良反应及月经恢复时间均无显著差异,P>0.05。结论加用生化汤可改善药物流产效果,缩短出血时间。     

米非司酮联合氨甲苯酸用于药物流产的临床观察

目的:探讨缩短药物流产出血时间及出血量的方法。方法:将286例自愿要求药物流产的早孕妇女随机分为治疗组和对照组,治疗组在孕囊排出后服用米非司酮,每日25 mg共3天,同时加服氨甲苯酸片0.5 g,每日3次共5天。对照组孕囊排出后服用益母草膏20 g,每日3次共5天。两组均加服抗生素。结果:治疗组比对照组完全流产率高(P<0.05),并且缩短了出血时间(P<0.05)。结论:药流后加服米非司酮和氨甲苯酸能有效提高完全流产率,缩短出血时间,减少出血量。     

小剂量米非司酮胶囊配伍米索前列醇终止早孕的临床研究

目的:观察小剂量米非司酮胶囊(75mg)配伍米索前列醇终止早期妊娠的效果。方法:共纳入120例自愿终止妊娠的孕妇(≤7孕周),采用米非司酮75mg分次口服,第3天顿服米索前列醇600μg的方案,分析临床效果。结果:完全流产率91.67%(110/120),不全流产率6.66%(8/120),继续妊娠率1.67%(2/120);1.7%(2/120)服用米非司酮胶囊后孕囊即排出,75.0%(90/120)服用米索前列醇后孕囊排出,23.3%(28/120)观察期间未见孕囊排出;平均孕囊排出时间为2.77h,流产6h内阴道流血量43.4ml,无一例输血或应用止痛药。随访发现药物流产后阴道流血时间12.2±7.7d,其中点滴出血时间8.1±7.3d;药物流产后至第1次月经复潮的时间35.8±9.1d。受试者对米非司酮和米索前列醇的药物耐受性较好,无严重不良事件发生,各种副反应无须特殊处理。结论:75mg米非司酮胶囊配伍米索前列醇600μg终止≤49d早期妊娠具有较好的临床效果,建议开展较大规模的随机对照临床试验进一步验证。     

雌二醇、孕酮水平与药物流产结局关系的研究

目的:为了解生殖激素雌二醇(estrad iol,E2),孕酮(progesterone,P)与药物流产结局的关系。方法:选择停经49 d以内米非司酮配伍米索前列醇药物流产的早孕妇女76例,其中完全流产43例,不全流产33例,于孕囊排出后7 d,14 d,21 d随诊时抽肘静脉血,以磁性颗粒酶联免疫法测定E2,P水平,并对出血超过2周的病例进行刮宫送病理检查。结果:药流后7 d时完全流产组与不全流产组E2水平迅速下降到卵泡期水平,两组无差异,而不全流产组P水平明显高于完全流产组(P<0.005)。药流后14 d与21 d时,不全流产组E2水平明显低于完全流产组(P<0.05),而两组P水平则无明显差异。完全流产组药流后14 d较7 d时E2明显上升(P<0.05),不全流产组14 d较7 d时E2无明显升高。完全流产组7 d时P处于卵泡期水平,不全流产组P则高于卵泡期水平。刮宫发现不全流产中全部有蜕膜和/或绒毛残留。完全流产中有6例发展为排卵期出血,2例发展为功能性子宫出血。结论:药流后出血的主要原因是不全流产,米非司酮药流致雌激素水平低下,可能是药流后出血的原因之一,药流后7 d时孕激素高于卵泡期水平,可能是预测不全流产的指标,但药流后功能性子宫出血不容忽视。     

米非司酮不同给药方式联合米索前列醇治疗瘢痕子宫早期妊娠人工流产效果

目的：探讨米非司酮不同给药方式联合米索前列醇对瘢痕子宫早期妊娠流产效果。方法 回顾性分析2017年9月-2020年9月本各院收治的瘢痕子宫早期妊娠流产104例临床资料，根据治疗方式的不同分为顿服组53例[米非司酮顿服200mg,服药后第3日早口服米索前列醇0.6mg],分服组51例[口服米非司酮75mg, 12h后25mg连服2天，第3d服用米索前列醇0.6mg]。比较两组流产效果及不良反应。结果：分服组完全流产率(94.1%)高于顿服组(81.1%)(P<0.05),月经复潮时间两组(40.2±3.9d、39.5±3.6d)无差异(P>0.05),分服组孕囊组织排出时间(3.1±1.1 h)及阴道流血时间(8.1±4.3d)均短于顿服组(4.6±1.4 h、12.2±4.5d)(P<0.05),不良反应总发生率顿服组与分服组(54.7%、37.7%)无差异(P>0.05)。结论：米非司酮连续给药配合米索前列醇应用，可提高完全流产率，缩短孕囊组织排出时间、阴道流血时间。     

超声在监测药物流产中的应用

目的探讨超声对药物流产的临床应用价值。方法对符合药物流产的妇女,在药物流产前、后均进行二维超声检查,确定流产效果,观察并比较子宫位置(前后位)和孕囊大小(<2cm和>2cm)对流产结果的影响。结果 400例药物流产患者中,完全流产360例、不全流产31例,流产失败9例;34例需清宫。其中子宫前位较子宫后位流产成功率高,孕囊大小<2cm较>2cm的成功率高,二者比较均有统计学差异。结论超声检查在药物流产前对适应症的选择和预测流产效果,在药物流产后评估流产效果、指导临床治疗均可发挥着重要的指导价值。     

复方米非司酮与米非司酮用于药物流产临床效果观察

目的:探讨复方米非司酮与米非司酮用于终止早孕的效果。方法:停经≤49天的早孕妇女80例,随机平分为两组,A组服复方米非司酮,1片/24h,连用2天;B组服米非司酮,1片/12h,连服3天,两组均于前一药物服完第2天服米索前列醇600μg,观察孕囊排出情况、出血时间、出血量及服药后的副反应,了解转经情况。结果:A、B两组完全流产率和胃肠道副反应发生率比较均无显著差异。孕囊排出时间和转经时间A、B两组间比较有显著差异(P<0.05)。结论:复方米非司酮与米非司酮相比可加速孕囊排出,减少出血量和出血时间,提高完全流产效果。     

双炔失碳酯加强米非司酮终止早孕的临床观察

目的:观察双炔失碳酯加强米非司酮对人体抗早孕的作用,以期提高药物流产的成功率,减轻药物流产后出血时间长的副作用。方法: 143例研究对象使用随机数字表法分为对照组72例,常规药物流产;观察组71例,在常规药物流产基础上加用双炔失碳酯7. 5mg,间隔24h, 2次。观察分析两组对象孕囊排出时间、流产后阴道出血情况及尿hCG的变化。结果:与对照组相比,观察组孕囊排出时间及流产后出血时间均明显缩短(P<0. 01 ),药流后出血时间≤14天者明显增加(P<0. 01 ), >21天者明显减少(P<0. 01 ),流产后两周尿hCG阳性率明显降低(P<0. 05);观察组完全流产率高于对照组,但无统计学差异(P>0. 05)。结论:在常规流产药物的基础上加用小剂量双炔失碳酯可以加强米非司酮的抗早孕作用,缩短药物流产后出血时间,提高药物流产的安全性。     

早早孕三种不同人工流产方法的比较

目的探讨复方米非司酮联合微管在早早孕人工流产中的效果及护理特点。方法对300例行人工流产术的早早孕患者,随机分为3组。观察组(100例)采用复方米非司酮联合微管人流术;对照Ⅰ组(100例)先服复方米非司酮2天,第三天晨服米索前列醇0.6 mg进行药物流产;对照Ⅱ组(100例)即直接用微管Y4.5型,一次性宫腔组织吸引管进行人工流产术。同时给予相应的护理配合。分别观察比较3组的孕囊排出情况、手术时间、疼痛程度、出血量及完全流产率、月经恢复情况等。结果观察组和对照Ⅱ组的流产效果较对照Ⅰ组好(p<0.01);观察组的疼痛程度均低于对照Ⅰ组、Ⅱ组(p<0.01);观察组和对照Ⅱ组的孕囊排出情况快于对照Ⅰ组,观察组的出血量少于对照Ⅰ组、Ⅱ组,观察组手术时间少于对照Ⅱ组。结论复方米非司酮联合微管在早早孕人工流产中效果更佳,值得临床推广应用。     

加服米非司酮对药物流产完全性的影响

目的研究药物流产后加服米非司酮对流产的完全性和阴道出血情况的影响.方法米非司酮配伍米索前列醇进行药物流产,排出胎囊后将160例流产者随机分为两组,观察组80例加服米非司酮,对照组80例不加服米非司酮,两组流产病例均于流产后服用妇血安片及抗生素7d.结果①完全流产率及不完全流产率情况.观察组与对照组分别为93.56%(75例)、83.63%(67例)及6.44%(5例)、16.37%(13例).两组完全流产率、不完全流产率均具有统计学显著差异(P＜0.05);②完全流产的平均出血天数(x±s).观察组为8.57±5.36d,对照组为10.01±5.41d,两组平均出血天数无统计学显著差异(P＞0.05).研究组与对照组相比出血量无明显增多.结论药物流产后加服米非司酮明显提高完全流产率,值得临床推广.     

A pilot study of mifepristone and misoprostol administered at the same time for abortion up to 49 days gestation

HYPOTHESIS: Simultaneous administration of mifepristone and misoprostol for medical abortion in women up to 49 days gestation will result in complete abortion in 90% of women within 24 h of treatment. MATERIALS AND METHODS: Forty women with pregnancies up to 49 days gestation inserted 800 mug vaginal misoprostol in our office immediately after taking mifepristone 200 mg orally. Follow-up visits, which included vaginal ultrasonography, occurred 24+/-1 h and 2 weeks after treatment. If a gestational sac was still present at the first follow-up visit, the misoprostol dose was repeated. Suction abortion was performed for a viable gestation at the second follow-up visit, presence of a nonviable gestation within 5 weeks of treatment and when clinically indicated. RESULTS: Expulsion occurred in 36/40 (90%, 95% CI 80-99) and 39/40 (98%, 95% CI 93-100) women by the first and second follow-up visits, respectively. One woman who had initially expelled the gestational sac after a single dose of misoprostol later required a suction curettage for an incomplete abortion. CONCLUSION: Simultaneous administration of mifepristone and vaginal misoprostol is a promising regimen for medical abortion up to 49 days gestation.     

Clinicians' perception of sonogram indication for mifepristone abortion up to 63 days

One barrier in the US to wider acceptance of mifepristone for abortion is the additional cost of the routine use of two sonograms, that is, for pregnancy dating and confirmation of a complete abortion. The purpose of this study is to document how the accuracy of medical abortion clinicians experienced with pelvic exams and dating pregnancies in assessing gestational age at the first visit compared with sonograms, and to identify the factors influencing whether they perceive that sonograms are desired or indicated at the first and follow-up visits. This was a prospective study of 1016 women wanting to participate in a medical abortion trial. After informed consent, clinicians (1) dated the pregnancy before routine sonography and (2) determined whether a sonogram was indicated. Women with sonographic pregnancies of less than 63 days were eligible for mifepristone followed by misoprostol 48 h later. Women returned on Day 4 to Day 8, and clinicians performed a clinical assessment of whether the abortion was complete and determined whether a sonogram was indicated. Fifteen sites participated. Advanced-level providers performed 56% of the assessments. When clinicians assessed a pregnancy under 43 days gestation, they perceived that a sonogram was "not indicated" in 60% of these women. This percentage increased to 66% at 43-49 days gestation, and declined to 46% of women assessed at more than 49 days. Clinicians correctly assessed gestational age as no more than 63 days in 87% of women. In only 1% (14/1013) of their assessments did clinicians underestimate gestational age. In 7/24 (29%) women with a persistent gestational sac, clinicians did not indicate the need for sonography when it was likely indicated. We conclude that the clinicians in our study felt confident in not using sonography in most cases. If clinicians monitor hCG levels to identify any ectopic or continuing pregnancies, medical abortion can be safely performed without sonography.     

Ability of the clinician and patient to predict the outcome of mifepristone and misoprostol medical abortion

We performed this analysis to evaluate the ability of both women and their clinicians to predict pregnancy expulsion after using mifepristone and misoprostol for medical abortion up to 63 days gestation. Women who participated in a multicenter, randomized trial comparing misoprostol 6-8 h vs. 23-25 h after mifepristone attended a follow-up visit approximately 7 days after mifepristone treatment. Each subject was asked if she felt she had expelled the gestational sac. Clinicians also assessed if the sac had been expelled based on the woman's history. Vaginal ultrasonography was then performed to assess the uterine cavity. Of the 1080 women enrolled in the multicenter study, 931 (86.2%) who attended the first follow-up visit by study day 12 and did not have a uterine suction aspiration prior to this visit were included in this analysis. Vaginal ultrasonography at the first follow-up visit demonstrated expulsion in 915 [98.3%, 95% confidence interval (CI): 97.2-99.0] women. Overall, sensitivity, specificity, and positive and negative predictive values for subjects were 96.5%, 31.3%, 98.8% and 13.5%, respectively. When both the clinician and patient felt that the gestational sac had passed (n = 880 [94.5%, 95% CI: 92.9-95.9]), expulsion was confirmed by sonography in 99.1% (95% CI: 98.2-99.6) of cases. Women and clinicians are very accurate at determining expulsion of gestational sac during medical abortion with mifepristone and misoprostol without ultrasonography or a physical examination.     

经直肠超声检测底蜕膜血流及子宫螺旋动脉血流参数预测药物流产结局的价值

目的:探讨经直肠超声检测底蜕膜血流及子宫螺旋动脉血流参数预测药物流产结局的价值。方法:回顾分析流产完全和流产不全者30例,流产前、流产当日、流产后15d经直肠超声检测子宫底蜕膜血流分型、血流阻力指数和子宫螺旋动脉血流参数。结果:流产完全组底蜕膜Ⅰ型血流信号、子宫螺旋动脉及底蜕膜血流阻力指数显著高于流产不全组;Ⅲ型血流信号显著低于流产不全组(P<0.05);Ⅱ型血流信号与流产不全组比较无显著性差异(P>0.05);流产当天与流产后15d所有指标与流产不全组比较均无显著性差异(P>0.05)。结论:药物流产当日经直肠超声检测子宫螺旋动脉及底蜕膜阻力指数和底脱膜血流分型能有效预测药物流产结局。     

Medical abortion outcomes after a second dose of misoprostol for persistent gestational sac

BACKGROUND: We sought to examine outcomes after a second dose of misoprostol was given at a 1-week follow-up visit after medical abortion for the presence of a persistent gestational sac (GS) on ultrasound examination. STUDY DESIGN: We examined outcomes in women who were enrolled in two randomized trials of medical abortion regimens. Pregnant women up to 63 days' gestation received mifepristone followed by misoprostol 800 mcg vaginally either 24 h later, 6-8 h later or within 15 min. Participants in both studies returned for an evaluation, including transvaginal ultrasonography, approximately 7 days after initiating treatment. We included women with a GS present at the follow-up visit. Subjects who had not expelled the GS received a second dose of misoprostol 800 mcg vaginally. Participants returned approximately 1 week later and were contacted by telephone 5 weeks after treatment. RESULTS: Of 1972 women who had a follow-up ultrasound examination within 11 days of treatment, a persistent GS was identified in 82 women (4.2%) of whom 68 opted to receive a second dose of misoprostol. All 68 women returned for follow-up evaluation and 42 (62%) expelled the GS. In the 26 women with an embryonic pole within the persistent sac, expulsion occurred in 5 (36%) of 14 with and 7 (54%) of 13 without gestational cardiac activity (GCA) (p = .45). Of the 14 pregnancies with GCA, only 5 (36%) had GCA at follow-up. CONCLUSIONS: More than half of women with a persistent GS after medical abortion will expel the pregnancy when treated with a second dose of misoprostol. One-third of women who have a GS with cardiac activity will expel the GS with a second dose of misoprostol, making a second dose a reasonable option.     

生化丸加云南白药胶囊用于药物流产的临床观察

目的观察生化丸加云南白药胶囊用于药物流产的临床效果。方法将320例自愿要求药物流产．无米非司酮和米索前列醇禁忌症的健康早孕妇女随机分为观察组和对照组,各160例。两组药物流产均采用相同服药剂量和方法。观察组在顿服米索前列醇时加服生化丸和云南白药胶囊;对照组则不加服任何药物。比较两组疗效并进行统计分析。结果观察组的完全流产率（96．87％）高于对照组的完全流产率（90．63％）,比较差异有统计学意义（P〈0．05）;观察组子宫出血量及出血时间优于对照组,两组比较差异有统计学意义（P〈0．005）。结论生化丸加云南白药胶囊能提高药物流产的完全流产率,减少药物流产子宫出血量,缩短子宫出血时间,疗效显著。     

优思明应用于药物流产后阴道出血的临床效果

目的研究优思明应用于药物流产后阴道出血的临床效果。方法募集自愿要求药物终止早期妊娠(妊娠时间≤49天)的健康流产女性200例,根据知情选择分为优思明组(100例)和对照组(100例)。优思明组于药物流产当日排出孕囊后口服优思明,1天/片,连服21天:对照组为未用优思明。两组在药流后2周及转经后到门诊或电话随访。研究内容为孕囊排出后阴道持续出血时间,流产结局,孕囊排出后宫内残留物和子宫内膜厚度,转经时间等。结果优思明组阴道持续出血时间、转经时间明显短于对照组,不全流产率明显低于对照组,同时子宫内膜厚度恢复明显优于对照组,而子宫内残留物无差异。结论药物终止早期妊娠后服用优思明能,减少阴道出血时间,提高药物流产成功率,缩短转经时间,促进月经恢复。     

CD1a、CD83在药物流产后异常子宫出血组织中的 表达及意义

摘要:目的　通过对树突状细胞（Dendritic Cells,DCs）表面标志物CD1a、CD83在异常子宫出血组织中表达状况的研究,探讨其在药物流产后异常子宫出血中的作用。方法　选取自愿终止妊娠的停经8周之内的早孕妇女,分为人工流产组、药流不全组、药流完全组各20例。收集3组蜕膜组织应用免疫组化法和Western blotting法检测不同分化阶段DCs的分布、形态、数量。结果　3组DCs均分布于腺体间、血管间;CD1a+未成熟DCs呈圆形、卵圆形;CD83+成熟DCs有多个分枝状突起。人流组CD1a的表达较药流组高,但CD83的表达较药流组低,差异有统计学意义（P＜0.01）;药流不全组CD1a的表达较药流全组高,但CD83的表达较药流全组低,差异有统计学意义（P＜0.01）。结论　不同分化阶段DCs与药物流产后异常子宫出血的发生发展有密切相关性。     

Termination of early pregnancy using flexible, low-dose mifepristone-misoprostol regimens

BACKGROUND: Various regimens of mifepristone and misoprostol are used in medical abortion. We examined the effect of a change in protocol from a fixed mifepristone-misoprostol interval to a flexible one on the efficacy and uptake of medical abortion. In addition, risk factors of incomplete abortions were evaluated. STUDY DESIGN: Altogether, 1289 medical abortions were carried out between August 2000 and December 2002. Between August 2000 and August 2001, a fixed protocol of 200 mg of oral mifepristone followed by 0.4 mg of vaginally administered misoprostol 2 days later was used. From September 2001, a flexible dosing interval of 1, 2 or 3 days between mifepristone and misoprostol was adopted. At the same time, the upper limit of gestational age was increased from 56 to 63 days. RESULTS: The uptake of medical abortion increased during the study period and was 45.8% during the use of fixed protocol versus 54.6% during flexible protocol (p<.0001). The rates of complete abortion were 94.9% and 94.4% (n.s.), respectively. Continuing pregnancy was rare (0.7%). Among all subjects, a history of abortion was associated with a significantly lower rate of complete abortion (90.9 vs. 96.3%, p<.002). The other parameters analyzed (age, parity, duration of pregnancy, smoking, mifepristone-misoprostol interval) did not have a significant effect on the rate of complete abortion. CONCLUSIONS: A flexible dosing protocol of mifepristone and misoprostol is effective; thus, its use is encouraged. Previous abortion is a significant risk factor of incomplete medical abortion. Thus, special attention should be paid to the follow-up of these women.     

B超监测结合口服米非司酮预防人工流产并发症的临床作用分析

目的观察B超监测和术后口服米非司酮对降低人流不全发生的影响,探讨一种有效的预防人流不全的方法。方法要求终止妊娠早孕妇女807例,按人工流产术是否与B超监测结合随机分为两个大组,每个大组分别按术后是否口服米非司酮,随机分成两个亚组,比较各组人流不全发生情况及术后阴道出血天数变化。结果在人流不全方面,B超监测结合口服米非司酮组人流不全发生率为0%,阴道出血(6.7±2.8)d,均显著低于其他3组,差异均具有统计学意义(P﹤0.05)。4组月经恢复时间差异经比较均无统计学意义(P﹥0.05)。结论 B超实时监测人工流产术,同时术后服用米非司酮可有效预防人流不全的发生,人流术后服用米非司酮可减少术后阴道出血天数。