宫血宁在预防药物流产后出血的多中心临床效果观察

为减少药物流产后出血时间长和出血量多的问题,采用常规药物流产同时加用宫血宁胶囊或安慰剂,每日二次,每次3枚,共9天,进行随机双盲多中心对比性临床试验,比较两组药物流产疗效和出血情况。结果表明:(1)完全流产率:试验组为88.24％,对照组为87.18％;(2)流产后出血量:与平时月经量相似,试验组为86.67％,对照组为78.43％;出血量比月经量多少于一倍,试验组为9.52％,对照组为18.63％,两组有统计学差异(P<0.05);(3)平均出血天数和出血量用评分法计算以及月经恢复情况,两组相似。提示:药物流产同时加服宫血宁胶囊可减少流产后出血量。     

海墨止血片对药物流产后出血时间影响的临床观察

目的:探讨海墨止血片对早孕药物流产后出血时间的影响。方法:采用随机、双盲方法进行临床对照试验。200例终止早孕对象药物流产后按1:1随机化顺序号分为观察组和对照组,药物流产孕囊排出后第3天晚起,两组分别加服海墨止血片或安慰剂2片/次,3次/日,共6天。结果:完全流产率观察组为95.24％,对照组为95.65％,两组比较无显著性差异(P>0.05);完全流产出血时间观察组为11.61±4.96天(4～33天),对照组为13.85±5.50天(7-34天),差异有显著性(P<0.05);出血时间≤14天者,观察组78.8％,对照组60.3％,两者比较有显著性差异(P<0.05)。结论:药物流产后加服海墨止血片可减少流产后出血时间。     

药物流产后阴道出血130例分析

米非司酮配伍前列腺素终止早孕的完全流产率达到90％以上，已被广泛应用于临床，但存在着出血时间长，出血多，部分病人需要清官的问题。本文对我院门诊接收的药物流产(药流)术后因出血多或出血时间长的130例进行总结分析。     

宫血宁减少药物流产后阴道出血的临床观察

<正> 药物流产已广泛用于临床,成功率在90％以上,但药物流产后阴道出血时间长、出血量多是目前尚未解决的主要问题。本院应用宫血宁预防药物流产后出血多,取得良好疗效,现报告如下。     

药物流产后阴道出血时间延长146例分析

目的:指导正确筛选药物流产病例,提高药物流产成功率。方法:对药物流产术后阴道出血时间≥15天的146例进行分析。结果:1360例药物流产者中,阴道出血时间≥15天共146例,药物流产后阴道出血时间延长发生率为10.74%;妊娠3次以上者药物流产后阴道出血时间延长的发生率明显增加,与妊娠次数3次者比较差异有统计学意义(P(0.05);孕囊≥2cm者药物流产后阴道出血时间延长的发生率明显增加,与孕囊(2cm者比较差异有统计学意义(P(0.05);子宫后位较前位或平位子宫易致药物流产后阴道出血时间延长,二者比较差异有统计学意义(P(0.05)。结论:严格筛选药物流产病例,选择妊娠次数(3次、前位或平位子宫、孕囊(2cm者,可降低药物流产不全的发生率。     

米非司酮配伍米索前列醇和卡前列甲酯栓终止早孕与吸宫流产临床对比研究

本研究采集750例妊娠妇女按自愿选择终止早孕的方法,比较药物(组Ⅰ、Ⅱ)与吸宫(组Ⅲ)的安全性、有效性、可接受性。三组治疗方案:①米非司酮首剂50mg,之后25mg/12h×4+PG05 1mg阴道塞药(组Ⅰ);②米非司酮同前+米索600μg(组Ⅱ);③吸宫流产(组Ⅲ)。结果显示:药流组与吸宫组完全流产率分别为94.2％(476/500)、100％(250/250),两组有显著性差异(P<0.001);不全流产率、失败率三个组分别为:2.4％和0、3.4％和0,组间有明显差异(P<0.01);出血量比月经量增多的对象占19.2％和10％,明显增多的占1.4％和0,组间有显著差异(P<0.05);出血持续时间为11.0±7.1和4.8±3.1,组间有显著差异(P<0.01);转经时间两种流产无统计学意义;两种流产的副反应,药流组的眩晕、下腹痛发生率高于手术组,而恶心、呕吐发生率低于手术组,两组间有显著性差异(P<0.01);对此次流产表示满意的药流组和吸宫组为:79.6％和84.4％,两组中分别有86.4％以及64.0％的对象在下一次发生意外妊娠时,仍然愿意采用本次选择的方法终止早孕。结果提示两种流产仍是目前终止早孕的最佳方法,药物流产作为终止早孕方法的补充是安全,有效、可接受的。     

针灸疗法对药物流产结局影响的临床观察

目的:探讨针灸疗法对药物流产结局的影响。方法:206例妊娠<49天、自愿接受药物终止妊娠的妇女,随机分成观察组和对照组各103例,两组均按常规用药方法服药。观察组从服药第1天开始针灸,针刺足三里、内关、中院、三阴交,用温和灸法灸隐白,每日2次,连续4日。结果:观察组和对照组孕囊排出时间分别为2.44±1.43h和2.89±1.39h(P<0.05);阴道出血时间分别为12.8±4.36天和13.5±5.89天(P<0.05);胃肠道症状分别为4.85％和11.7％(P<0.05)。完全流产率与不全流产率,两组无显著性差异(P>0.05)。结论:药物流产时辅以针灸疗法,可缩短孕囊排出时间、减少阴道出血时间,对减轻胃肠道症状等有一定效果,应当加以探讨研究。     

延长米索前列醇用药时间对药物流产结局影响的临床研究

目的:探讨延长米索前列醇用药时间对药物流产结局的影响。方法:205例妊娠小于7周的药物流产孕妇,常规服用米非司酮配伍米索前列醇的同时,延长米索前列醇用药400μg(观察组),每日1次,连用3天;与未加用米索前列醇组(对照组)作疗效比较。结果:观察组和对照组完全流产率分别为96.6％和88.9％;不全流产率为2.9％和10.1％,流产失败率为0.5％和1.0％(P<0.01);两组出血时间分别为8.2±3.1天和12.6±4.0天(P<0.01),观察组失血量较对照组明显减少;两组副反应比较无显著性差异(P>0.05)。结论:在常规应用米非司酮片配伍米索前列醇的前提下,延长米索前列醇的用药时间可提高完全流产率,缩短出血时间,减少失血量,且不增加副反应,值得临床推广。     

常用检查方法在药物流产后出血诊断中的价值

目的:探讨药物流产后长时间出血的原因及常用检查手段在药物流产后出血诊断中的价值。方法:选择药物流产后出血≥14天的患者48例作为研究组,选择平时月经正常的20例妇女作为对照组,两组均进行B超、宫腔镜及病理检查,并测定血FSH、LH、E2、P值。结果:研究组中不全流产率为83.33%,子宫内膜炎发生率与流血时间呈正相关(P<0.05),不全流产患者垂体FSH、LH显著低于完全流产患者(P<0.05);完全流产患者E2显著高于对照组(P<0.05)。对于不全流产的诊断,B超灵敏度为91.67%,宫腔镜检查灵敏度为100.00%。结论:药物流产后长时间出血的首要原因是不全流产,子宫内膜炎多为长期出血的继发性病变,完全流产后长期出血患者子宫内膜修复及发育不良是出血的主要原因。宫腔镜用于药物流产出血的病因诊断准确性高于B超,且可定位刮宫。     

茜芷胶囊用于药物流产后的临床观察

药物流产是终止早孕的一种避孕失败的补救措施。目前米非司酮配伍米索前列醇，已在临床广泛应用，其完全流产率达90％以上，但存在流产后出血时间长、出血量多等主要不良反应，直接影响药物流产的患者接受程度和效果。     

三地固冲汤治疗节育手术并发子宫异常出血的研究

本文通过动物实验和临床研究,证明了三地固冲汤对节育手术并发子宫异常出血有较好疗效,并探讨了其作用机理。临床研究表现本药能改善节育手术并发子宫异常出血的临床症状与体征,其临床有效率与对照组比较,两者之间有显著性差异(P<0.01,P<0.05,P<0.05)。动物实验结果表明:(1)三地固冲汤能明显缩短小鼠出、凝血时间。(2)三地固冲汤对具有正常兴奋性的离体大鼠子宫平滑肌具有抑制作用。(3)三地固冲汤对已受抑制的离体子宫平滑肌具有兴奋作用。     

早孕妇女人工流产方式意向的临床调查研究

人工流产(简称人流)是各种避孕失败的主要补救措施,目前早孕妇女人流的主要方式有吸刮术与药物流产两种。本文通过对天津市黄河医院意外早孕妇女选择人流方式意向的临床调查研究,探讨现阶段该两种人流方式的可接受性,结果:1000例早孕妇女中选择药物流产(简称药流)者666例(66.6％),吸刮术者334例(33.4％)。本组选择人流方式的理由,其中519例(51.9％)认为药流痛苦少,占第一位,认为手术干脆而选择吸刮术的217例(21.7％),占第二位,其它依次为吸刮术费用低、药流不必手术、吸刮术流产完全、药流不需请假、吸刮术出血时间短、药流安全、吸刮术副作用少、药流保密。药流是近年来使用的流产新方法,本组研究资料及意向选择只反映现阶段早孕妇女的接受状况。     

Mifepristone-induced abortion and vaginal bleeding in subsequent pregnancy

BackgroundThe aim of this study is to explore the effect of first-trimester mifepristone-induced abortion on vaginal bleeding in subsequent pregnancy.Study DesignThis observational cohort study was conducted during 1998–2001 at antenatal clinics in Beijing, Chengdu, and Shanghai, China. The study enrolled 4,931 women with one previous mifepristone-induced abortion, 4,925 women with no history of induced abortion, and 4,800 women with one previous surgical abortion and followed them through pregnancy and childbirth.ResultsThe rates of vaginal bleeding in pregnant women with a history of medical abortion, no abortion, and surgical abortion were 16.5%, 13.9%, and 17.3%, respectively. The women with medical abortion had a higher risk (adjusted relative risk (aRR)=1.17, 95% confidence interval (CI): 1.07, 1.29) of vaginal bleeding compared with those with no abortion but similar risk to prior surgical abortion. When the correlation between medical abortion and vaginal bleeding was examined by period, increased risk was observed only in the early period (<16 gestational weeks) (aRR=1.25, 95% CI: 1.12, 1.39). The comparison between subgroups of medical abortion and no abortion showed that the observed risks increased particularly in those with abortion at gestational age ≤7 weeks (aRR=1.33, 95% CI: 1.18, 1.49), those followed by a postabortion curettage (aRR=1.58, 95% CI: 1.37, 1.84) or complications (aRR=1.99, 95% CI: 1.67, 2.37). There was no difference between women with medical abortion and women with surgical abortion in the occurrence of vaginal bleeding for either period.ConclusionsOne previous mifepristone-induced abortion increased the risk of vaginal bleeding in early gestation period of subsequent pregnancy compared with no abortion, especially if abortion occurred before 7 weeks of gestation and was followed by a curettage or complications.     

微型吸宫器终止早早孕效果评价

目的　探讨微型吸宫器终止早早孕 (孕 31～ 4 5 d)的优越性和临床应用价值。　方法　采用微型吸宫器对 30 0例早早孕妇女进行子宫内膜及孕囊负吸法终止妊娠 ,并与常规人工流产组(简称人流组 )和药物流产组 (简称药流组 )对比 ,观察完全流产率、术中疼痛、出血量、术后出血等情况。　结果　完全流产率 ,微型吸宫器组 (简称微管组 ) 99.7% (2 99/ 30 0 )与药流组 92 .7%(2 78/ 30 0 )比较 ,差异有显著性 (P<0 .0 0 5 ) ,与人流组 99.0 % (2 97/ 30 0 )比较 ,差异无显著性(P<0 .0 5 ) ;无痛率 ,微宫组、药流组和常人流组 0级分别为 87.7% (2 6 3/ 30 0 ) ,0 .7% (2 / 30 0 ) ,9.3% (2 8/ 30 0 ) ,差异有显著性 (P<0 .0 0 5 ) ;术中出血量 ,微宫组平均为 4 .5 ml,药流组平均为9.6 m l,人流组为 9.5 ml。微管组分别与药流组和人流组比较 ,差异有显著性 ,(P<0 .0 0 5 )。　结论　微型吸宫器法终止早早孕 ,手术简单、无损伤、腹痛轻、出血少、术后恢复快、无术时和术后并发症 ,易被受孕妇女接受 ,可作为安全有效的方法用于临床。     

Mifepristone-induced abortion and vaginal bleeding in subsequent pregnancy

Background

The aim of this study is to explore the effect of first-trimester mifepristone-induced abortion on vaginal bleeding in subsequent pregnancy.

Study Design

This observational cohort study was conducted during 1998–2001 at antenatal clinics in Beijing, Chengdu, and Shanghai, China. The study enrolled 4,931 women with one previous mifepristone-induced abortion, 4,925 women with no history of induced abortion, and 4,800 women with one previous surgical abortion and followed them through pregnancy and childbirth.

Results

The rates of vaginal bleeding in pregnant women with a history of medical abortion, no abortion, and surgical abortion were 16.5%, 13.9%, and 17.3%, respectively. The women with medical abortion had a higher risk (adjusted relative risk (aRR)=1.17, 95% confidence interval (CI): 1.07, 1.29) of vaginal bleeding compared with those with no abortion but similar risk to prior surgical abortion. When the correlation between medical abortion and vaginal bleeding was examined by period, increased risk was observed only in the early period (<16 gestational weeks) (aRR=1.25, 95% CI: 1.12, 1.39). The comparison between subgroups of medical abortion and no abortion showed that the observed risks increased particularly in those with abortion at gestational age ≤7 weeks (aRR=1.33, 95% CI: 1.18, 1.49), those followed by a postabortion curettage (aRR=1.58, 95% CI: 1.37, 1.84) or complications (aRR=1.99, 95% CI: 1.67, 2.37). There was no difference between women with medical abortion and women with surgical abortion in the occurrence of vaginal bleeding for either period.

Conclusions

One previous mifepristone-induced abortion increased the risk of vaginal bleeding in early gestation period of subsequent pregnancy compared with no abortion, especially if abortion occurred before 7 weeks of gestation and was followed by a curettage or complications.     

Outcomes of suction curettage and mifepristone abortion in the United States. A prospective comparison study.

A prospective, nonconcurrent cohort analysis of 178 mifepristone/misoprostol and 199 suction curettage abortion subjects, ages > or = 18 years, with intrauterine pregnancies < or = 63 days estimated gestational age, was conducted to compare the outcomes of suction curettage abortion to those of medical abortion. The medical abortion subjects received 600 mg of mifeprisone orally, followed by 400 micrograms of oral misoprostol 2 days later. Surgical abortion subjects underwent electronic vacuum aspiration. All subjects were followed for 2 weeks or until the absence of clinical bleeding. Outcome measures included a successful abortion (complete abortion without a surgical intervention), duration of bleeding, and morbidity. Overall, 18.3% medical and 4.7% surgical patients failed their primary procedure and received an unanticipated suction curettage (RR 3.93, 95% CI 1.87, 8.29). Four mifepristone subjects required curettage for acute bleeding, nine to manage ongoing pregnancy, and five for incomplete abortion. Fourteen mifepristone and eight surgical subjects required curettage for persistent bleeding. The median time delay for therapeutic curettage was significantly longer in the medical abortion group (35 versus 8 days; Mann-Whitney U = 17.0, p = 0.008). Medical subjects experienced significantly longer bleeding (mean difference = 9.6 days, 95% CI 6.8, 12.4). No significant change in hemoglobin occurred in either group. Mifepristone patients reported significantly greater pain (77.1% vs 10.5%; RR 7.4, 95% CI 4.7, 11.5), and nausea or vomiting (68.6% vs 0.6%; RR 117.9, 95% CI 16.7, 834.7). Women receiving mifepristone/misoprostol are more likely to require an unplanned surgical intervention than women who undergo suction curettage. They experience more discomfort with their procedure and in the follow-up interval, bleed for a longer period, and remain at risk for surgical completion curettage for several weeks.     

复发性流产和异常子宫出血患者宫腔镜检查结果分析

目的:评价宫腔镜在复发性流产和异常子宫出血中的应用价值。方法:对198例复发性流产患者(A组)以及257例异常子宫出血者(B组)行宫腔镜检查,了解其宫腔情况,对宫腔异常者,在宫腔镜下进行矫治,追踪随访其妊娠结局。结果:A组198例复发性流产患者宫腔镜检查正常宫腔80例(40.40%),异常宫腔118例(59.60%),其中主要病变类型包括子宫纵隔48例,宫腔粘连32例等;B组257例异常子宫出血患者宫腔镜检查正常宫腔62例(24.12%),异常宫腔195例(75.88%),其中主要病变类型包括子宫内膜肥厚49例,子宫内膜炎46例,子宫内膜息肉45例,子宫粘膜下肌瘤22例。两组患者宫腔镜下的宫腔病变类型有显著性差异(P<0.05)。A组病人共随访到104例,其中正常宫腔17例,足月分娩4例(23.53%);异常宫腔87例,行矫正手术后,足月妊娠分娩45例(51.72%),足月分娩率明显提高。结论:宫腔镜是安全、有效、可行的诊断宫腔病变的检查方法,有助于明确复发性流产和异常子宫出血的病因。对宫腔异常的复发性流产患者,在宫腔镜下进行矫治后,可以明显提高足月分娩率。     

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。     

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。