安宫颗粒防治药物流产后阴道出血的临床观察

目的:观察研究复方安宫颗粒防治药物流产后阴道出血的疗效与安全性。方法:接纳无药物流产禁忌证的早孕妇女195例,随机单盲对照分为观察组77例、中药对照组77例以及空白对照组41例。药物流产采用相同服药剂量与方法,于妊娠囊排出后,观察组服用安宫颗粒1袋,Bid×7天;中药对照组服用益母草冲剂1袋;Bid×7天;空白对照组不服药。3组同时加服替硝唑1.0g,qd×7天。结果:观察组药物流产后阴道出血时间、出血量、完全流产率、2周后尿hCG转阴率等项均优于对照组。结论:药物流产后服用安宫颗粒,可缩短阴道出血时间、减少出血量,提高完全流产率2周后尿hCG转阴率。     

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。     

药物流产失败原因与阴道出血时间的分析

本文重点分析米非司酮合并PG05抗早孕的失败与阴道出血时间长的原因,米非司酮的生产途径有半合成与全合成二种。用药方法,米非司酮按双盲法给药,多次给药者首次服50mg,当晚再服25mg,以后每隔12小时,服25mg,第3天来门诊阴道塞PG05 1mg,单次给药米非司酮为200mg/片一次顿服,第3天来门诊用PG05 1mg,结果180例完全流产90％,失败率(包括不全流产与继续妊娠)占有10％,失败的有关因素米非司酮与米非司酮生产途径,200mg顿服与150mg分次服用,孕妇年龄在35岁以前,妊娠在49天以内,体重在66kg以下,身高在177cm以下,初孕还是经产与是否有宫腔内操作史等参数无明显相关性,用药后绒球排出的快慢与不全流产亦无显著差异,相关因素有用药后是否有阴道出血以及尿hCG是否转阴。阴道出血时间的长短与hCG转阴的日期呈正相关。要进一步提高疗效与缩短阴道出血时间,关键在于提高完全流产率有待摸索最佳配伍与用药方案。     

药物流产严重并发症6例报告

<正> 1996年1～12月我院收治药物流产后严重并发症6例,现报告如下: 一、病例报告 例1 31岁,经产妇,停经41天,尿hCG(+),B超提示宫内早孕,在我院行米非司酮配伍米索前列醇药物流产,服药3h排出胎囊离院。阴道持续出血10天后大量阴道出血伴晕厥,急诊入院。BP14/     

米非司酮配伍米索前列醇终止早孕187例疗效及护理

目的探讨米非司酮配伍米索前列醇终止早孕的临床疗效。方法对187例自愿选择药物人流的早孕妇女的流产效果与不同孕次及停经天数进行观察,并分析流产后阴道出血与不同孕次及停经天数的影响。结果完全流产率95%,且完全流产率与停经天数及孕次有关。结纶药物流产孕妇的心理轻松,流产痛苦少。药流是安全、有效、副作用少的好方法。     

药物流产中动态B超观察孕囊演变及尿hCG值的价值

总结98例米非司酮配伍前列腺素抗早孕资料,分析孕囊直径及服药前后孕囊形态学变化及尿hCG定量的下降速度对流产后出血时间的影响:孕囊直径与流产后出血时间呈正相关(r=0.31,P<0.01);孕囊形态学的演变可能影响出血时间。认为孕囊直径及形态变化和尿hCG值的动态监测对判断预后,提高药物流产质量有重要价值。     

药物流产与人工流产两种方法终止早期妊娠的效果比较

目的 比较药物流产和人工流产终止早孕的临床疗效,探讨药物流产与人工流产术终止早期妊娠的效果比较.通过药物流产组与人工流产组(文中下列简称:药流组和人流组)所产生的完全流产率、阴道出血时间、疼痛评分值三个方面进行对比.方法 针对2010年来我站需要终止早孕者(妊娠10周以内,妊娠10周以上除外)采用药物流产及人工流产,随机挑选病例分组,单日病例为药流组,双日病例为人流组,各30例进行观察临床研究.结果 药流组完全流产率为86.66％,人流组完全流产率为100％;药流组阴道平均出血时间为(15.2±7.3)天,人流组阴道平均出血时间为(7.5±2.6)天;药流组疼痛评分值为(6.8±5.2),人流组疼痛评分值(8.5±6.6).两组比较:完全流产率、阴道平均出血时间、疼痛评分值,差异均有统计学意义(P＜0.05).结论 药流组完全流产率低;阴道出血时间长、腹痛轻.人流组完全流产率高;阴道出血时间缩短,腹痛明显.     

药物流产后持续阴道流血清宫时机的探讨

目的探讨药物流产后持续阴道流血产妇的清宫时机。方法为了解决药物流产后出血时间过长和失血量过多的问题,本研究对不同时机行清宫术的孕妇进行术后出血量、出血持续时间及并发症发生情况的对比研究。结果本文1210例接受药物流产的孕妇中完全流产者1015例,占83.88%(1015/1210),流产失败195例,占16.12%(195/1210);流产失败195例产妇均行清宫术,其中出血量大于月经量即行清宫术,留院8d后仍然未能排出孕囊并于当天即行清宫术60例(I组);药物流产后d8复诊时行清宫术85例(Ⅱ组);药物流产后d15复诊时行清宫术50例(Ⅲ组)。I组的出血量和出血持续时间明显低于Ⅱ组,而Ⅱ组的出血量和出血持续时间则明显低于Ⅲ组,差异有统计学意义(t=8.96、5.68,P均﹤0.05)。各组间比较差异有统计学意义(F=7.02,P﹤0.05)。I组产妇清宫术后宫内感染及尿HCG转阴时间≥15d者所占比例均明显高于Ⅱ组,而Ⅱ组的产妇清宫术后宫内感染及尿HCG转阴时间≥15d者所占比例均明显高于Ⅲ组,差异有统计学意义(χ2=7.86、4.11、6.94、4.57,P均﹤0.05)。各组间宫内感染及尿HCG转阴时间≥15d者所占比例比较差异有统计学意义(P﹤0.05);而3组间不全流产率相比较则差异无统计学意义(P﹥0.05)。结论在药物流产后根据出血量判断其中药物流产失败者,并应尽早行清宫手术,可以有效解除造成流血量过多和流血时间过长的原因,并大大降低药物流产并发症的发生机率,帮助孕妇迅速康复。     

影响药物流产效果的分析

目的:探讨影响药物流产效果的有关因素。方法:选取216例停经84天内早孕健康妇女口服米非司酮配伍米索前列醇终止妊娠,并对其年龄、停经天数、孕次、产次进行分析。结果:口服药物流产效果与早孕妇女的年龄、孕次、产次无关,与停经天数有关。停经50～59天组,不全流产率最低(12.9%)。停经<49天与50～59天流产效果比较,其流产率基本相同(P>0.05),提示口服药物流产适用于停经59天内的早孕妇女,且效果安全、可靠。     

药物流产后尿HCG转阴时间的临床分析

目的:通过观察并药物流产后尿HCG转阴的时间,分析流产后复诊项目的临床意义及相互关系。方法:复习我院妇科门诊874例药物流产成功按时复诊的病历。复诊时间依是否见到胎囊排出而不同,服米索当天未见胎囊排出者于第8天复诊见到胎囊排出者则在2周时复查B超、尿HCG及出血情况。结果:药流后阴道持续出血5～28天,平均14.6天。尿HCG转阴最早7天,最迟29天,平均15.2天。正常出血组(≤16天)和出血延长组(>16天)平均出血天数及尿HCG转阴平均时间不同。结论:药流2周后尿HCG未转阴并不意味一定有宫内残留物;B超不是药物流产后复诊的必查项目。     

Mifepristone and misoprostol for early abortion when no gestational sac is present.

The study was conducted to determine whether the administration of mifepristone followed by vaginal misoprostol can induce an abortion in early pregnancy when no gestational sac is present on sonogram. This report presents a prospective, pilot study of 30 healthy adult women, pregnant and seeking an abortion, and with no gestational sac on sonogram. All women had a baseline serum chorionic gonadotropin (hCG) level measured prior to using mifepristone 200 mg orally followed by misoprostol 800 mcg vaginally 48 h later, and then returned up to 4 days later for a repeat sonogram and serum hCG level. Women with initial hCG levels > 2000 IU/L were evaluated for ectopic pregnancy. At the first follow-up visit, if the hCG decreased by >50%, the women were followed with home pregnancy (25 IU/L) tests weekly until negative. If the levels did not decrease by 50%, a second dose of misoprostol was given. Surgical intervention was indicated for persistent hCG levels or excessive bleeding. Of the 30 women enrolled, the mean number of days of amenorrhea was 40 (SD 9) days. Two women had surgical intervention for continuing pregnancy, 2 had ectopic pregnancies, and 1 was lost to follow-up. Complete medical abortions occurred in 25/30 (88%) women, but when recalculated, in 25/27 (93%) women who completed the protocol and who did not have an ectopic pregnancy. There was 1 adverse event in a woman with an ongoing pregnancy who then received methotrexate. She was hospitalized a day later with a complicated pelvic infection and likely methotrexate-induced pneumonitis. Twenty-three women had a decrease in hCG at first follow-up visit of >50%. All 27 women who completed the protocol found the overall regimen acceptable. Mifepristone followed at 48 h by vaginal misoprostol were effective and acceptable in inducing an abortion in very early pregnancy. There may be a higher incidence of failure in very early pregnancies. Documentation of a complete abortion by hCG level is necessary to ensure the pregnancy is neither ongoing nor ectopic.     

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.     

Serum human chorionic gonadotropin decline following aspiration abortion in early pregnancy less than 42 days gestation

ObjectiveTo define serum human chorionic gonadotropin (hCG) decline following complete aspiration abortion.Study DesignWe performed a secondary analysis of 86 patients who underwent uncomplicated aspiration abortion for ultrasound-confirmed pregnancy ≤42 days gestation and had serum hCG at the time of aspiration and within 3 days postprocedure.ResultsMedian hCG declines were 72.9% by day 1 (n = 14), 87.6% by day 2 (n = 50), and 92.8% by day 3 (n = 22). Ninetieth percentile declines were 67.8%, 81.5%, and 90.8%. Minimum hCG declines were 56.2%, 77.3%, and 83.2%. Trends did not vary by gestational age or by initial hCG <3000 mIU/mL.ConclusionPostprocedure hCG trend varies over the first few days in early gestation. At ≤42 days gestation, serial hCG decline at 1 day after completed aspiration abortion is greater than 50%, consistent with the decline observed in medication abortion.ImplicationsThis study confirms previously estimated human chorionic gonadotropin decline after aspiration abortion of at least 50% at 24 hours for completed procedure in very early gestations. Minimum declines on days 2 and 3 are approximately 70% and 80%.     

Induced abortion and risk of subsequent miscarriage

BACKGROUND: To evaluate the impact of surgically induced first-trimester abortion on the risk of miscarriage in a subsequent pregnancy. METHODS: The study is a pregnancy cohort study. It was conducted among 15 general hospitals or maternity and infant health institutes in Shanghai, China from November 1993 to March 1998. The abortion cohort consisted of pregnant women whose previous pregnancies were terminated by vacuum aspiration (98%). The reference cohort consisted of primigravidae. Subjects were recruited at 35-63 days of gestational age. A total of 2953 pregnant women were enrolled; 1502 in the abortion cohort, 1451 in the reference cohort. RESULTS: There were only 62 women lost to follow-up. The remaining 2891 women had 2732 live births, and 137 miscarriages. About 5.5% of pregnancies in the abortion cohort were miscarried and 4.0% in the reference cohort. Once potential confounders were controlled for by logistic regression, odds ratio (OR) of miscarriage between the abortion cohort and the reference cohort was 1.55 (95% CI: 1.08-2.23). The adjusted OR were 2.44 (95% CI: 1.16-5.15) among women who were recruited within 49 days of gestational age, and 1.72 (95% CI: 1.09-2.72) for the first-trimester miscarriage. CONCLUSIONS: Induced abortion by vacuum aspiration is associated with an increased risk of first-trimester miscarriage in the subsequent pregnancy.     

Analgesia during at-home use of misoprostol as part of a medical abortion regimen

The objective of this study was to identify predictors of narcotic analgesic use during medical abortion. Two-thousand-seven-hundred-forty-seven women with pregnancies of 63 days gestational age or less received 200 mg mifepristone followed by at-home use of 800 μg vaginal misoprostol in two consecutive clinical trials in the United States, and also reported their use of analgesics. Overall, 79% of these subjects used narcotic analgesics. Women in the 2nd of the two studies were randomized to use misoprostol 24, 48, or 72 h after mifepristone. Those who were randomized to 24 h were more likely to use narcotic analgesics than those who were randomized to 48 or 72 h. In both studies, the use of narcotic analgesia during medical abortion was less prevalent among parous women and Asian women, and among those with a gestational age of 56 days or less. The clinic providing care for the patient was the most important determinant of narcotic analgesia use, even though the analgesia was used at home. Use of narcotic analgesics in these women undergoing medical abortion at home was more prevalent than use reported in previous studies where women underwent medical abortion in a clinical setting.     

胎盘组织白血病抑制因子和hCG的表达与妊娠期高血压疾病的关系

目的:探讨白血病抑制因子(LIF)基因和人绒毛膜促性腺激素(hCG)基因在胎盘组织的表达与妊娠期高血压疾病(HDCP)的关系。方法:采用荧光定量RT-PCR(FQ-RT-PCR)技术,对37例子痫前期患者、50例妊娠期高血压患者和80例正常足月妊娠妇女胎盘组织进行LIF-mRNA和hCG mRNA的检测,分析目的基因与β-actin拷贝数的比值。结果:①子痫前期组LIF mRNA的表达较妊娠期高血压组和正常对照组明显降低,差异有统计学意义(P0.01),且随着病情的加重,LIF mRNA表达下降。妊娠期高血压组和正常对照组比较,LIF mRNA的表达稍有降低,但差异无统计学意义(P0.05)。②hCG mRNA的表达水平均按照正常对照组、妊娠期高血压组、子痫前期组依次升高,子痫前期组与妊娠期高血压组、正常对照组比较差异有统计学意义(P0.01)。妊娠期高血压组与正常对照组比较,hCG mRNA表达水平的差异无统计学意义(P0.05)。③通过pearson相关分析,子痫前期组LIF mRNA的表达量和hCG mRNA的表达量相关系数为-0.57,呈显著性负相关(P0.05)。结论:HDCP患者胎盘中LIF表达下降和hCG水平升高,可能通过影响细胞滋养细胞的浸润能力而影响血管床的发育,共同参与了子痫前期的发病过程。     

血管内皮生长因子在自然流产胚胎和人工流产胚胎中的表达

目的 探讨自然流产胚胎和人工流产胚胎中血管内皮生长因子(VEGF)表达量的差异. 方法 按照孕周分组,采用免疫组化法检测30例自然流产胚胎(病例组)绒毛组织中VEGF的表达,同时收集50例人工流产的胚胎绒毛组织(对照组)检测VEGF进行对照分析研究. 结果 在不同的孕周,病例组其VEGF的表达量均较对照组降低,且对照组VEGF的表达量随着孕周的增加而增加,在病例组中却没有这样的趋势. 结论 自然流产的胚胎组织与同孕周的人工流产的胚胎组织相比其VEGF表达量下降,提示VEGF表达量下降可能与自然流产相关.     

Nutritional status and unfavourable pregnancy outcome in Egyptian women

The nutritional status in 43 cases of repeated spontaneous (habitual and threatened) abortion with both favorable and unfavorable results was assessed by the 24-hour recall method, as compared to 19 normal terminating pregnancies, all of which were in women of low socioeconomic class and who were considered to be malnourished. All pregnant women were monitored at 2 points during gestation, namely 6-12 weeks and 12-16 weeks, by measuring human chorionic gonadotropin as the main hormonal marker in pregnancy and by total and fractional serum protein estimation as a biochemical probe to both the nutritional status and to the course and outcome of pregnancy. Chorionic gonadotropin was significantly decreased in cases of unfavorable outcome in both gestational periods. Apart from the usual physiological changes of pregnancy in total serum protein and its fractions, a significant increase of the beta globulin fraction in the earlier gestational period only was observed. This increase corresponded to and was inversely proportional to the decreased levels of hCG. The authors therefore suggest the introduction of serum protein electrophoresis as a simple routine procedure for screening high risk pregnancies and thus, the early prediction of unfavorable pregnancy outcome.     

Recruitment for a community-based study of early pregnancy: the Right From The Start study

Despite the high incidence of spontaneous abortion, little is known about its causes, in part because of the challenge of assembling a large cohort of women in early pregnancy for prospective study. We describe the effectiveness of recruitment strategies used in Right From The Start (RFTS), a prospective, community-based study of spontaneous abortion. Between December 2000 and September 2002, 803 pregnant women enrolled in RFTS, 103 of whom were recruited while trying to conceive. The mean gestational age at enrollment was 52 days, with 25% of the cohort enrolling before 6 completed weeks' gestation. Participants recruited directly from the community typically enrolled earlier in their pregnancies (mean of 44 days) and accounted for 24% of the total cohort and 83% of all participants who were recruited while trying to conceive. Posting brochures in drug stores and targeted mailings to new homeowners were the most effective community recruitment strategies. Recruitment at private and public prenatal care sites accounted for 57% and 19% of the participants respectively. Recruitment from public clinics required direct contact by RFTS staff and yielded women who enrolled at later gestational ages (mean of 58 days), but was valuable for inclusion of minorities and lower income women with less favourable health behaviours. Although intensive, diverse efforts were required, when recruitment efforts were maximised, we successfully recruited over 10% of the estimated number of pregnant women in the community.     

A comparison of tamoxifen and misoprostol to misoprostol alone for early pregnancy termination

A study was undertaken to determine whether the combination of oral tamoxifen and moistened misoprostol administered vaginally was superior to that of placebo and moistened misoprostol administered vaginally for elective termination of early pregnancies.

A clinical trial was conducted with a study group of 150 healthy women with pregnancies of ≤56 days gestational age who desired pregnancy termination. Subjects were randomized to ingest either 20 mg of tamoxifen (group 1) or placebo (group 2) twice daily for 1 day, followed 48 h later by vaginal administration of 800 μg of saline-moistened misoprostol. This dose of misoprostol was repeated 24 h later and 8 days later if an abortion had not occurred. The main outcome measures were incidence of complete abortion, hemoglobin levels, duration of vaginal bleeding, and incidence of side effects. Complete abortion occurred in 709 (93.3%) in group 1 and 68 (90.7%) in group 2. There were no differences in either group between earlier (≤49 days) and later (50–56 days) gestations. The mean duration of uterine bleeding was 7.9 days and 8.2 days in group 1 and group 2, respectively. In group 1, 94.3% who aborted bled for <14 days, and in group 2, 95.6%. No subject required a blood transfusion. There were no significant differences in side effects between the two groups. These data suggest that pretreatment with tamoxifen is not necessary when using moistened vaginal misoprostol for abortion of pregnancies of ≤56 days of gestation.