维生素C溶液湿化米索前列醇用于人工流产术效果观察

目的探讨维生素C（VitC）溶液湿化米索前列醇阴道置药用于人工流产术的临床效果。方法将306例早孕未产妇女随机分成三组,每组102例,Ⅰ组阴道置米索前列醇,Ⅱ组、Ⅲ组分别用注射用水及VitC溶液湿化米索前列醇。结果Ⅲ组宫颈松弛效果最佳,术中出血量最少,手术时间最短,人工流产综合征发生率最低。Ⅱ组次之,Ⅰ组最差,差异有统计学意义（P〈0.05）。结论 VitC溶液湿化米索前列醇阴道置药用于人工流产术的效果优于其它方法。     

单用米索前列醇终止10～16周妊娠的临床研究

目的　总结米索前列醇终止 1 0～ 1 6周妊娠的临床效果。方法　应用米索前列醇阴道放置终止 1 0～1 6周妊娠 1 0 0例临床效果观察并与米非司酮配伍米索前列醇、利凡诺组各 5 0例流引产进行效果和副作用等对比。结果　观察组在产程、成功率、出血量、疼痛程度、住院时间及费用等方面明显优于对照组 ,未出现明显并发症。结论　米索前列醇终止 1 0～ 1 6周妊娠具有操作简便、经济实用、流产时间短、成功率高、副作用少等优点 ,值得临床推广应用。     

米非司酮配伍米索前列醇终止妊娠的临床观察

目的：探讨米非司酮配伍米索前列醇用于孕10周－16周引产的有效性及安全性。方法：120例孕10周－16周自愿要求终止妊娠的健康妇女分为两组,A组60例口服米非司酮,每12小时1次,首次50mg,以后每次25mg,共5次总量150mg,第3天始每3小时口服米索前列醇0．6mg,若出现有效宫缩即停药,总剂量不超过1．8mg;B组60例用利凡诺100mg羊膜囊内注射引产作为对照组。结果：两组引产成功率分别为90％及75％（P＜0．05）。A组有效引流产时间较B组明显缩短（P＜0．01）。两组产后出血、药物副作用及胎盘胎膜残留的发生率间无显著性差异。结论：米非司酮配伍索用于孕10周－16周引产是一种安全、有效、方便的方法,且效果优于利凡诺。     

米非司酮联合米索前列醇终止10～24周妊娠临床观察

目的探讨米非司酮联合米索前列醇终止10～24周妊娠的疗效。方法米非司酮150mg分次口服后,米索前列醇400Ixg重复阴道后穹隆给药。结果完全流产140例占93％,不全流产10例占7％,失败0例。结论米非司酮150mg分次口服,联合米索前列醇阴道给药终止10～24周妊娠引产流产时间短,成功率高,清宫率低。     

米非司酮配伍米索前列醇终止14～24周妊娠的临床观察

<正> 本站2000年10月～2002年9月,对93例孕14～24周妇女采用米非司酮配伍米索前列醇(米索)终止妊娠,效果满意,现报道如下。 一、资料与方法 1.一般资料 2000年10月～2002年9月在本站门诊选择妊娠14～24周,年龄20～36岁,自愿接受药物终止妊娠的健康孕妇93例,无用药禁忌证,心、肝、肾功能正常,无生殖道畸形,宫颈损伤和修补史,无药物过敏史,经妇科及B超检查证实为宫内妊娠,胎盘位置正常。     

米非司酮配伍米索前列醇终止10～14孕周妊娠临床观察

目的探讨米非司酮配伍米索前列醇用于10～14孕周终止妊娠的临床效果。方法10～14孕周终止妊娠者69例,予米非司酮口服和米索前列醇后穹窿填塞。结果69例患者全部排出胚胎及部分组织,并及时行清宫术。结论米非司酮配伍米索前列醇用于10～14孕周终止妊娠,痛苦小、副作用小、流产后恢复快,且降低了感染率。     

米非司酮配伍米索前列醇终止11～15周妊娠的临床效果观察

目的探讨米非司酮配伍米索前列醇用于终止11～15周妊娠的临床效果。方法回顾性分析应用米非司酮配伍米索前列醇对240例妊娠11—15周终止妊娠的效果和副作用，并与传统方法终止11～15周妊娠的效果进行对比。结果观察组宫腔操作时间（5．20±1．20）min明显少于对照组（14．00±3，30）min，两组比较有统计学意义（P〈0．01）。术中出血量（52．00±15．60）ml明显少于对照组（77±22．30）ml，两组比较有统计学意义（P〈0．05）。宫颈成熟：观察组，显效率（97．16％）明显高于对照组（18％），两组比较有统计学意义（P〈0，01）。刮出组织物量，观察组（26．00±10．48）g明显少于对照组（56．00±42．25）g（P〈0．01），两组比较有统计学意义（P〈0．01）。并发症：观察组无，对照组17例。结论米非司酮配伍米索前列醇用于终止妊娠11～15周是一种安全、有效、痛苦小、并发症少的方法。     

口服米索前列醇足月妊娠引产的临床观察

我院在临床实践中发现,口服米索前列醇用于足月妊娠引产,有安全、效佳、经济、用药更方便的特点。报告如下。1 资料与方法1.1 对象年龄23岁～35岁。足月妊娠,单胎头位,宫颈Bishop 分<6分,因各种原因需引产结束妊娠者,排除胎位异常、头盆不称、胎儿窘迫、严重内科合并症及前列腺素类药物禁忌症者。研究对象共229例,征得产家同意后,随机分为试验组(米索前列醇组)126例和对照组(缩宫素组)103例。两组年龄、孕产次及孕周无显著差异。     

米非司酮配伍米索前列醇用于妊娠14～26周引产的临床观察

目的探讨米非司酮配伍米索前列醇用于妊娠14~26周引产的疗效。方法选取2010年10月—2012年9月来自该院要求终止妊娠的孕14~26周引产病例196例,随机分为观察组(米非司酮配伍米索前列醇)98例,对照组(依沙吖啶羊膜腔内注射)98例,比较两组引产效果。结果观察组产程时间短、引产成功率高、产后2h出血量少,胎盘残留率低,各项指标均优于对照组,P均<0.05,有显著性差异。结论米非司酮配伍米索前列醇用于终止14~26W妊娠成功率高,操作简单,安全有效,值得应用和推广。     

Pilot study on the use of sublingual misoprostol in termination of pregnancy up to 7 weeks gestation

BACKGROUND: This study was conducted to assess the efficacy and incidence of side effects of a regimen of repeated doses of 400 microg sublingual misoprostol for termination of pregnancy of <7 weeks gestation. METHOD: Fifty women were given 400 microg sublingual misoprostol every 3 h for three doses. Two additional doses were given if necessary. RESULTS: Forty-three women (86%) had a complete abortion. Two women (4%) had incomplete abortion and 5 (10%) had an ongoing pregnancy. The median interval between the first dose of misoprostol and the passage of tissue mass was 14.1 h (3.25-561.6 h). The median duration of vaginal bleeding was 20 days (8-85 days). Side effects were mild and there was no significant drop in hemoglobin level. CONCLUSIONS: Our preliminary results on sublingual misoprostol show that it is a promising method for medical termination of pregnancy of <7 weeks. It may be used as an alternative for women who do not want surgical evacuation and who live in an area where mifepristone is not available.     

米非司酮配伍米索前列醇终止16～24周妊娠的临床研究

目的:探讨米非司酮配伍米索前列醇终止16~24周妊娠的有效性和安全性。方法:研究对象随机分组,分别采用米非司酮配伍米索前列醇(药物组)或米非司酮配伍依沙吖啶羊膜腔内注射(手术组)引产,各53例,胎儿及胎盘排出后药物组不做常规清宫,手术组常规清宫。结果:药物组和手术组胎儿排出率分别为94.3%、98.1%,差异无统计学意义(P0.05);首次用药至胎儿排出时间分别为(48.7±7.0)h和(38.5±9.4)h,宫缩至胎儿排出时间分别为(10.6±6.7)h和(14.2±9.0)h,差异均有统计学意义(P0.05);药物组清宫率18.9%,以院内清宫为主。结论:米非司酮配伍米索前列醇终止16~24周妊娠安全、有效,避免了羊膜腔穿刺,是终止16~24周妊娠安全可靠的方案之一。     

A pilot study of mifepristone in combination with sublingual or vaginal misoprostol for medical termination of pregnancy up to 63 days gestation

Of the total women included in the study, 96 women chose to receive misoprostol 600 microg sublingually while 53 women received misoprostol 800 microg vaginally 36-48 h after receiving mifepristone 200 mg. Complete abortion occurred in 93 women (98.9%) in the sublingual and 51 women (96.2%) in the vaginal group (p = 0.27). The mean induction-to-abortion interval was 3.2 h (SD = 1.4) in the sublingual and 4.1 h (SD = 1.5) in the vaginal group (p = 0.02). The mean gestation at abortion in weeks was 7.1 (SD = 1.0) in the sublingual and 7.7 (SD = 1.3) in the vaginal group (p = 0.003). Women in the sublingual group experienced more vomiting (p = 0.03), diarrhea (p = 0.02) and unpleasant taste in their mouth (p = 0.0001) while those in the vaginal group experienced more headache (p = 0.002). Of women in the sublingual group, 77% were satisfied with the route of misoprostol administration compared to 68% in the vaginal group (p = 0.25). These findings now need to be assessed in the context of a randomized controlled trial.     

Comparison of two dose regimens of misoprostol for second-trimester pregnancy termination

Objective

The study was conducted to compare the efficacy of two different dose regimens of misoprostol administered vaginally in combination with mifepristone for second trimester termination of viable and non-viable pregnancies.

Design

Double-blind randomized controlled trial conducted at the University hospital in the Netherlands. One hundred seventy-six women between 14 and 24 weeks gestation with an intrauterine fetal death (n=31), congenital or genetic abnormalities of the fetus (n=116) or requesting a termination of pregnancy for psychosocial reasons (n=29) were studied.Randomization was into one of two groups. Both groups ingested mifepristone 200 mg. Depending on the randomization group, this was followed by either 200 or 400 mcg misoprostol given vaginally beginning 36-48 h later at 4-h intervals (with a maximum of 10 administrations in 48 h) until the fetus was delivered. Randomization, administration of the medication and assessment of the outcome was performed independently from the investigators.Main outcome measures were expulsion rate and the number of incomplete abortions warranting surgical evacuation of retained products of conception. Secondary outcome measures consisted of the time between the first administration of misoprostol to the delivery of the fetus, side-effects, blood loss, live births and changes in hemoglobin level.

Results

In the 200-mcg misoprostol group, 66% (57/86) had a complete expulsion of fetus and placenta compared to 73% (66/90) in the 400-mcg group (p=NS). The time between the first administration of misoprostol and delivery of the fetus was significantly longer in the misoprostol 200-mcg group: mean 11.6 h (range: 9.7-13.5 h) versus 9.3 h (range: 8.1-10.5 h) in the 400-mcg group (p=.042). No significant differences between the groups were found for frequency of side-effects like nausea, retching, vomiting, fever, headaches and diarrhea. Blood loss was similar in both groups with a mean of 337 mL in the 200 mcg misoprostol and 296 mL in the 400-mcg misoprostol group (p=NS). Of the women with a viable pregnancy at the beginning of the trial, 18.6% (13/70) in the 200 mcg misoprostol group delivered a live fetus compared to 22.8% (17/75) in the 400 mcg misoprostol group (p=NS).

Conclusions

Both regimens used in this trial proved to be equally effective for termination of both viable and non-viable pregnancies during the second trimester. The time between the first administration of misoprostol and delivery of the fetus was significantly longer in the 200-mcg group than in the 400-mcg group. This outcome may be used as the rationale for choosing a 400 mcg misoprostol regimen for termination of pregnancy during the second trimester.     

依沙吖啶与米非司酮配伍米索前列醇用于孕16～28周引产对比观察

目的对依沙吖啶（利凡诺）与米非司酮配伍米索前列醇用于孕16～28周引产进行对比观察。方法因各种原因自愿终止妊娠的孕16—28周患者100例,随机均分为两组：A组依沙吖啶100mg经腹羊膜腔内注射,B组清晨空腹口服米非司酮150mg,同时阴道后穹窿放置米索前列醇。观察两组患者胎盘及胎儿排除时间、阴道流血量、住院时问及引产效果等。结果A组完全引产率为76％（38／50）、清宫率为20％（10,50）、胎盘及胎儿排除时间为（42．0±5．8）h、住院时间为（96±6）h、阴道流血量为（110．6±6．5）ml,B组各指标分别为98％（49／50）、2％（1／50）、（12．5±4．5）h、（72±4）h、（46．3±5．6）ml,两组比较差异均有统计学意义（P〈0．05）。结论口服米非司酮配伍阴道用米索前列醇用于孕16～28周引产,与依沙吖啶羊膜腔内注射比较,胎盘及胎儿排除时间、住院时间短,阴道流血量少,成功率高,值得临床推广。     

依沙吖啶与米非司酮配伍米索前列醇用于孕16～28周引产对比观察

目的 对依沙吖啶(利凡诺)与米非司酮配伍米索前列醇用于孕16～28周引产进行对比观察.方法因各种原因自愿终止妊娠的孕16～28周患者100例,随机均分为两组:A组依沙吖啶100 mg经腹羊膜腔内注射,B组清晨空腹口服米非司酮150 mg,同时阴道后穹窿放置米索前列醇.观察两组患者胎盘及胎儿排除时间、阴道流血量、住院时间及引产效果等.结果 A组完全引产率为76%(38/50)、清宫率为20%(10/50)、胎盘及胎儿排除时间为(42.0±5.8)h、住院时间为(96±6)h、阴道流血量为(110.6±6.5)ml,B组各指标分别为98%(49/50)、2%(1/50)、(12.5±4.5)h、(72±4)h、(46.3±5.6)ml,两组比较差异均有统计学意义(P<0.05).结论口服米非司酮配伍阴道用米索前列醇用于孕16～28周引产,与依沙吖啶羊膜腔内注射比较,胎盘及胎儿排除时间、住院时间短,阴道流血量少,成功率高,值得临床推广.     

补佳乐联合米索前列醇片治疗稽留流产的临床观察

目的:探讨补佳乐联合米索前列醇在稽留流产中的应用效果。方法:将156例稽留流产患者随机分为3组,每组52例。补佳乐组:口服补佳乐5 mg,每天3次,共3天,第4天早晨阴道内放置米索前列醇片600 g,观察2～6 h后B超下行清宫术;单用米索前列醇组:直接阴道内放置米索前列醇片600 g,行清宫术;米非司酮组:口服米非司酮50 mg,每天2次,共2天,第3天阴道内放置米索前列醇片600 g,行清宫术。观察3组胚胎自然排出情况、是否急诊清宫、宫颈扩张程度、手术时间、术中出血量及清宫后阴道出血持续时间。结果:3组中补佳乐组和米非司酮组胚胎自然排出率分别为67.3%、78.8%,宫颈扩张满意率分别为96.2%、98.1%,两组间比较无统计学差异(P>0.05),两组与米索前列醇组比较有统计学差异(P<0.05)。米非司酮组有9例需要急诊清宫,与补佳乐组和单用米索前列醇组相比有统计学差异(P<0.05)。单用米索前列醇组手术时间最长(P<0.05)。术中出血以补佳乐组最少,单用米索前列醇组最多,3组比较有统计学差异(P<0.05)。结论:补佳乐配伍米索前列醇片治疗稽留流产效果满意,值得在临床上推广。     

不同剂型米索前列醇用于无痛人工流产术的临床观察

目的比较米索前列醇粉剂和片剂用于无痛人工流产的临床效果。方法选择需行无痛人工流产术的未产妇女200例,按随机原则分为A组和B组各100例,A组手术前1h阴道放置米索前列醇粉剂400μg,B组术前1h阴道放置米索前列醇片剂400μg,比较两组患者术中宫颈扩张程度、手术时间、术中出血量和不良反应。结果 A组在术中宫颈扩张程度、手术时间和术中出血量方面均明显优于B组,差异均有统计学意义（P〈0.05）,而两组不良反应比较差异无统计学意义（P〉0.05）。结论在无痛人工流产术中,米索前列醇粉剂短时间内能更好地扩张宫颈,缩短手术时间,减少术中出血。     

Flexible mifepristone and misoprostol administration interval for first-trimester medical termination

Background

The administration interval between mifepristone and misoprostol is usually about 36-48 h, which might affect a woman's choice of method of termination. Unwanted outcomes such as uterine bleeding, painful cramps and psychosocial issues which may occur during this long interval can be altered by a shorter administration interval. A shorter interval will be cost-effective as it saves both women's and clinician's time and other resources. If the waiting time interval between therapeutic interventions could be reduced without compromising efficacy, it will potentially improve compliance, patient acceptability and quality of care.

Study design

A systematic review of randomized controlled trials published from 1999 to 2008 was conducted to assess the evidence for a shorter mifepristone and misoprostol administration interval at first trimester medical termination. Searching strategy included MEDLINE, EMBASE, CLINAHL and Cochrane Library. The primary outcome measure was complete abortion without the need for a surgical procedure.

Results

Five randomized controlled trials (RCT) compared the efficacy of mifepristone and misoprostol administration intervals between 0 and 72 h in 5139 participants. The complete abortion rates varied between 90% and 98%. Although the meta-analysis of pooled data of all RCTs shows no statistically significant difference in efficacy between the shorter and longer dosing intervals, there is a trend toward slightly lower success rates with administration intervals earlier than 8 h.

Conclusions

Overall efficacy of complete abortion is not statistically different between the longer and shorter administration intervals. This might encourage the clinician to adopt a ‘flexible policy’ with fully informed consent and consideration of all circumstances.     

Second-trimester pregnancy termination with 600-microg vs. 400-microg vaginal misoprostol and systematic curettage postexpulsion: a randomized trial

BACKGROUND: This study was conducted to compare efficacy and safety of 600 mcg of misoprostol vaginally every 6 h up to four doses vs. 400 mcg of misoprostol vaginally every 4 h up to five doses, followed by systematic curettage of the uterine cavity, for pregnancy termination between 12 and 20 weeks' gestation. STUDY DESIGN: We used a randomized clinical trial conducted at Hospital Gineco-Obstétrico "Eusebio Hernández", Havana, Cuba. Subjects were women requesting voluntary termination of pregnancies between 12 and 20 weeks' gestation. Two hundred ten women were randomly assigned to receive 600 mcg of vaginal misoprostol every 6 h up to four doses (Group I) vs. 400 mcg of vaginal misoprostol every 4 h up to five doses (Group II), followed by curettage 1 h after expulsion. The main outcomes measured were successful abortion rate and mean expulsion time. RESULTS: Successful abortion occurred in 103/105 women (98.1%) in Group I and in 99/105 (94.3%) in Group II [p=.279, relative risk (RR)=3.121 and 95% confidence interval for RR=0.615 to 15.833]. Fetus mean expulsion time was 10.7+/-1.3 (SD) h in Group I and 11.5+/-5.0 (SD) h in Group II (p=.209). CONCLUSIONS: Six hundred micrograms of misoprostol administered vaginally every 6 h was as effective as 400 mcg of misoprostol every 4 h for second-trimester pregnancy termination.