米索前列醇舌下含服在晚期妊娠引产的应用

目前临床上晚期妊娠最常用的引产方法是静滴催产素,但这种方法尚有不足之处。近年口服或阴道用米索前列醇合并米非司酮抗早孕及中期妊娠引产,成功率可达85~95%。米索前列醇还可用于促宫颈成熟及晚期妊娠引产。为了解米索前列醇在晚期妊娠引产中的有效性与安全性,我们应用米索前列醇舌下含服对20例足月的单胎头位初产妇进行引产,并与传统的催产素引产对照。现将结果报告如下。对象与方法1．对象分组:1997年6月至1998年2月间,选择无并发症及合并症,可经阴道分娩且无使用前列醇禁忌症的孕妇40例,随机分为米索组及催产素组各20例。2．方法(1)米索组:米索50μg(澳大利亚Searle生     

舌下含服米索前列醇对药物流产结局影响的临床研究

目的:探讨舌下含服米索前列醇对药物流产结局的影响。方法:将208例妊娠天数<49天的早孕妇女随机分组,对照组常规口服米非司酮配伍米索前列醇,观察组口服米非司酮配伍舌下含服米索前列醇,药物剂量相同。结果:观察组和对照组完全流产率分别为96.0%和89.1%,不全流产率为3.0%和5.9%,流产失败率为1.0%和5.0%(P<0.05);两组阴道持续出血时间分别为12.8±4.4天和13.1±4.5天,两组出血量无显著性差异;观察组中出现寒颤的例数比对照组明显增加(P<0.001),其它副反应比较无显著性差异(P>0.05)。结论:应用米非司酮片配伍舌下含服米索前列醇可提高完全流产率,值得临床推广。     

400μg米索前列醇口服和舌下含服预防产后出血的临床研究

产后出血是导致孕产妇死亡的主要原因之一，预防产后出血已经列入河北省卫生科技发展十一五规划。子宫收缩乏力是引起产后出血最主要的原因，传统的预防产后出血方法主要采用缩宫素或麦角新碱促进子宫收缩，存在着很多局限性。近年来，应用米索前列醇预防产后出血有许多报道，效果肯定，但报道的剂量和给药途径不同。     

400 μg米索前列醇口服和舌下含服预防产后出血的临床研究

产后出血是导致孕产妇死亡的主要原因之一,预防产后出血已经列入河北省卫生科技发展十一五规划。子宫收缩乏力是引起产后出血最主要的原因,传统的预防产后出血方法主要采用缩宫素或麦角新碱促进子宫收缩,存在着很多局限性〔1〕。近年来,应用米索前列醇预防产后出血有许多报道,效果肯定,但报道的剂量和给药途径不同〔2,3〕。我们采用随机对照前瞻性研究方法,应用米索前列醇400μg分别口服和舌下含服给药,比较两种用药方法预防产后出血的有效性和安全性,为临床提供安全有效的用药方法。1资料与方法1.1研究对象选择2006年10月~2007年6月间在我…     

米索前列醇舌下含服在产后出血应用探讨

目的：探讨产后出血患者舌下含服米索前列醇治疗的临床疗效。方法：对住院治疗的40例患者资料进行分析,将患者按照治疗时间分为实验组和对照组。对照组采用催产素治疗,实验组舌下含服米索前列醇治疗,比较两组治疗效果。结果：实验组分娩出时平均出血量为（33±82ml）、娩出后2小时出血量为（62±25ml）、娩出后24小时总出血量为（91±28ml）低于对照组（P〈0.05）;实验组用药后3例出现并发症;对照组6例出现并发症差异不显著（P〉0.05）。结论：对产后出血患者采用舌下口服米索前列醇治疗效果较好,患者治疗后并发症较少,值得推广使用。     

舌下含服米索前列醇预防产后出血的临床观察

产后出血是分娩期严重并发症，占我国产妇死亡原因的首位，而产后子宫收缩不良导致的产后出血占90％。本院采用舌下含服米索前列醇预防产后出血，现将观察结果报告如下。     

米索前列醇舌下含服联合缩宫素静脉滴注预防产后出血效果观察

目的观察剖宫产术中舌下含服米索前列醇联合静脉点滴缩宫素预防产后出血的效果。方法选择有发生产后出血高危因素的剖宫产产妇随机分为治疗组、对照组各100例。对照组单纯静脉滴注缩宫素10 U,治疗组在剖宫产术中胎儿娩出后舌下含服米索前列醇0.2 mg同时静脉点滴缩宫素10 U,观察两组用药后子宫出血量及宫底下降情况。结果对照组产妇产后30 min、2 h出血量分别为(396.9±40.2)ml、(488.7±82.6)ml,治疗组产妇产后30 min、2 h出血量分别为(214.5±45.3)ml、(359.1±83.4)ml;对照组产后2 h子宫底下降(16.2±1.5)cm,治疗组产后2 h子宫底下降(20.3±1.2)cm。结论舌下含服米索前列醇联合静脉点滴缩宫素促进子宫收缩明显,能很好地预防剖宫产产后出血且用药方便、安全。     

剖宫产术中舌下含服米索前列醇减少术中术后出血的效果观察

近年来我院尝试舌下含服米索前列醇用于剖宫产术中有产后高危出血因素的产妇,预防及减少产后出血,效果满意。现报道如下。 1 资料与方法 1.1 资料选择我院行剖宫产并有产后高危出血因素的产妇154例,其中妊高症56例,巨大儿47例,双胎24例,前置胎盘20例,羊水过多7例。均无前列腺素应用禁忌症。把154     

米索前列醇舌下含服用于足月妊娠引产效果观察

足月妊娠引产是产科工作的重要组成部分,缩宫素是30多年来常规引产的药物,但需静脉给药、专人管理、定时调节剂量.米索前列醇为前列腺素类似药,具有促进子宫收缩的作用[1].本文应用米索前列醇对足月妊娠进行引产,并与缩宫索引产组作对照,以了解其在足月妊娠引产中的作用.……     

米索前列醇舌下含服预防剖宫产后出血的临床观察

选择性剖宫产是妊娠晚期常用的治疗手段，但由于术前病人无宫缩，术后部分病人子宫平滑肌不能及时收缩，致产后出血量增多。过去常用缩宫素和麦角新碱来预防剖宫产后出血，但存在较大的个体差异及过敏反应，对子宫收缩的疗效不稳定，有些妊娠高血压病人的应用也受到限制。近年来国内外又将子宫收缩作用更强的前列腺素应用于临床，但如何选择更方便的给药途径及恰当的给药时间，     

Two-pill regimens of misoprostol after mifepristone medical abortion through 63 days' gestational age: a randomized controlled trial of sublingual and oral misoprostol

Background

A 400 mcg dose of sublingual misoprostol has high efficacy and few side effects when used with 200 mg mifepristone for medical abortion through 63 days' gestation.

Study Design

Eligible and consenting women (n=480) were randomized to 400 mcg of misoprostol sublingually or orally, 24 h after 200 mg of mifepristone. Abortion status was assessed two weeks later.

Results

Complete abortion occurred in 98.7% of the sublingual group and 94.0% of the oral group (p value=.006, RR: 1.05, 95% CI=1.01--1.09). Over 90% of women in both arms expressed high satisfaction with the method. Side effects were similar in both groups, with only fever or chills reported by significantly more women in the sublingual arm.

Conclusions

The sublingual route appears superior to the regimen of 400 mcg misoprostol used orally and may be a good option for mifepristone medical abortion.     

Randomized trial of oral versus vaginal misoprostol 2 days after mifepristone 200 mg for abortion up to 63 days of pregnancy

This prospective, open-label, randomized trial of healthy adult women up to 9 weeks pregnant compared mifepristone 200 mg followed 2 days later with misoprostol 400 microg orally versus misoprostol 800 microg vaginally. The study was interrupted after the oral misoprostol group experienced a higher than expected failure rate. This treatment was discontinued and another substituted consisting of oral misoprostol 800 microg divided into two doses two hours apart. Women returned for a follow-up visit from Day 4 to 8. All women with a continuing pregnancy received a repeat dose of misoprostol vaginally and returned before Day 15. The primary outcome measure was a complete medical abortion without surgical intervention at the first visit. Of the 1045 women enrolled, 1011 had complete data: Group 1 (220) used oral misoprostol 400 microg, Group 2 (269) used oral misoprostol 800 microg, and Group 3 (522) used vaginal misoprostol 800 microg. At first follow-up visit, the primary outcome, that is, a complete abortion, was 84% for Group 1, 92% for Group 2, and 96% for Group 3, p < 0.001. After a second dose of vaginal misoprostol in women with on-going pregnancies at their first follow-up visit, the complete abortion rates were 91%, 95%, and 98%, respectively, p < 0.001. There were minimal differences in side effects, onset of bleeding and overall acceptability in the three groups. Mifepristone 200 mg followed by vaginal misoprostol 2 days later was more effective at inducing an abortion up to 9 weeks of pregnancy than the same dose of mifepristone followed by oral misoprostol.     

Comparison of misoprostol plasma concentrations following buccal and sublingual administration

BACKGROUND: New indications for misoprostol include medical abortion, cervical softening, induction of labor and treatment of postpartum hemorrhage. Various routes of misoprostol administration under study include oral, vaginal, buccal, sublingual and rectal. MATERIALS AND METHODS: This was an open-label, randomized, cross-over study of the pharmacokinetic differences of buccal vs. sublingual misoprostol 800 mug in 10 healthy women. RESULTS: Of the 10 women enrolled, 2 withdrew after experiencing excessive cramping from the sublingual route of misoprostol. The mean misoprostol plasma concentration-time curves at 4 h [area under the curve (AUC)0-4)] and the maximum concentration (C(max)) showed that levels were significantly higher for sublingual administration than the buccal route. Buccal misoprostol administration resulted in fewer symptoms and was found to be more acceptable. CONCLUSIONS: Sublingual administration of misoprostol had a higher AUC and C(max) compared with buccal administration. The pharmacokinetics may help to determine the best application of misoprostol depending on the indication.     

Early abortion with buccal versus sublingual misoprostol alone: a multicenter,randomized trial

ObjectiveTo compare efficacy, safety/side effects and acceptability of buccal versus sublingual administration of a misoprostol-only regimen commonly used for early medical abortion.Study designWe conducted a randomized trial at six clinics in two Latin American countries. We randomized women seeking early abortion to buccal or sublingual administration of three doses of misoprostol 800 mcg repeated every 3 h. At initial follow-up (7–14 days after misoprostol), we offered women without a complete abortion aspiration or additional misoprostol plus waiting 7 more days. The primary outcome was continuing pregnancy at initial follow-up. Secondary outcomes included continuing pregnancy at final follow-up, incomplete abortion, successful abortion, side effects, acceptability and complications. We analyzed all outcomes as intention to treat.ResultsWe enrolled 401 women and randomized 202 into the buccal arm and 199 into the sublingual arm. Continuing pregnancy at initial follow-up occurred in 11/201 (5.5%) and 2/189 (1.1%) women, respectively (p=.02). Additional misoprostol at follow-up increased success, defined as complete abortion, from 170/201 (84.6%) to 184/199 (92.5%) in the buccal arm and 165/189 (87.3%) to 177/189 (93.7%) in the sublingual arm. We found no differences by gestational age. Women reported similar acceptability and side effects across groups except for chills and fever, which women using sublingual misoprostol reported more frequently (p<.05).ConclusionsSublingual administration was superior to buccal administration in reducing continuing pregnancy risk after a three-dose regimen of 800 mcg misoprostol. Complete abortion rates were comparable across groups, and in both cases, additional misoprostol at follow-up increased success.ImplicationsIf the primary goal is to avoid continuing pregnancy, sublingual administration of misoprostol 800 mcg every 3 h for three doses should be recommended. If chills or fever are a concern and the primary goal is to avoid surgery, buccal administration may be preferable. For either route, additional misoprostol can be given for incomplete abortion or continuing pregnancy.     

米非司酮配伍米索前列醇不同给药方式终止早孕的临床随机比较研究

目的研究米非司酮配伍米索前列醇舌下含服及口服的药物流产效果。方法将158例早孕妇女(停经≤56天)随机分为2组,连续口服米非司酮2天,3次/d,每次25mg,第3天上午使用米索前列醇(本文简称米索)口服400μg同时阴道给400μg(组Ⅰ),或者舌下含400μg同时阴道给400μg(组Ⅱ)以终止妊娠。结果总体完全流产率为94.9%,组I为92.5%,组Ⅱ为97.4%,两组无显著性差异(P>0.05);总体不全流产率为4.43%,组I为7.5%(6/80),高于组Ⅱ1.28%(1/78),但两组无显著性差异(P>0.05);总体失败率为0.63%,其中组Ⅰ为0,组Ⅱ为1.28%,两组亦无显著性差异(P>0.05);组Ⅰ从应用米索至孕囊排出时间为(2.39±1.20)h,明显低于组Ⅱ(2.98±1.33)h(P<0.01)。结论组I终止早孕的不全流产率高于组Ⅱ(但无明显组间差异,可能与样本较小有关),可能与舌下含服米索可使有效血药浓度维持时间较长,生物利用度较高有关,故在药物流产中米非司酮配伍舌下含服米索是1种很有前景的用药方法。     

Randomized trial of buccal versus vaginal misoprostol for induction of second trimester abortion

Background

We evaluated the efficacy and acceptability of repeat doses of buccal misoprostol compared to vaginal misoprostol for second trimester pregnancy termination by induction.

Study Design

Women requesting termination of a pregnancy between18 and 22 weeks gestation were approached for participation. All women received 400 mcg misoprostol vaginally on admission. Participants were randomized to receive subsequent doses of 200 mcg misoprostol every 6 h either buccally or vaginally. All participants completed an acceptability survey.

Results

Sixty-four women participated. The mean gestational age was 19.7 weeks. The median time to abortion in the buccal group was 15 h, which was not significantly different (p=0.44) from the vaginal-only group of 12 h. Most women in both groups preferred their allocated administrative route.

Conclusion

Repeat doses of buccal misoprostol are as effective as vaginal misoprostol in inducing abortions in the midtrimester and are highly acceptable to most women. It is reasonable to offer both options to women.     

Mifepristone dose in the regimen with misoprostol for medical abortion

Medical abortion with the antiprogesterone mifepristone followed by a prostaglandin is highly effective and widely used. The mifepristone dose registered is a single dose of 600 mg followed by a suitable prostaglandin analogue 36-48 h later. The 600-mg dose was chosen arbitrarily, and later studies have proven one third of this dose to be equally effective when combined with a prostaglandin analogue. This report reviews published data on the efficacy of mifepristone in different doses and demonstrates that there are no differences neither clinically nor in pharmacokinetics if the dose is reduced to 200 mg.     

Oral and vaginal misoprostol 800 microg every 8 h for early abortion

The objective of the study was to evaluate the efficacy and safety of 800 μg misoprostol (Cytotec) every 8 h for 24 h for pharmacological abortion; the treatment was repeated if abortion did not occur in the first 24-h interval. The first misoprostol doses were always self-administered into the vagina; the second and third doses could be administered orally or vaginally depending on the amount of bleeding. Four-hundred and fifty-two women with gestations between 36 and 63 days were recruited into the study. The main outcomes assessed were: successful abortion (complete abortion without surgery), side effects, mean drop in hemoglobin, vaginal bleeding and mean time of return of menstruation. Complete abortion occurred in 409/452 (90.5%; 95% confidence interval [CI] 87%, 93%) patients. Medication to relieve symptoms was administered to all women before the first misoprostol dose. Vaginal bleeding lasted 15.9 ± 4.4 days. The mean drop in hemoglobin, measured 14 days after abortion, was statistically significant (p = 0.0001) but without clinical relevance. According to the results obtained, 800 μg of misoprostol administered every 8 h for 24 h could be a valid method for abortion for up to 9 weeks of gestation.     

Effectiveness of medical abortion with mifepristone and buccal misoprostol through 59 gestational days

Background

From 2001 to March 2006, Planned Parenthood Federation of America (Planned Parenthood) health centers throughout the United States provided medical abortions principally by a regimen of oral mifepristone, followed 24-48 h later by vaginal misoprostol. In late March 2006, analyses of serious uterine infections following medical abortions led Planned Parenthood to change the route of misoprostol administration and to employ additional measures to minimize subsequent serious uterine infections. In August 2006, we conducted an extensive audit of medical abortions with the new buccal misoprostol regimen so that patients could be given accurate information about the success rate of the new regimen.

Objectives

We sought to evaluate the effectiveness of the buccal medical abortion regimen and to examine correlates of its success during routine service delivery.

Methods

In 2006, audits were conducted in 10 large urban service points to estimate the success rates of the buccal regimen. Success was defined as medical abortion without vacuum aspiration. These audits also permitted estimates of success rates with oral misoprostol following mifepristone in a subset in which 98% of the subjects stemmed from two sites.

Results

The effectiveness of the buccal misoprostol-mifepristone regimen was 98.3% for women with gestational ages below 60 days. The oral misoprostol-mifepristone regimen, used by 278 women with a gestational age below 50 days, had a success rate of 96.8%.

Conclusion

In conjunction with 200 mg of mifepristone, use of 800 mcg of buccal misoprostol up to 59 days of gestation is as effective as the use of 800 mcg of vaginal misoprostol up to 63 days of gestation.     

Vaginal misoprostol 800 microg every 12 h for second-trimester abortion

The objective of the study was to evaluate the efficacy and safety of 800 microg misoprostol every 12 h, up to three doses, for pharmacological second-trimester abortion. The misoprostol doses were always administered by doctors into the vagina. Two-hundred and sixty-nine women with gestations within 12 and 20 weeks were recruited into the study. The main outcomes measured were successful abortion (passage of fetus and placenta without surgery), side effects and mean drop in hemoglobin, vaginal bleeding and mean time of return of menstruation. Complete abortion occurred in 245/269 (91.1%, 95% confidence interval 87-94%) patients. Vaginal bleeding lasted 15.7 +/- 4.1 days. The mean drop in hemoglobin, calculated 24 h after abortion, were statistically significant (p = 0.0001), as also was the mean hemoglobin measured 14 days after abortion, but without clinical relevance. According to the results obtained, 800 microg of misoprostol administered every 12 h, up to a maximum of three doses, could be a valid method for abortion within 12 and 20 weeks of gestation.