负压吸宫术前口服和阴道放置米索前列醇及米非司酮对宫颈扩张作用的比较

目的:比较终止早期妊娠负压吸宫术前口服和阴道放置米非司酮及米索前列醇对宫颈的扩张作用,观察副反应、手术时间及术中出血量。方法:将停经6～8周要求手术终止妊娠的130名妇女随机分为4组,A组(口服米非司酮)34例、B组(阴道放置米非司酮)32例、C组(口服米索前列醇)36例、D组(阴道放置米索前列醇)28例。阴道用药组于用药后12h,口服组于用药后24h行负压吸宫术。记录观察对象的宫颈扩张度、用药后副反应及术中出血量和手术时间。结果:宫颈扩张程度,D组与其他各组相比,差异有显著性(P<0.05),其余各组之间差异无显著性;D组的手术时间较B组明显缩短(P<0.05);D组无一例出现胃肠道反应,与其他各组相比,差异有显著性(P<0.05),术前阴道出血发生率较其他各组高(P<0.01),下腹痛的发生率较A组、B组高(P<0.01)。结论:负压吸宫术前口服或阴道放置米索、米非司酮均可扩张宫颈,但阴道放置米索前列醇效果好,且胃肠道反应发生率低,更适合有早孕反应的妇女。     

Comparison of oral and vaginal misoprostol for cervical ripening before manual vacuum aspiration of first trimester pregnancy under local anesthesia: a randomized placebo-controlled study

The objective of this prospective randomized placebo-controlled study was to determine the effectiveness of 400 mug oral and 400 mug vaginal misoprostol administration for cervical priming 3 h prior to manual vacuum aspiration (MVA) under local anesthesia for voluntary termination of pregnancy before 10 weeks of gestation in comparison with placebo oral or placebo vaginal administration (n=40 in each group). Postmedication cervical dilatation was similar in the oral (mean, 6.6+/-1.5) and vaginal (mean, 7.2+/-0.8) misoprostol groups but significantly higher compared with the oral (mean, 3.4+/-0.2) and vaginal (mean, 3.6+/-1.9) placebo groups. Duration of the procedure was also significantly shorter in the misoprostol groups in comparison with their placebo counterparts. Preoperative bleeding and side effects were more common in the misoprostol groups, but none required medical intervention. Intraoperative bleeding was less in the vaginal misoprostol group compared with the placebo groups. There was no significant difference in terms of visual analogue scores during the procedure, patient satisfaction, days of postoperative bleeding and rate of postoperative complications among the groups. Cervical priming with misoprostol administered orally or vaginally 3 h before MVA for termination of pregnancy under local anesthesia facilitates the procedure by decreasing the need for cervical dilatation and by shortening its duration without improving patients' pain perception and satisfaction mainly due to side effects.     

Randomized controlled trial of misoprostol for second-trimester pregnancy termination associated with fetal malformation

OBJECTIVE: Our purpose was to compare the effectiveness, women's views of the termination procedure, and success of umbilical cord culture for vaginal and oral misoprostol versus intra-amniotic prostaglandin PGF(2alpha) for second-trimester pregnancy termination (STPT). STUDY DESIGN: We randomized 217 women, 15 to 24 weeks' gestation, into 3 groups. Oral (OM) and vaginal (VM) misoprostol groups received 400 microg of misoprostol every 4 hours for 24 hours. The intra-amniotic PGF(2alpha) (IAPG) group received 40 mg of PGF(2alpha) followed by oxytocin infusion. Women completed self-administered questionnaires 3 weeks after the termination procedure. Umbilical cord samples were collected at delivery for karyotype analysis. The primary outcome was the time from start of the procedure to placental delivery. Secondary outcomes were maternal complications, women's acceptance of the termination procedure, and success rates of umbilical cord culture. RESULTS: The time was longer for the OM group (30.5+/-14.4 hours) compared with the VM group (18.3+/-8.2 hours) and the IAPG group (21.1+/-10.2 hours), P<.001 for both comparisons. Women in the VM group reported being more willing to repeat the termination method in the future and reported fewer side effects than those in the other groups, P<.001. Failure rates for umbilical cord cultures were 9.6%, 17.0%, and 45.6% for the VM, OM, and IAPG groups, respectively. CONCLUSION: Oral misoprostol is less effective than intra-amniotic PGF(2alpha) or vaginal misoprostol for STPT. Women report vaginal misoprostol more acceptable than other methods. Umbilical cord culture failure rate is highest in the IAPG group.     

Comparative study between single dose 600 microg and repeated dose of oral misoprostol for treatment of incomplete abortion

OBJECTIVE: To evaluate and compare the effectiveness and side effects of two regimens of oral misoprostol, single dose (600 microg) and repeated dose (1200 microg), in the treatment of incomplete abortion. METHODS: A prospective randomized controlled trial was conducted. One-hundred women who had incomplete abortion (gestational age < 20 weeks) and consented to randomization by computer-generated randomization model prior to treatment. A single oral 600-microg dose or repeated oral dose after 4 h (total 1200 microg) was given to the randomized women. RESULTS: The overall incidence of complete abortion was 86.9%. This incidence was not statistically different between the single-dose and repeated-dose groups (81.6% vs. 92%, p > 0.05). However, there was a significantly decreased incidence of diarrhea (18.4% vs. 40%, p < 0.05) with the use of single-dose treatment. Overall rate of acceptability and tolerable side effects were 88.9% and 97.9%, respectively. These rates were similar in both groups (87.8% vs. 90% and 98% vs. 98%, p > 0.05). CONCLUSIONS: Oral misoprostol may be a practical alternative in the management of incomplete abortion. Oral misoprostol is acceptable and tolerable to women. Single-dose regimen is as effective as repeated-dose regimen, with a reduction in the incidence of diarrhea.     

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.     

Infection after medical abortion: a review of the literature

Medical abortion regimens have become widely used, but the frequency of infection after medical abortion is not well documented. This systematic review provides data on infectious complications after medical abortion. We searched Medline for articles written before July 2003 to determine the frequency of infection after medical abortion up to 26 weeks of gestation. We reviewed all articles and extracted data on the frequency of infection from 65 studies. The frequency of diagnosed and/or treated infection after medical abortion was very low (0.92%, N = 46,421) and varied among regimens. Results of this review confirm that, with respect to infectious complications, medical abortion is a safe and effective option for first- and second-trimester pregnancy termination. After accounting for regional variations in diagnosis, there is little difference in frequency of infection among the regimens reviewed. Future studies should report clear diagnosis and treatment standards for infection so that more precise information becomes available.     

Randomized controlled trial of 50 and 100 mcg of misoprostol for induction of labor at term

To compare the safety and efficacy of two different regimens of misoprostol for labor induction at term, we conducted a randomized controlled trial on women presenting for induction of labor at >37 weeks’ gestation. Eligible women were randomized to receive intra-vaginal misoprostol 50 μg every 4 h or 100 μg every 6 h until any of the following: 1) adequate contraction pattern (3 contractions/10 min); 2) dilatation >3 cm; 3) artificial rupture of membranes; or 4) signs of uterine hyperstimulation. Use of oxytocin during labor was at the discretion of the managing clinician. The main outcome variable considered for analysis was cesarean section rate. Secondary outcome measures were induction to delivery interval and neonatal outcome (Apgar scores, meconium staining, and umbilical artery pH). A total of 58 women were randomized to receive either misoprostol 100 μg (n=26) or 50 μg (n=32). The 100 and 50 μg groups had similar mean Bishop’s scores at induction (4.0±2.3 vs 4.1±2.2, p=0.87), rates of nulliparity, use of epidural anesthesia, and oxytocin augmentation. The number of doses of misoprostol used was similar in the two groups (1.4±0.6 vs 1.8±1.2). The mean±standard deviation time to delivery (hours) (11.9± 7.3 vs 14.3±9.6 h, p=0.30) and cesarean section rate (35% vs 19%, p=0.30, relative risk: 1.8, 95% confidence interval 0.7–5.4) were not different in the 100 vs 50 μg group. Power analysis demonstrated that 132 women would be required in each group to achieve statistical significance in the primary outcome measure (α=0.05, β=0.80). Similarly, rates of 5-minute Apgar scores <7 (4% vs 3%, p=1.0), and of meconium passage (17% vs 25%, p=0.73) were not significantly different between the two groups. Received: 20 January 2001 / Accepted: 7 March 2001     

Sublingual misoprostol for preabortion cervical ripening in first-trimester pregnancy termination

The objective of this prospective randomized placebo-controlled study was to determine the efficacy of sublingual misoprostol in facilitating cervical dilatation before surgical abortion in first trimester pregnancy. Sixty healthy pregnant women between 6 and 11 weeks of gestation opting for voluntary medical termination of pregnancy at All India Institute of Medical Sciences hospital were included in this study. Women were randomized to two groups, the study group (n = 30) received 400 micro g of sublingual misoprostol and the control group (n = 30) received placebo, 2 h prior to surgical abortion. Using Hegar's dilators, cervical dilatation prior to vacuum aspiration was measured. Other parameters assessed included the total time required for the procedure, intraoperative blood loss and associated side effects. The mean cervical dilatation in the misoprostol group was 7.7 mm as compared to 3.4 mm for placebo group. The average time required for pregnancy termination was significantly shorter (p < 0.001) in the misoprostol group. The procedure-related blood loss was also significantly decreased in the misoprostol group. However, side effects including pre-evacuation vaginal bleeding, lower abdominal pain, nausea and vomiting were significantly higher in the misoprostol group than in placebo group (p < 0.005). There was no case of hemorrhage or uterine perforation in either group. Sublingual misoprostol is effective in facilitating cervical dilatation prior to surgical abortion. Its usage significantly decreased the time of surgical evacuation and minimized blood loss during the procedure.     

Synergistic effects of DL111-IT in combination with mifepristone and misoprostol on termination of early pregnancy in preclinical studies

This study evaluated the effectiveness and acute toxicity of DL111-IT combined with mifepristone (RU486) and misoprostol (MISO) on early pregnancy termination. In the pregnant rats experiments, the ED(50) values of RU486 in two-drug combinations were 0.16 (combined with DL111-IT) and 0.40 (combined with MISO) mg x kg(-1) x d(-1), while in three-drug combination treatment group (DL111-IT 9.0 mg x kg(-1) (相似文献   

The possibility of using mifepristone for menstrual induction

Menstrual induction is a variant of suction aspiration that was originally defined to be performed in women with a menstrual delay of up to 2–3 weeks without knowing if the women is pregnant or not. Prerequisites for a pharmacological method for menstrual induction are a high efficacy to induce a bleeding in nonpregnant women and an expulsion of the pregnancy in pregnant women. Treatment with prostaglandins, specifically intramuscular sulprostone, can be as effective as suction aspiration for menstrual induction. However, the administration of prostaglandin in therapeutically effective doses was associated with a high frequency of gastrointestinal side effects and, to a lesser extent, of strong abdominal pain, which limited their routine use. More recent studies indicate that mifepristone in combination with either misoprostol or gemeprost is a more promising alternative. Further studies to identify the best treatment schedule are, however, needed, as is a randomized comparison with suction aspiration before a pharmaceutical method can be recommended.