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.     

Luteal phase treatment with mifepristone and misoprostol for fertility regulation

Emergency contraception (EC) with 10 mg mifepristone can prevent pregnancy up to 5 days after a single act of unprotected intercourse. No methods have been shown to be effective when treatment is administered more than 5 days after a single unprotected act or after several unprotected acts. Therefore, we tested, among 699 Chinese women requesting EC and exposed to the risk of pregnancy described, the potential of 100 mg mifepristone followed 2 days later by 0.4 mg misoprostol orally, when administered in the luteal phase of the cycle. At the time of treatment urinary pregnancy test had to be negative. Despite treatment, 25 women (2.7%) became pregnant. Among women with treatment delayed more than 5 days, the pregnancy rate was related to the number of acts of intercourse before treatment, being 1.4% with one episode and increasing to 6.5% when the number of episodes was two or more (relative RISK = 4.62, 95% CI: 1.06–20.18). Side effects within a week after treatment were mild, and most women (57.2%) had menstruation within 3 days as expected. An occasional treatment with mifepristone in combination with misoprostol could provide an option for preventing unwanted pregnancies in women who are late for EC.     

负压吸宫术前口服和阴道放置米索前列醇对宫颈扩张作用的随机比较研究

目的:比较在终止早期妊娠负压吸宫手术前口服和阴道放置米索前列醇对宫颈的扩张作用以及副反应。方法:将停经6～10周要求手术终止妊娠的100名妇女随机分为两组,分别口服或阴道放置400μg米索前列醇,用药后3～3.5小时行负压吸宫术。记录观察对象的宫颈扩张程度和用药后副反应以及术中出血量、手术所用时间。结果:两组对象宫颈扩张程度无明显差异(平均直径分别为6.96mm和7.02mm,P>0.05),口眼用药组恶心、呕吐发生率明显高于阴道用药组(P<0.05),阴道用药组腹痛的发生率大于口服用药组(分别为56％和44％),但差异无显著性(P>0.05)。其他副作用及术中出血量、手术所用时间等均无显著差异。结论:在终止早期妊娠的负压吸引术前口服或阴道放置米索前列醇400μg,均能有效扩张宫颈。口服用药方法简单、方便,可接受性好,但对于妊娠反应较明显的妇女,阴道用药更为可取。     

舌下含服米索前列醇在剖宫产术后放置宫内节育器中的应用

目的:探讨舌下含化米索前列醇在剖宫产术后放置宫内节育器中的作用。方法:选择剖宫产术后满6个月、自愿要求放置宫内节育器而无禁忌症、初孕初产妇女500例分为研究组240例,术前1小时舌下含化米索前列醇400μg;对照组260例,术前不用药。两组年龄、是否哺乳期无统计学差异(P>0.05)。结果:研究组手术成功率为100%,疼痛Ⅰ级为98.75%,疼痛Ⅱ级为1.25%疼痛Ⅲ级为0,子宫穿孔发生率为0,宫颈损伤发生率0.42%,心脑反应发生率为0;阴道流血量多为3.33%,与对照组(78.85%、35.00%、53.46%、11.54%、5.77%、16.52%、11.15%、23.46%)相比,差异有统计学意义(P<0.01)。结论:舌下含化米索前列醇用于剖宫产术后放置宫内节育器,给药方便、副作用少,手术安全性好、无痛苦、并发症少、成功率高,是一种值得推广的方法。     

3种不同终止中期妊娠方法的临床效果研究

目的：探讨米非司酮配伍米索前列醇、米非司酮配伍米索前列醇联合卡孕栓以及羊膜腔内注入依沙吖啶终止中期妊娠的临床疗效。方法：回顾分析自愿要求终止妊娠的中期妊娠妇女99例。分为A组（米非司酮配伍米索前列醇组）24例；B组（米非司酮配伍米索前列醇联合卡孕栓组）30例；C组（依沙吖啶组）45例。结果：用药至规律宫缩时间、产程、产时及产后2h内出血量、胎盘胎膜列留等，A组与B组相比差异均无统计学意义（P〉0．05）；C组与A、B两组比较差异均有显著性统计学意义（P〈0．05）。引产成功率、住院天数3组差异均无统计学意义（P〉0．05）。结论：药物引产效果优于依沙吖啶引产，米非司酮配伍米索前列醇是一种方便、经济、有效的引产方法。     

米非司酮配伍米索前列醇终止早孕598例临床效果及相关因素的分析

<正>米非司酮联合米索前列醇用于药物流产,近年来已经广泛应用于临床,此药用于流产是一种安全、简便、有效的终止早孕的方法。我所门诊妇产科在2005年7月至2006年7月,应用米非司酮与米索前列醇进行598例药物流产,取得令人满意的效果,现将资料报告如下。1对象和方法     

异丙酚联合米索前列醇及异丙酚联合芬太尼用于人工流产的疗效比较

目的了解异丙酚联合米索前列醇及异丙酚联合芬太尼分别用于无痛人流的临床疗效观察比较。方法随机抽取观察组和对照组病例各100例，分别予异丙酚和米索前列醇、异丙酚和芬太尼，用于无痛人流术中用药，进行疗效对比观察。结果观察组比对照组操作更顺利，缩短了手术时间。结论异丙酚和索前列酚两者联合应用，能迅速软化宫颈，增强其顺应性，减少了无痛人流术中不良反应并缩短了操作时间，减少了麻醉用药量。     

米索前列醇在青春期妊娠人工流产中的应用

目的探讨青春期少女行人工流产术前口服米索前列醇对扩张宫颈、避免宫颈损伤、减少术中出血及缩短手术时间的效果。方法实验组62例,人工流产术前口服米索前列醇400μg,对照组61例术前不用药（两组术中均用丙伯酚镇痛）。结果术中可顺利通过6号扩宫器的是：实验组56例,对照组2例（P〈0.01）,宫颈损伤中实验组0例,对照组6例（P〈0.05）,两组术中出血分别（5.8±2.1）mL,（12.8±3.3）mL（P〈0.05）,手术时间分别是（2.8±1.0）min,（5.6±1.2）min（P〈0.05）。结论青春期少女妊娠,在行人工流产术前口服米索前列醇可明显软化扩张宫颈,避免宫颈损伤,减少术中出血及缩短手术时间。     

Choosing early pregnancy termination methods in Urban Mozambique

Little is known about who chooses medication abortion with misoprostol and why. Women seeking early abortion in 5 public hospitals in Maputo, Mozambique were recruited in 2005 and 2006 to explore decision-making strategies, method preferences and experiences with misoprostol and vacuum aspiration for early abortion. Client screenings (n = 1799), structured clinical surveys (n = 837), in-depth exit interviews (n = 70), and nurse focus groups (n = 2) were conducted. Triangulation of qualitative and quantative data revealed seemingly contradictory findings. Choice of method reflected women’s heightened concerns about privacy, pain, quality of home support, HIV infection risk, sexuality, and safety of research participation. Urban Mozambican women are highly motivated to find early pregnancy termination techniques that they deem socially and clinically low-risk. Although 42% found vaginal misoprostol self-administration challenging and 25% delayed care for over a week to amass funds for user fees, almost all (96%) reported adequate preparation and comfort with home management. Women reported satisfaction with all methods and quality of care, even if the initial method failed or pain management or postabortion contraception were not offered. A more nuanced understanding of what women value most can yield service delivery models that are responsive and effective in reducing maternal death and disability from unsafe abortion.     

米索前列醇预防产后出血临床效果研究

目的:探讨米索前列醇应用于预防治疗产后出血的临床效果。方法:217例产妇被随机分为试验组(110例)和对照组(107例),对照组给予治疗缩宫素预防治疗,试验组给予米索前列醇预防治疗。结果:两组在2h出血量,24h出血量、用药不良反应和产后出血量>500ml等方面比较差异均有统计学意义(P<0.05),试验组疗效显著优于对照组。结论:米索前列醇预防治疗应用于产后出血,能显著提高疗效,改善患者生活质量,值得在临床上应用和推广。