口服米非司酮配伍米索前列醇与阴道置米索前列醇终止妊娠蜕膜和胎盘超微结构的比较性研究

从超微结构水平，比较口服米非司酮配伍米索前列醇（米索）与单独阴道放置米索终止妊娠后蜕膜及胎盘超微结构的改变。将１２～２２孕周要求终止妊娠的孕妇１６例随机分为３组：组Ｉ（６例），口服米非司酮（５０ｍｇ，２次／日×２天）后加服米索（０．２ｍｇ／４ｈ）；组Ｉ（５例），阴道单独置米索（０．２ｍｇ／１２ｈ），组ＩＩ（５例）水囊引产作为正常对照。结果：组Ｉ与组Ｉ蜕膜及胎盘超微结构均有影响，其中，对蜕膜的影响组Ｉ较组ＩＩ更为明显，对胎盘绒毛滋养细胞的影响组Ｉ较组Ｉ更显著。表明米非司酮终止妊娠主要通过对孕激素作用的阻断而直接影响蜕膜；米索阴道用药则可能主要通过影响子宫血供而使胎盘绒毛结构发生明显改变。

Comparative study of effects on ultrastructure of human decidua and placenta following termination of pregnancy by mifepristone combined with misoprostol orally and misoprostol intravaginally alone

Objectives: To compare effects on ultrastructure of human decidua and placenta between mifepristone combined with misoprostol orally and misoprostol intravaginally alone for termination of second trimester pregnancy. Setting: Obstetrics & Gynecology Hospital,Shanghal Medical University. Design: A clinical comparative study. Methods: 16 women with gestational age of 12￣22 weeks requesting induced abortion were devided randomly into three groups,6 cases in group 1 were given mifepristone (50 mg,Bid×2d) and misoprostol (0.6 mg,q4h) orally;5 cases in group 2 were given misoprostol (0.6 mg,q12h) intravaginally alone; 5 cases in group 3 were administered with water bougic for termination of pregnancy. Results: Drugs used in both group 1 and 2 can influence the ultrastructure of placenta and decidua.The ultrastructure changes in decidua from group 1 was more obvious than that from group 2;the effect on placenta trophoblast cells from group 2 was more significant than that from group 1. Conclusion: It suggests that mifepristone can affect decidua directly by antagonizing progesterone action,whereas misoprostol intravaginally alone may induce the diffinite change in placenta trophoblast cells by reducing blood supply of utrine.