复方米非司酮联合米索前列醇口服或经阴道给药在中孕期引产中的应用效果比较

Comparison of effect of compound mifepristone combined with misoprostol administered orally versus vaginally in induced labor during the second trimester of pregnancy

目的比较复方米非司酮联合米索前列醇口服或经阴道给药在中孕期引产中的应用效果。方法回顾性分析2018年2月至2020年1月于永济市妇幼保健计划生育服务中心行复方米非司酮联合米索前列醇引产的85例孕13~16周自愿要求终止妊娠的健康妇女的临床资料,根据米索前列醇给药方式分为口服给药组(口服组,44例)和经阴道给药组(阴道组,41例)。记录两组引产相关指标(引产成功率、胎盘胎膜残留率、胎儿排出时间、阴道出血量、阴道出血时间)、引产前后血红蛋白(Hb)变化情况及药物不良反应、月经恢复情况,并比较引产成功者米索前列醇使用次数及剂量。结果两组引产成功率、胎盘胎膜残留率、胎儿排出时间、阴道出血时间及月经复潮时间比较,差异未见统计学意义(P>0.05);但口服组引产2、24 h出血量均高于阴道组(P均<0.05)。两组引产后Hb均较引产前降低(P<0.05),且口服组低于阴道组(P<0.05),口服组引产前后Hb差值也大于阴道组(P<0.05)。口服组药物不良反应总发生率(43.18%,19/44)低于阴道组(65.85%,27/41),P<0.05。口服组引产成功者米索前列醇使用次数为(2.35±0.45)次,高于阴道组的(1.58±0.34)次(P<0.05),但两组米索前列醇使用总剂量比较差异未见统计学意义(P>0.05)。结论复方米非司酮联合米索前列醇口服或经阴道给药,在孕13~16周中期妊娠终止中应用效果均较好,经阴道给药在减少出血方面更具优势,但不良反应更多,临床应结合实际情况选择合适的药物引产方案。

Objective To compare the effect of compound mifepristone combined with misoprostol administered orally versus vaginally in induced labor during the second trimester of pregnancy.Methods A retrospective analysis was performed on the clinical data of 85 healthy women who voluntarily requested termination of pregnancy at 13 to 16 weeks of gestation and were given compound mifepristone and misoprostol for labor induction in Yongji Maternal and Child Health and Family Planning Service Center from February 2018 to January 2020.The pregnant women were divided into oral administration group(oral group,44 cases)and transvaginal administration group(vaginal group,41 cases)according to the administration methods of misoprostol.The labor induction-related indicators(success rate of labor induction,residual rate of placental membranes,fetal discharge time,vaginal bleeding volume,vaginal bleeding time),changes of hemoglobin(Hb)before and after labor induction,adverse drug reactions and menstrual recovery were recorded in the two groups,and the frequency and dosage of misoprostol were compared among women with successful labor induction.Results There was no significant difference in the success rate of labor induction,residual rate of placental membranes,fetal discharge time,vaginal bleeding time and menstrual recovery time between the two groups(P>0.05),but the bleeding volume at 2 h and 24 h after labor induction in oral group were more than those in vaginal group(P<0.05).The Hb level of the two groups after labor induction was lower than that before labor induction(P<0.05),and the Hb level of oral group was lower than that of vaginal group after labor induction(P<0.05),and the difference of Hb before and after labor induction of oral group was also higher than that of vaginal group(P<0.05).The total incidence of adverse drug reactions in oral group(43.18%,19/44)was lower than that in vaginal group(65.85%,27/41),P<0.05.The frequency of misoprostol in oral group(2.35±0.45)was higher than that in vaginal group(1.58±0.34),P<0.05;but there was no significant difference in the total dosage of misoprostol between the two groups(P>0.05).Conclusions Oral and transvaginal administration of misoprostol combined with compound mifepristone both have a good application effect in the termination of pregnancy at 13 to 16 weeks of gestation.Transvaginal administration of misoprostol has advantages in reducing bleeding,but has more adverse reactions.It is necessary to select the appropriate drug induction regimen based on the actual situation in clinical practice.