米非司酮联合利凡诺用于瘢痕子宫中期妊娠引产的系统评价

Evaluation of mifepristone combined with rivanol for induced labor in scars uterus midtrimester pregnancy

目的系统评价米非司酮片联合利凡诺用于瘢痕子宫中期妊娠引产的临床效果。方法计算机全面检索相关数据库,并通过筛选与质量评价,对符合要求的文献应用Rev Man 5.1软件进行Meta分析。结果共23篇已发表研究符合纳入标准,合计2 045例,其中米非司酮片联合利凡诺引产1 028例,单用利凡诺引产1 017例,Meta分析结果显示:研究组(米非司酮片联合利凡诺组)与对照组(利凡诺组)比较,引产失败率低[WMD=0.22,95%CI (0.14,0.35),P <0.001];规律宫缩开始时间[WMD=-9.17,95%CI (-11.15,-7.18),P <0.001]、宫缩至胎盘娩出时间缩短[WMD=-6.37,95%CI (-8.78,-3.96),P <0.001]、总产程缩短[WMD=-6.12,95%CI (-7.64,-4.61),P <0.001];阴道出血少[WMD=-51.00,95%CI (-67.60,-34.39),P <0.001];胎盘、胎膜残留率低[WMD=0.17,95%CI (0.11,0.27),P <0.001];软产道损伤少[WMD=0.08,95%CI (0.04,0.16),P <0.001];研究组有减少子宫破裂的风险,但组间比较差异无统计学意义[WMD=0.27,95%CI (0.06,1.36),P=0.11]。结论米非司酮片联合利凡诺用于瘢痕子宫中期妊娠引产效果及安全性显著增加,规律宫缩开始时间、宫缩至胎盘娩出时间及总产程缩短、产后出血量少、产后胎盘胎膜残留率低及软产道损伤少,值得临床推广。

Objective To evaluate the clinical efficacy of mifepristone combined with rivano for induced labor in scarred uterus midtrimester pregnancy.Methods The computer comprehensively retrieved the relevant database,and through screening and quality evaluation.Meta-analysis of the included studies was performed by Rev Man 5.1 software.Results 23 trials with 2 045 patients were included,which involving 1 028 cases with mifepristone combined with rivanol for induced labor and 1 017 cases with rivanol for induced labor.The Meta-analysis showed that,compared with the control group(rivanol),experimental group(mifepristone combined with rivanol) had lower failure induction rate [WMD = 0.22,95 % CI(0.14,0.35)(P<0.001) ].Comparison was made on uterine contraction start time[WMD =-9.17,95 % CI(-11.15,-7.18),P<0.001],contractions to the placenta delivery time[WMD =-6.37,95 % CI(-8.78,-3.96),P<0.001],total time of induced labor[WMD =-6.12,95 % CI(-7.64,-4.61),P<0.001],vaginal bleeding volume[WMD =-51.00,95 % CI(-67.60,-34.39),P<0.001 ],residual of placenta and membranes[WMD = 0.17,95 % CI(0.11,0.27),P<0.001] and laceration of birth canal [WMD = 0.08,95 % CI(0.04,0.16),P<0.001]between the two groups,the differences were statistically significant.The experimental group had reduced the risk of uterine rupture,but the difference was not statistically significant [WMD = 0.27,95 % CI(0.06,1.36),P = 0.11].Conclusion Combination of mifepristone and rivanol shows creditable effect and safety for induced labor in scarred uterus midtrimester pregnancy.This method has high effective rate.It is beneficial for shortening uterine contraction start time,time of contractions to the placenta delivery and total time of induced labor,along with few bleeding volume and laceration of birth canal,lower residual of placenta and membranes.It’s worthy of clinic application.