米非司酮紧急避孕及催经止孕同时降低葡萄胎及异位妊娠发生风险的探讨

The Study of Effect of Mifepristone on Emergent Contraception and Hastening Menses Contraception and Decreasing the risk of Hydatidiformmold and Ectopic Pregnancy

目的探讨应用米非司酮紧急避孕及催经止孕减少非意愿妊娠同时降低葡萄胎及异位妊娠发生风险的可能性。方法回顾性分析我院2000年10月至2014年6月期间米非司酮紧急避孕病例12 573例、米非司酮催经止孕病例10 970例,所有病例均符合尿HCG阴性、盆腔超声未见异常、子宫内膜厚度0.6-1.2 cm、无口服米非司酮禁忌症,并且排除宫内妊娠、异位妊娠及盆腔器质性疾病等。无保护性生活120 h内要求紧急避孕者空腹口服米非司酮10 mg,无保护性生活超过120 h要求催经止孕者空腹口服米非司酮150 mg,禁止重复性行为,2 w后随访,血HCG无升高、盆腔超声子宫内膜无增厚为紧急避孕或催经止孕有效,血HCG升高或/和子宫内膜变厚者严密观察下继续随访,直至明确宫内妊娠或异位妊娠。整理资料进行统计学分析。结果紧急避孕组避孕有效率91.57%,避孕失败率8.43%,输卵管妊娠发生率0.66%;催经止孕组避孕有效率100%,失败率0%,两组葡萄胎发生率均为0%,明显低于异位妊娠的自然发病率（2%）和葡萄胎的自然发病率（0.78‰）,米非司酮催经止孕避孕效果优于米非司酮紧急避孕效果（P〈0.05）。结论无保护性生活120 h内或超过120 h排除宫内妊娠及异位妊娠者分别给予空腹顿服米非司酮10 mg及米非司酮150 mg在有效避孕同时,可降低葡萄胎及异位妊娠的发生风险。

Object To explore the possibility of emergency contraception and hastening menses contraception as well as decreasing the risk of hydatidiform mold and ectopic pregnancy by means of mifepristone. Methods The cases of our hospital from Oct.2000 to Jun. 2014 were retrospectively analyzed,among which 12 573 cases were treated with emergency contraception through mifepristone,and 10970 cases were dealt with hastening menses contraception by the use of mifepristone. All the cases conformed to the status below： regular menstrual period,negative urine HCG,normal pelvic ultrasonic image,membrane thickness range from 0. 6 cm -to 1. 2 cm,excluding pregnancy in uterus,ectopic pregnancy,pelvic organic diseases,and mifepristone contraindications. Those who had unprotected intercourse within 120 hours were asked to take 10 mg dose of mifepristone while those overdue for 120 hours were required to take 150 mg dose of mifepristone. All these cases were forbidden to undergo sexual intercourse and were asked to consult again to check HCG level in blood in 2 weeks. For some patients whose level of HCG didn＇t rise and uterus membrane thickness didn＇t get thicker under ultrasonic,and the emergency contraception or hastening menses contraception was effective. For those whose results were the opposite,the emergency contraception or the hastening menses contraception failed. Then these patients were observed until they were diagnosed clearly. Finally,the data were analyzed statistically. Results The efficiency rate in the emergency contraception group was 91. 57%（ 11 513 of 12 573） while its failure rate（ ongoing pregnancy in uterus or in fallopian tube） was 8. 43%（ 1 060 of12 573）,among which the salpinx pregnancy rate was 0. 66%（ 83 of 12 573）,the uterus pregnancy rate was 7. 77%（ 977 of 12573） and the hydatidiform mold rate was zero. The efficiency rate of hastening menses contraception was 100%（ 10 970 of 10 970）.There was no pregnancy in uterus,no oviduct pregnancy or hydatidiform mold,which were remarkably below the natural incidence（ 2% and 0. 78‰ respectively）. By use of mifepristone,the contraceptive effectiveness of hastening menses was superior to that of emergency contraception. Conclusion The research shows emergency contraception within 120 hours after unprotected intercourse by taking 10 mg mifepristone and hastening menses beyond 120 hours by taking 150 mg mifepristone can be effective for both ceasing pregnancy and reducing the risk of hydatidiform mole and oviduct pregnancy.