不同用药方案在瘢痕子宫孕妇中期妊娠引产效果的meta分析

Meta-analysis of induced abortion in scar pregnancy in the second trimester with different drug regimens

目的 比较2种不同用药方案对瘢痕子宫孕妇中期妊娠引产的效果,以期为临床提供参考。方法 检索万方、维普、中国知网、PubMed、Cochrane Library、Embase、Web of Science数据库中2012—2022年关于不同用药方案对瘢痕子宫孕妇中期妊娠引产效果的文献。所纳入文献按不同用药方案分为“米非司酮+米索前列醇”组和“米非司酮+依沙吖啶”组,比较两组用药方案的引产效果。根据米索前列醇的不同给药方式又分为2个亚组,即“米非司酮+口服米索前列醇”组和“米非司酮+阴道放置米索前列醇”组。采用Review Manager 5.2软件对数据进行meta分析,并对引产成功率及产后出血量进行亚组分析。结果 共16篇文献纳入研究。“米非司酮+米索前列醇”组的引产成功率较“米非司酮+依沙吖啶”组高(RR=0.97,95%CI:0.94~1.00;P=0.05),引产时间(SMD=3.33,95%CI:1.91~4.74;P <0.05)及总产程(SMD=1.29,95%CI:0.24~2.34;P=0.02)较“米非司酮+依沙吖啶”组短。两组的用药至宫缩发动时间(SMD=0.04,95%CI:-1.52~1.61;P=0.96)、产后出血量(SMD=0.07,95%CI:-0.26~0.39;P=0.69)、胎盘胎膜残留率(SMD=0.95,95%CI:0.53~1.71;P=0.87)及软产道损伤率(SMD=2.22,95%CI:0.83~5.97;P=0.11)的比较差异均无统计学意义。亚组分析结果表明,口服或阴道放置米索前列醇对引产成功率及产后出血量无明显影响(均P> 0.05)。结论 “米非司酮+米索前列醇”的用药方案在瘢痕子宫孕妇中期妊娠引产成功率、引产时间及总产程方面优于“米非司酮+依沙吖啶”,值得临床推广。米索前列醇的给药方式可能对引产结果无影响。

Objective To compare the effects of two different drug regimens on inducted abortion in scar pregnancy in midtrimester,in order to provide evidence for clinical work.Methods Literatures on the effects of different drug regimens on labor induction in second trimester of scar pregnancy during 2012-2022 were searched from database of Wanfang,Weipu,CNKI,PubMed,Cochrane Library,Embase and Web of Science.They were divided into‘mifepristone+misoprostol’group and‘mifepristone+esacridine’group,and the effect of induced abortion were compared between 2 groups.According to the way of administration of misoprostol,they were divided into 2 subgroups,namely‘mifepristone+oral misoprostol’group and‘mifepristone+vaginal misoprostol’group.Review Manager 5.2 software was used for meta-analysis,and subgroup analysis were performed for success rate of induced abortion and the volume of postpartum haemorrhage.Results Sixteen articles were involved in our study.The success rate of induced abortion in the‘mifepristone+misoprostol’group was significantly higher than that of the‘mifepristone+exacridine’group(RR=0.97,95%CI:0.94-1.00;P=0.05),while the period of induced abortion(SMD=3.33,95%CI:1.91-4.74;P<0.05)and total labor time(SMD=1.29,95%CI:0.24-2.34;P=0.02)were significantly shorter in the‘mifepristone+misoprostol’group than those in the‘mifepristone+exacridine’group.However,there were no differences between 2 groups in terms of the time from medication use to uterine contraction(SMD=0.04,95%CI:-1.52-1.61;P=0.96),the volume of postpartum hemorrhage(SMD=0.07,95%CI:-0.26-0.39;P=0.69),the incidence of residual placental membrane(SMD=0.95,95%CI:0.53-1.71;P=0.87),and the rate of soft birth canal injury(SMD=2.22,95%CI:0.83-5.97;P=0.11).Subgroup analysis showed that there were no differences between oral misoprostol and vaginal misoprostol group in terms of the success rate of induced abortion and the volume of postpartum hemorrhage(all P>0.05).Conclusion‘Mifepristone+misoprostol’is superior to‘mifepristone+esacridine’in aspects of success rate,the period,and total labor time of induced abortion in scar pregnancy,which is worth of clinical promotion.In addition,the way of misoprostol administration might have no effect on the result of induced abortion.