Unsupervised medical abortion with misoprostol among adolescent—what is the prospect of demedicalise abortion in sub-Saharan Africa?

Objective: To find out clinical presentation and outcome of unsupervised use of misoprostol as abortifacent among adolescents presenting with abortion complications. Methods: Case series of thirty one adolescents that presented with abortion complications following unsupervised use of misoprostol. Results: Over a period of 3 years, 31 adolescents were seen, with median age of 17 years. Twenty nine (93.5%) were unmarried and 22 (71%) were in secondary school. Pregnancy duration was 3months and above in 23 (74.2%) of the patients. The cumulative dose of misoprostol tablet ingested was 2 (400 μg) in 17 (54.8%) of the patients. Twenty three (74.2%) patients presented with incomplete abortion with mild sepsis while the remaining 8 (25.8%) patients were admitted and managed with incomplete abortion with severe sepsis. Treatments offered were manual vacuum aspiration in 23 (74.2%) patients, evacuation of retained product of conception under anaesthesia in 7 (22.6%) patients and 1 (3.2%) patient had laparotomy with uterine repair following inadvertent uterine perforation complicating curettage for incomplete abortion. Complications encountered were anaemia 67.7%, uterine perforation 3.2%, blood transfusion 9.7% and diarrhoea in 8 (25.8%) patients. Conclusion: Demedicalise abortion with misoprostol due to improper dosing protocol may be associated with incomplete abortion and its sequelae in an uninformed adolescent population. Establishment of adolescent friendly medical centre that offers post abortion care will go a long way in alleviating this problem.

Efficacy of Single Dose of Mifepristone Combined with Two Doses of Misoprostol in Early Medical Abortions

Objective To study the efficacy of single dose of mifepristone and two doses of misoprostol in women undergoing early medical abortion （EMA） up to 9 weeks of gestation. Methods An audit was performed on a retrospective data analysis of 162 women who underwent an early medical abortion in Southampton U.K. Relevant data on completeness of abortion and other details were analyzed. Results Majority of the women （67%） aged 20-30 years old, 22% were between 30 and 40 years old and 1% were above 40 years old when they came for abortion. About 94.5% women had complete abortion following the use of single dose mifepristone combined with two doses of misoprostol, 4.9% had an incomplete abortion and 0.6% had failure of the procedure. These figures had significantly improved over the results of similar audit in 2005 with single dose of misoprostol to women below 7 weeks of pregnancy. The results in this audit were 82.1% complete abortion, 7.2% incomplete abortion and O. 7% failed procedure. Conclusion Mifepristone in combination with two doses of misoprostol appears to be more effective in all cases of early medical abortion when compared with single dose of misoprostol for termination below 49 d （7 weeks） and two doses of misoprostol between 49 d and 63 d （7-9 weeks） of pregnancy.

Clinical Observation on Termination of Early Pregnancy of 213 Cases after Caesarian Section with Repeated Use of Mifepristone and Misoprostol

Objective To investigate the efficacy and safety in women after caesarian section for termination of early pregnancies by treatment, or repeated treatment with mifepristone and misoprostol. Subjects and Methods A total of 213 pregnant women with amenorrhea of 34~69 d after caesarian section who asked for medical abortion were recruited, including 63 cases undergoing their second medical abortion. A total amount of mifeprisstone of 150 mg given in separate doses (25 mg×4 and 50 mg at the first time) was administered orally within 3 d, followed by misoprostol of 0.6 mg orally in the morning of d 3. Results The complete abortion rate was 92.5%, incomplete abortion was 4.7% and failure was 2.8%. Conclusion The sequential use of mifepristone and misoprostol could be successfully and repeatedly used for induced abortion in those women with a caesarian section history. Its efficacy was similar to that for ordinary population. Its safety and effectiveness were satisfactory.

A randomized clinical trial of mifepristone plus different routes of administration of misoprostol for terminating a pregnancy up to 37 days

<正>Objective:To explore the efficacy of 400μg of misoprostol administered sublingually on medical abortion for early pregnancy by comparing with routine administration of misoprostol. Methods;Women presenting for termination of early pregnancy,whose gestational ages were not more than 37 days,were randomly allocated into two groups.Women in group A were given 50 mg of mifepristone orally on the first day and 25 mg of mifepristone 8 to 12 hours later.The schedule on the second day was as the same as above followed by 400μg of misoprostol orally on the third day.Women in group B were given a dose of 150 mg of mifepristone orally followed by 400μg of misoprostol sublingually 36 to 48 hours later.Both completed abortion rates and side effects were evaluated. Results:The completed abortion rates were 93.4%in group A and 91.0%in group B,showing no significant difference(χ~2 =2.3846,P>0.05).About 80%of the women experienced nausea,vomit,dizziness,headache and breast tenderness.There were no significant differences in side effects of the two groups(P all>0.05).The duration of vaginal bleeding in the two groups were(9.08 + 3.49) days and(9.04 + 3.43) days,showing no significant difference(t= 0.15,P>0.05).About 97.3%of validated questionnaires on patient satisfaction were recovered.The proportions of patient satisfaction were 88.1%in group A and 92.0%in group B,showing no significant difference (P>0.05). Conclusion:Administration of 150 mg mifepristone orally followed by 400μg of misoprostol sublingually could be more suitable for termination of early pregnancy due to its higher complete abortion rate and less side effects.

A Simple Procedure for Termination of Pregnancy in the Late First Trimester with Mifeprostone and Misoprostol

Purpose: To assess the efficacy of medical methods for termination of pregnancy at 9 - 12 weeks of gestation. Methods: Between December 2008 and December 2010, the 116 consecutive women received 200 mg oral mifepristone and after 24 - 36 hours they applied 800 μg vaginal misoprostol to medically terminate pregnancy. If the products of conception did not pass, three further doses of 400 μg misoprostol were given vaginally at three hours intervals to medically terminate pregnancy. Results: Of the 116 patients undergoing the procedure 104 (90%) aborted completely. Half of the patients aborted within 6 hours. After medical termination, five per cent of the women were treated because of infection, and five per cent needed a revisit to hospital because of excessive bleeding. Two women received a blood transfusion. Previous live births or previous inducted abortion is presented in the study results. Conclusions: Medical abortion at 9 - 12 weeks’ gestation is a safe alternative to surgery.

A prospective randomized, placebo-controlled trial comparing mifepristone and vaginal misoprostol to vaginal misoprostol alone for elective termination of early pregnancy

A prospective randomized, placebo-controlled trial comparing mifepristone and vaginal misoprostol to vaginal misoprostol alone for elective termination of early pregnancy. Author: Dr Roopa Malik, Assistant Professor, Obstetrics and gynaecology department Pt BDS PGIMS Rohtak BACKGROUND: Vaginal misoprostol has been shown to be an effective single agent for medical agent for medical abortion. This randomized, placebo controlled trial compared a regimen of mefipristone and misoprostol with misoprostol alone for termination of early pregnancy. METHODS: 200 women with gestation <56 days were randomized by a random number table to receive either 200 mg mifepristone orally or placebo followed 48 h later by 800 ug vaginal misoprostol. Abortion success was defined as complete abortion without the use of surgical aspiration. RESULTS: Successful medical abortions occurred in 96 out of 100 subjects (96%) after mifepristone followed by vaginal misoprostol. In all, 79 out of 100 subjects (79%) successfully aborted after placebo and vaginal misoprostol. The higher success rate of complete abortion with mifepristone and misoprostol regimen was statistically significant compared with the placebo and misoprostol regimen (p < 0.05). CONCLUSION: A regimen of mifepristone and misoprostol was significantly more effective for termination of pregnancies <56 days than misoprostol alone. The misoprostol alone regimen for termination of early pregnancy is not a very good method for medical abortion but 79% efficacy obtained with vaginal misoprostol alone may clinically acceptable when mifepristone is not available.

米非司酮联合米索前列醇用于不同孕周药物流产效果

目的:探究米非司酮联合米索前列醇用于不同孕周药物流产效果。方法:选取2022年10月-2023年10月本院要求行药物流产者100例,根据妊娠孕周分为5~7周组(n=46)和8~12周组(n=54)。均给予米非司酮+米索前列醇药物干预,分析两组流产成功率、孕囊自然排出时间、阴道出血量、阴道出血时间、不良反应以及性激素水平变化。结果:5~7周组流产成功率(97.8%)高于8~12周组(83.3%),阴道出血量(71.1±8.1ml)和阴道流血时间(8.0±0.9d)均低于8~12周组(169.1±10.8ml、14.3±1.0d);流产后1周,两组孕酮水平均升高、雌二醇和卵泡刺激素水平均降低,且5~7周组改善效果优于8~12周组;5~7周组不良反应发生率(4.4%)低于8~12周组(18.5%)(均P<0.05)。结论:米非司酮联合米索前列醇药物流产对孕早期效果更优,可提高流产成功率,降低阴道出血量、出血时间和不良反应,改善性激素水平。

米非司酮配伍米索前列醇终止妊娠后子宫异常出血与术前凝血因子水平关系

目的:探究米非司酮配伍米索前列醇终止妊娠后子宫异常出血与术前凝血因子水平相关性。方法:选取2020年5月-2023年5月本院接诊自愿要求药物流产者88例,术前检测凝血因子,均给予口服米非司酮片+米索前列醇。分析药物流产后子宫异常出血情况并以此分为异常出血组(n=30)和非异常出血组(n=58),对比两组术前凝血因子水平,Spearman相关性分析子宫异常出血与术前凝血因子关系;受试者工作特征(ROC)曲线分析术前凝血因子水平对子宫异常出血的预测价值。结果:88例术后出血子宫异常出血率为34.1%;非异常出血组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)均低于异常出血组,纤维蛋白原(FIB)水平高于异常出血组(均P<0.05);Spearman相关性分析,PT、APTT和TT与子宫异常出血存在正相关,FIB与子宫异常出血存在负相关(均P<0.001);PT、APTT、TT和FIB联合诊断药物流产后子宫异常出血的曲线下面积(0.913)高于各单独指标检测(0.716、0.799、0.788、0.815)(均P<0.05)。结论:米非司酮配伍米索前列醇药物流产后子宫异常出血发生与女性术前凝血因子PT、APTT、TT和FIB之间具有相关性,且术前凝血因子PT、APTT、TT和FIB联合检测对药物流产后子宫异常出血有较高预测价值。

米索前列醇片致重度过敏性休克1例分析

目的探讨米索前列醇片致过敏性休克不良反应及其不同给药途径的影响,为临床安全使用提供参考。方法分析1例29岁女性药物流产患者舌下含化米索前列醇片(400μg)后出现过敏性休克并致心搏骤停的可能原因,检索同类文献病例,提出用药建议。结果患者服用米索前列醇片后出现过敏性休克、心搏骤停,分析相关用药和给药时间,考虑疑似为米索前列醇引起的严重药品不良反应。梳理相关文献和病例,提示不同给药途径皆有可能发生不良反应。结论米索前列醇片可能会增加心搏骤停不良反应的风险,临床用药时需警惕,并做好用药教育。

米非司酮联合米索前列醇药物流产中的护理措施分析

目的分析综合性护理在米非司酮结合米索前列醇药物流产中的效果。方法随机选取2020年1—12月江苏省苏州市立医院妇产科门诊收治的80例行米非司酮结合米索前列醇药物流产患者为研究对象,按照随机数表法分为观察组和对照组,各40例。对照组行常规门诊护理,观察组在对照组基础上联用综合性护理。对比两组不良情绪、应对方式以及生活质量。结果护理后,观察组患者抑郁评分(34.24±1.53)分、焦虑评分(40.13±2.33)分,均低于对照组,差异有统计学意义(t=25.965、21.374,P均<0.05)。护理后,观察组患者面对评分显著高于对照组,且回避与屈服评分均低于对照组,差异有统计学意义(P均<0.05)。护理后,观察组生活质量各评分均高于对照组,差异有统计学意义(P<0.05)。结论加强对行米非司酮结合米索前列醇药物流产患者的综合性护理干预,可有效缓解不良情绪,增强心理韧性,且一定程度上提高生活质量,可行性良好。

生化汤加味对于米非司酮配伍米索前列醇药物流产患者的应用效果

目的:观察生化汤加味对于米非司酮配伍米索前列醇药物流产患者的应用效果。方法:选择2020年12月至2021年12月于我院进行药物流产的患者200例,按照随机数字表法分为探究组和参照组,每组各100例。探究组患者米非司酮配伍米索前列醇给药后给予生化汤加味治疗,参照组患者仅采用米非司酮配伍米索前列醇给药。药流前、药流后检测两组患者血清孕酮(P)、雌激素(E 2)、卵泡刺激素(FSH)、人绒毛膜促性腺激素(HCG)、血管内皮生长因子(VEGF)、可溶性fms样酪氨酸激酶1(sFlt-1)、Th1细胞因子γ干扰素(IFN-γ)、肿瘤坏死因子α(TNF-α)及Th2细胞因子白细胞介素4(IL-4)水平;记录两组患者孕囊排出时间、阴道出血时间、腹痛时间、月经恢复时间、出血量;治疗3 d后给予患者疼痛数字评分法(NRS)评价;复查时,检测两组患者子宫动脉血流参数[阻力指数(RI)、收缩期峰值流速(PSV)、博动指数(PI)]水平及子宫内膜厚度、左右卵巢体积;记录两组患者完全流产率,比较两组患者临床疗效及不良反应发生率。结果:药流后,探究组患者性激素相关指标P、FSH水平低于参照组(P<0.05),E 2水平高于参照组(P<0.05);血清HCG、VEGF水平低于参照组(P<0.05),sFlt-1水平高于参照组(P<0.05);炎症因子IFN-γ、TNF-α水平低于参照组(P<0.05),IL-4水平高于参照组(P<0.05)。探究组患者孕囊排出、阴道出血、腹痛、月经恢复时间短于参照组(P<0.05),出血量少于参照组(P<0.05)。探究组患者NRS评分低于参照组(P<0.05);药流后PSV水平高于参照组(P<0.05),RI、PI水平低于参照组(P<0.05);子宫内膜厚度、左右卵巢体积大于参照组(P<0.05)。探究组患者治疗总有效率、完全流产率高于参照组(P<0.05),不良反应发生率低于参照组(P<0.05)。结论:对于米非司酮配伍米索前列醇药物流产患者,生化汤加味治疗可调节机体性激素水平,调节HCG、VEGF、sFlt-1水平,抑制机体炎症,改善卵巢状态及子宫血流,提高临床疗效及完全流产率,减少不良反应发生。

米非司酮配伍米索前列醇行早期妊娠药物流产的有效性评价

目的系统评价米非司酮配伍米索前列醇行药物流产的有效性。方法计算机检索中国生物医学文献数据库(CBM)等9种数据库,手工检索《生殖医学杂志》等10种杂志,追查已纳入文献的参考文献,纳入所有前瞻性临床对照研究。两位系统评价员独立进行文献筛查、质量评价和资料提取,并交叉核对,如遇分歧与第三者讨论解决。Meta分析采用RevMan4.2软件,文献间经异质性检验(α=0.05),无异质性采用固定效应模型合并分析;有异质性则分析异质性原因,并用敏感性分析、亚组分析或随机效应模型处理。二分类变量用比值比(OR)表示;连续性变量用加权均数差(WMD)表示,二者均计算95%CI。结果共纳入药物流产与手术流产比较的原始研究8篇(3348例),同种药物不同孕龄比较的文献9篇(6116例);米非司酮分服与顿服比较的文献5篇(1934 例);米非司酮与米索前列醇不同间隔时间比较的文献2篇(2381例)。国外原始研究的质量高于国内文献。药物流产完全流产率低于手术流产[OR合并0.18,95%CI(0.11,0.27)];药物流产不完全流产率和流产失败率均高于手术流产,其OR合并值及95%CI分别为3.32(1.79,6.17)和7.36(4.17,12.98);孕龄>49天组完全流产率低于孕龄≤49天组,其OR合并(95%CI)为0.51(0.43,0.61);孕龄>49天组的不完全流产率和流产失败率高于孕龄≤49天组,其OR合并(95%CI)分别为1.66(1.32,2.09)和3.37(2.30,4.94)。米非司酮分服与顿服的完全流产率、不完全流产率、流产失败率、孕囊排除时间、第一次月经恢复时间和流产后平均出血时间的差别无统计学意义。米非司酮与米索前列醇不同间隔时间比较,间隔<48h组完全流产率较高,有统计学意义,不完全流产率、流产失败率的差异均无统计学意义。结论提高国内原始研究的质量非常重要。虽然手术流产的完全流产率更高,但药物流产的完全流产率也能达到91.6%(1648/1800),临床可以接受。孕龄>49天比≤49天的完全流产率更低,有统计学意义,但孕龄>49天组的完全流产率也能达到87%(2590/3013),故适当放宽法定药物流产适用孕龄值得考虑,尤其是对有禁忌症和恐惧手术的孕妇。米非司酮分服与顿服的效果相似,顿服在给药程序上更简单,可推广应用。缩短用药间隔的方案因病人更易接受而应予以考虑,但确定最佳间隔时间尚需更多证据。

米非司酮配伍米索前列醇不同给药方式终止早孕的临床随机比较研究

目的研究米非司酮配伍米索前列醇舌下含服及口服的药物流产效果。方法将158例早孕妇女(停经≤56天)随机分为2组,连续口服米非司酮2天,3次/d,每次25mg,第3天上午使用米索前列醇(本文简称米索)口服400μg同时阴道给400μg(组Ⅰ),或者舌下含400μg同时阴道给400μg(组Ⅱ)以终止妊娠。结果总体完全流产率为94.9%,组I为92.5%,组Ⅱ为97.4%,两组无显著性差异(P>0.05);总体不全流产率为4.43%,组I为7.5%(6/80),高于组Ⅱ1.28%(1/78),但两组无显著性差异(P>0.05);总体失败率为0.63%,其中组Ⅰ为0,组Ⅱ为1.28%,两组亦无显著性差异(P>0.05);组Ⅰ从应用米索至孕囊排出时间为(2.39±1.20)h,明显低于组Ⅱ(2.98±1.33)h(P<0.01)。结论组I终止早孕的不全流产率高于组Ⅱ(但无明显组间差异,可能与样本较小有关),可能与舌下含服米索可使有效血药浓度维持时间较长,生物利用度较高有关,故在药物流产中米非司酮配伍舌下含服米索是1种很有前景的用药方法。

甲氨蝶呤和丙酸睾丸酮辅助加强药物流产的临床观察

目的 :评估一种新的加强药物流产方案的效果。方法 :将孕 4 2～ 56d的 168例按孕周随机分组 ,研究组 84例予以甲氨蝶呤 (MTX)和睾酮辅助的加强药物流产处理 ,对照组 84例 ,予以睾酮辅助的药物流产处理。结果 :研究组血 β -hCG和孕酮水平下降速度较快 (P <0 .0 5) ,清宫率为 1.3% ,低于对照组的 9.1% (P <0 .0 5) ,流产成功率为 69.7% ,高于对照组的 50 .7% (P <0 .0 5) ,出血持续少于 2 2d者占 76.7%低于对照组的 60 .5% (P<0 .0 5) ,用药后血白细胞数和消化道反应、转经天数和月经恢复延迟例数无增加。结论 :MTX和睾酮辅助的加强药物流产方案优于单纯睾酮辅助的常规药物流产方案 。

米非司酮配伍不同给药途径米索前列醇用于终止5周内妊娠的临床观察

目的通过与常规药物流产方法进行对比分析，探讨400μg米索前列醇舌下给药用于早期流产的效果。方法2008年6月至2009年9月接收就诊于全国6个研究中心停经〈37d要求药物流产的受试者，随机分为两组：A组：第1天晨空腹服米非司酮50mg，8～12h后再服25mg，第2天按照第1天同样方法服用，首次服米非司酮后36～48h口服米索前列醇600μg；B组：第1天顿服米非司酮150mg，服药后36-48h舌下含服米索前列醇400μg。观察两组的流产效果。结果根据纳入及排除标准，共接收575例受试者，其中4例失访。A组完全流产267例（93．4%），失败16例；B组完全流产262例（91．0％），失败26例，两组比较差异无统计学意义（x^2=2．3846，P〉0．05）。约〉80％妇女有恶心、呕吐、头晕、乏力、头痛和乳胀的反应，两组副反应比较无显著性差异（P均〉0．05）。服药后两组出血分别为（9．08士3．49）和（9．04±3．43）d，差异无统计学意义（t=0．15，P〉0．05）。两组受试者满意度调查的有效问卷回收率为97．3％，对研究方法的满意率分别为88．1％（245／278）和92．0％（256／278），差异无统计学意义（P〉0．05）。结论400μg米索前列醇舌下用药用于早期流产可获得较好的效果，且副反应较少。

米非司酮配伍不同给药途径及剂量米索前列醇用于催经止孕的临床研究

目的：应用米非司酮配伍米索前列醇催经止孕,探讨米索前列醇选用不同剂量及不同给药途径对临床效果的影响。方法：根据纳入及排除标准,2008年7月至2009年7月间100例停经≤37天的妇女被随机分为两组,对照组（50例）：第1天晨空腹服米非司酮50 mg,8～12小时后再服25mg,第2天按照第l天同样方法服用,首次服米非司酮36～48小时后口服米索前列醇600μg;观察组（50例）：第1天顿服米非司酮150 mg,服药36～48小时后舌下含服米索前列醇400μg,比较两组治疗结局及药物副反应情况。结果：尿HCG阳性的妇女,对照组完全流产40例,失败5例;观察组完全流产37例,失败6例,两组比较差异无统计学意义（χ2=0.16,P〉0.05）。尿HCG阴性的妇女,对照组中有4例,观察组中有7例月经来潮,两组均达到了较好的催经效果。57例（对照组31例,观察组26例）患者有恶心、呕吐、头晕、乏力、头痛和乳胀等副反应,两组比较差异无统计学意义（χ2=1.02,P〉0.05）。服药后对照组及观察组阴道流血时间分别为7.10±1.62天和7.00±2.50天,两组比较差异无统计学意义（t=-0.24,P〉0.05）。结论：减少米索前列醇给药剂量及使用舌下含化的方法和常规药物流产相比,催经止孕效果一致,且不增加副反应。

针灸配合米非司酮、米索前列醇终止早孕临床观察

目的 :观察针灸配合药流的临床疗效。方法 :将 186例自愿服药终止早孕的妇女 ,分为治疗组和对照组。治疗组在最后一次服药后即给予针刺治疗 ,孕囊排出后给予温针灸治疗。结果 :治疗组在完全流产率、阴道出血持续时间、出血量等方面明显优于对照组。 结论 :针灸提高了机体对药物的敏感性、增强了子宫收缩力、促进了蜕膜及绒毛的排出 ,配合药流终止早孕可防治药流的副作用。

米非司酮配伍米索前列醇不同给药方式终止早早孕的临床研究

目的对比观察米非司酮配伍米索前列醇阴道给药及舌下含服对早早期妊娠的药物流产效果。方法将70例停经妇女(停经≤37d)随机分为两组,第1天均顿服米非司酮150mg,第3天(服米非司酮36～48h后)使用米索前列醇,分为阴道给药400μg(组Ⅰ)和舌下含服400μg(组Ⅱ)两种方式以终止妊娠。结果总完全流产率为92.86%,其中组Ⅰ为97.06%,组Ⅱ为88.89%,两组比较有显著性差异(P<0.05);两组均无不全流产发生;总失败率为7.14%,其中组Ⅰ为2.94%,组Ⅱ为11.11%,两组比较有显著性差异(P<0.05);70例患者血hCG值与药物流产后的出血时间成显著正相关(P=0.000)。结论对于停经37d以内的早早孕终止妊娠,米非司酮配伍米索前列醇阴道给药能达到更好的药物流产效果,不完全流产率极低,但要警惕异位妊娠的可能。

不同方法服用米非司酮配伍米索前列醇终止10～14周妊娠的临床观察

目的探讨不同方法服用米非司酮配伍米索前列醇终止10～14周妊娠的临床效果。方法妊娠10～14周孕妇250例,随机分为观察组和对照组。观察组于第1天晚上服用米非司酮75mg,12h后再服用米非司酮75mg,间隔2h后阴道塞米索前列醇600μg;对照组按以往常规方法早上服用米非司酮50mg,晚上服用25mg,连续2天,第3天早上口服米索前列醇600μg。结果观察组流产率与对照组比较,差异有统计学意义(p<0.05);观察组宫缩发动时间少于对照组(p<0.05);两组妊娠物排出时间、阴道流血量无显著性差异(p>0.05);两组阴道流血持续时间及月经复潮时间差异无统计学意义(p>0.05)。结论观察组米非司酮配伍米索前列醇的用药方法可缩短给药时间,缩短宫缩发动时间,提高流产率,是值得推广的药物流产方法。

新生化颗粒改善米非司酮联合米索前列醇用于早期妊娠药物流产效果的系统评价

目的:系统评价新生化颗粒对米非司酮联合米索前列醇用于早期妊娠药物流产的干预效果,为临床早期药物流产提供循证参考。方法:计算机检索Cochrane图书馆、PubMed、EMBase、中国知网、中国生物医学文献数据库、万方数据库和维普数据库等,收集新生化颗粒(研究组)对比空白组(对照组)干预米非司酮联合米索前列醇用于早期妊娠药物流产的随机对照试验,检索时限均为建库至2020年3月。使用Cochrane手册指南中的标准评价纳入文献的质量,同时对纳入文献采用RevMan 5.3软件进行荟萃分析(Meta分析)。结果:最终纳入15项研究,共2513例患者(研究组患者1272例,对照组患者1241例)。Meta分析结果显示,与对照组比较,研究组治疗方案可显著提高患者的完全流产率(RR=1.14,95%CI=1.11~1.18,P<0.00001)、阴道出血持续时间正常率(≤7 d)(RR=2.19,95%CI=1.34~3.56,P=0.002)和阴道出血量正常率(≤平素月经量)(RR=1.37,95%CI=1.30~1.44,P<0.00001),缩短患者的阴道出血持续时间(WMD=-4.24,95%CI=-4.48~-4.00,P<0.00001)、月经复潮时间(WMD=-3.44,95%CI=-4.22~-2.65,P<0.00001)和孕囊排出时间(WMD=-2.48,95%CI=-2.70~-2.25,P<0.00001),差异均有统计学意义。结论:新生化颗粒能有效改善米非司酮联合米索前列醇用于早期妊娠药物流产的效果,提高完全流产率,缩短阴道出血持续时间、月经复潮时间及孕囊排出时间,减少阴道出血量。未来需要质量更高、方法学更完备的多中心、大样本的随机对照试验,进一步验证新生化颗粒对早期药物流产效果的干预作用。