Schaff E A, Fielding S L, Eisinger S, Stadalius L
Reproductive Health Program, Department of Family Medicine, University of Rochester School of Medicine, Rochester, NY, USA.
Contraception. 2001 May;63(5):251-4. doi: 10.1016/s0010-7824(01)00200-1.
The study was conducted to determine whether the administration of mifepristone followed by vaginal misoprostol can induce an abortion in early pregnancy when no gestational sac is present on sonogram. This report presents a prospective, pilot study of 30 healthy adult women, pregnant and seeking an abortion, and with no gestational sac on sonogram. All women had a baseline serum chorionic gonadotropin (hCG) level measured prior to using mifepristone 200 mg orally followed by misoprostol 800 mcg vaginally 48 h later, and then returned up to 4 days later for a repeat sonogram and serum hCG level. Women with initial hCG levels > 2000 IU/L were evaluated for ectopic pregnancy. At the first follow-up visit, if the hCG decreased by >50%, the women were followed with home pregnancy (25 IU/L) tests weekly until negative. If the levels did not decrease by 50%, a second dose of misoprostol was given. Surgical intervention was indicated for persistent hCG levels or excessive bleeding. Of the 30 women enrolled, the mean number of days of amenorrhea was 40 (SD 9) days. Two women had surgical intervention for continuing pregnancy, 2 had ectopic pregnancies, and 1 was lost to follow-up. Complete medical abortions occurred in 25/30 (88%) women, but when recalculated, in 25/27 (93%) women who completed the protocol and who did not have an ectopic pregnancy. There was 1 adverse event in a woman with an ongoing pregnancy who then received methotrexate. She was hospitalized a day later with a complicated pelvic infection and likely methotrexate-induced pneumonitis. Twenty-three women had a decrease in hCG at first follow-up visit of >50%. All 27 women who completed the protocol found the overall regimen acceptable. Mifepristone followed at 48 h by vaginal misoprostol were effective and acceptable in inducing an abortion in very early pregnancy. There may be a higher incidence of failure in very early pregnancies. Documentation of a complete abortion by hCG level is necessary to ensure the pregnancy is neither ongoing nor ectopic.
本研究旨在确定在超声检查未见妊娠囊的情况下，先服用米非司酮再经阴道给予米索前列醇是否能诱导早期妊娠流产。本报告呈现了一项针对30名健康成年孕妇且寻求流产、超声检查未见妊娠囊的前瞻性试点研究。所有女性在口服200毫克米非司酮前测量基础血清绒毛膜促性腺激素（hCG）水平，48小时后经阴道给予800微克米索前列醇，然后在最多4天后返回进行重复超声检查和血清hCG水平检测。初始hCG水平>2000 IU/L的女性接受异位妊娠评估。在首次随访时，如果hCG下降>50%，则让这些女性每周进行家用妊娠（25 IU/L）检测，直至检测结果为阴性。如果水平未下降50%，则给予第二剂米索前列醇。对于持续的hCG水平或大量出血，需进行手术干预。在纳入的30名女性中，平均闭经天数为40（标准差9）天。2名女性因持续妊娠接受了手术干预，2名患有异位妊娠，1名失访。25/30（88%）的女性发生了完全药物流产，但重新计算后，在完成方案且未患异位妊娠的25/27（93%）女性中发生了完全药物流产。1名持续妊娠的女性随后接受甲氨蝶呤治疗后出现了1例不良事件。一天后她因复杂的盆腔感染和可能由甲氨蝶呤引起的肺炎住院。23名女性在首次随访时hCG下降>50%。所有完成方案的27名女性都认为整个方案是可以接受的。米非司酮48小时后经阴道给予米索前列醇在诱导极早期妊娠流产方面有效且可接受。极早期妊娠流产失败的发生率可能更高。通过hCG水平记录完全流产情况对于确保妊娠既未持续也非异位是必要的。
