Grønlund Annelise, Grønlund Lars, Clevin Lotte, Andersen Bodil, Palmgren Nina, Lidegaard Øjvind
Departments of Obstetrics and Gynecology at Gentofte University Hospital, Herlev University Hospital, and Glostrup University Hospital, Denmark.
Acta Obstet Gynecol Scand. 2002 Nov;81(11):1060-5.
To compare the efficacy of two different medical treatment regimens: mifepristone 600 mg orally + misoprostol 0.4 mg vaginally (Mf + Ms) or misoprostol 0.4 mg vaginally (Ms) with conventional surgical evacuation (SE) in women with missed abortion.
Prospective crossover study with alternating regimens every 4 months. The three university clinics of Obstetrics and Gynecology in Gentofte, Herlev and Glostrup of Copenhagen County. During the period October 1999 to October 2000, 176 women with missed abortion accepted to participate in the study.
The proportion of women who needed surgical evacuation after medical treatment, number of women who needed re-evacuation after primary surgical evacuation, duration of vaginal bleeding, treated infections, need of analgesics, and the subjective experiences from the participating women. Fifty-four, 73 and 49 patients were randomized to Mf + Ms, Ms and SE, respectively. Within 1 week, complete expulsion occurred in 40 (74%), 52 (71%), 47 (96%) of the three arms, respectively. Duration of bleeding was 6.9, 7.1 and 2.5 days in the three arms, respectively (p < 0.01). Women with an initial plasma chorionic gonadotrophine (p-hCG) between 2000 and 20 000 IU/l and a gestational age less than 75 days had a significantly better response to the medical treatment than those not fulfilling these two criteria. Initial p-progesterone did not correlate with success of medical treatment.
Proportion of women who needed surgical evacuation after medical treatment, and the number of women who needed re-evacuation after primary surgical evacuation, duration of vaginal bleeding, treated infections, the need of analgesics, and subjective experiences from participating women.
Vaginal misoprostol 0.4-0.6 mg is effective in most patients with missed abortion. Pre-treatment with the antiprogesterone mifepristone does not increase the success rate. The selection of women with missed abortion for medical treatment based on gestational age and initial p-hCG level may increase the success of medical treatment significantly.
比较两种不同药物治疗方案的疗效：口服米非司酮600mg+阴道用米索前列醇0.4mg（Mf+Ms）或阴道用米索前列醇0.4mg（Ms）与传统手术清宫（SE）用于稽留流产女性的疗效。
前瞻性交叉研究，每4个月交替使用治疗方案。研究在哥本哈根郡根措夫特、赫勒夫和格洛斯楚普的三家大学妇产科诊所进行。在1999年10月至2000年10月期间，176例稽留流产女性同意参与本研究。
药物治疗后需要手术清宫的女性比例、初次手术清宫后需要再次清宫的女性数量、阴道出血持续时间、治疗的感染情况、镇痛药物的需求以及参与研究女性的主观感受。分别有54、73和49例患者被随机分配至Mf+Ms组、Ms组和SE组。1周内，三组中完全排出的患者分别为40例（74%）、52例（71%）、47例（96%）。三组的出血持续时间分别为6.9天、7.1天和2.5天（p<0.01）。初始血绒毛膜促性腺激素（p-hCG）在2000至20000IU/L之间且孕周小于75天的女性对药物治疗的反应明显优于不满足这两个标准的女性。初始p-孕酮与药物治疗的成功率无关。
药物治疗后需要手术清宫的女性比例、初次手术清宫后需要再次清宫的女性数量、阴道出血持续时间、治疗的感染情况、镇痛药物的需求以及参与研究女性的主观感受。
0.4 - 0.6mg阴道用米索前列醇对大多数稽留流产患者有效。抗孕激素米非司酮预处理不会提高成功率。根据孕周和初始p-hCG水平选择稽留流产女性进行药物治疗可能会显著提高药物治疗的成功率。
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