Akoury Hani A, Hannah Mary E, Chitayat David, Thomas Martin, Winsor Elizabeth, Ferris Lorraine E, Einarson Thomas R, Seaward P G R, Ryan Greg, Willan Andrew R, Windrim Rory
Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada.
Am J Obstet Gynecol. 2004 Mar;190(3):755-62. doi: 10.1016/j.ajog.2003.09.037.
Our purpose was to compare the effectiveness, women's views of the termination procedure, and success of umbilical cord culture for vaginal and oral misoprostol versus intra-amniotic prostaglandin PGF(2alpha) for second-trimester pregnancy termination (STPT).
We randomized 217 women, 15 to 24 weeks' gestation, into 3 groups. Oral (OM) and vaginal (VM) misoprostol groups received 400 microg of misoprostol every 4 hours for 24 hours. The intra-amniotic PGF(2alpha) (IAPG) group received 40 mg of PGF(2alpha) followed by oxytocin infusion. Women completed self-administered questionnaires 3 weeks after the termination procedure. Umbilical cord samples were collected at delivery for karyotype analysis. The primary outcome was the time from start of the procedure to placental delivery. Secondary outcomes were maternal complications, women's acceptance of the termination procedure, and success rates of umbilical cord culture.
The time was longer for the OM group (30.5+/-14.4 hours) compared with the VM group (18.3+/-8.2 hours) and the IAPG group (21.1+/-10.2 hours), P<.001 for both comparisons. Women in the VM group reported being more willing to repeat the termination method in the future and reported fewer side effects than those in the other groups, P<.001. Failure rates for umbilical cord cultures were 9.6%, 17.0%, and 45.6% for the VM, OM, and IAPG groups, respectively.
Oral misoprostol is less effective than intra-amniotic PGF(2alpha) or vaginal misoprostol for STPT. Women report vaginal misoprostol more acceptable than other methods. Umbilical cord culture failure rate is highest in the IAPG group.
我们的目的是比较阴道和口服米索前列醇与羊膜腔内注射前列腺素PGF(2α)用于中期妊娠终止（STPT）时的有效性、女性对终止程序的看法以及脐带培养的成功率。
我们将217名妊娠15至24周的女性随机分为3组。口服（OM）和阴道（VM）米索前列醇组每4小时接受400微克米索前列醇，共24小时。羊膜腔内注射PGF(2α)（IAPG）组接受40毫克PGF(2α)，随后静脉滴注缩宫素。女性在终止程序3周后完成自行填写的问卷。分娩时采集脐带样本进行核型分析。主要结局是从程序开始到胎盘娩出的时间。次要结局是母体并发症、女性对终止程序的接受程度以及脐带培养的成功率。
与VM组（18.3±8.2小时）和IAPG组（21.1±10.2小时）相比，OM组的时间更长（30.5±14.4小时），两组比较P<0.001。VM组的女性报告更愿意在未来重复使用该终止方法，且报告的副作用比其他组少，P<0.001。VM、OM和IAPG组的脐带培养失败率分别为9.6%、17.0%和45.6%。
口服米索前列醇用于STPT的效果不如羊膜腔内注射PGF(2α)或阴道米索前列醇。女性报告阴道米索前列醇比其他方法更易接受。IAPG组的脐带培养失败率最高。
