Reynolds A, Ayres-de-Campos D, Costa M A, Montenegro N
Departamento de Ginecologia e Obstetríca, Faculdade de Medicina da Universidade do Porto, Hospital de São João, Portugal.
Eur J Obstet Gynecol Reprod Biol. 2005 Jan 10;118(1):71-6. doi: 10.1016/j.ejogrb.2004.06.031.
There is currently no consensus on how success should be defined after medical management of first-trimester missed abortion. The aim of this study was to determine the transvaginal ultrasound criterion associated with highest success rate and, at the same time, lowest long-term complications.
Prospective observational study of consecutively enrolled patients.
A tertiary care university hospital in northern Portugal.
Forty-four women submitted to medical management of first-trimester missed abortion using a regimen of vaginal misoprostol, with histologically confirmed conception products passed vaginally. A transvaginal ultrasound scan was performed by an experienced sonographer in the morning after treatment, to characterise uterine content. Patients were provided with a chart for daily registration of axillary temperature, vaginal bleeding and lower abdominal pain. Transvaginal ultrasound was repeated 2-3 weeks later, and again after the following menses.
Success rates of medical management when post-treatment transvaginal ultrasound criteria for subsequent expectant management were: absence of intra-uterine sac, largest anteroposterior diameter of hyperechogenic content, and maximum area of hyperechogenic intra-uterine content in a sagittal view. Self-reported duration of vaginal bleeding and abdominal pain after medical treatment.
Success rate was 86% (38/44) when absence of gestational sac on the 12 h transvaginal ultrasound was used as the main criterion for subsequent expectant management and there was no need for further intervention. The success rate using the ultrasound criterion anteroposterior diameter < or = 15 mm was 51% (22/43), and with maximum sagittal plane area under 7.5 cm(2), 72% (31/43). Mean duration of vaginal haemorrhage was 9 days (minimum 2 days, maximum 14 days) and of lower abdominal pain 6 days (minimum 0 days, maximum 14 days). No patient recorded an axillary temperature exceeding 37 degrees C. No apparent relationship between the size of ultrasound-estimated intra-uterine content and duration of symptoms was observed.
Absence of gestational sac on transvaginal ultrasound should be the criterion used to document success after medical management of first-trimester missed abortion, as it is associated with the highest short and long-term success rates, as well as mild and self-limited symptoms in the days following treatment.
目前对于孕早期稽留流产药物治疗后的成功标准尚无共识。本研究的目的是确定与最高成功率及同时最低长期并发症相关的经阴道超声标准。
对连续纳入的患者进行前瞻性观察研究。
葡萄牙北部的一家三级医疗大学医院。
44名接受孕早期稽留流产药物治疗的女性，采用阴道米索前列醇方案，组织学证实妊娠产物经阴道排出。治疗后次日上午由经验丰富的超声检查医师进行经阴道超声扫描，以确定子宫内情况。为患者提供图表，用于每日记录腋温、阴道出血和下腹痛情况。2 - 3周后及下次月经后再次进行经阴道超声检查。
后续期待治疗的经阴道超声标准为子宫内无孕囊、高回声内容物的最大前后径以及矢状面高回声子宫内内容物的最大面积时，药物治疗的成功率。药物治疗后自我报告的阴道出血和腹痛持续时间。
以治疗后12小时经阴道超声未见孕囊作为后续期待治疗的主要标准时，成功率为86%（38/44），无需进一步干预。超声标准为前后径≤15 mm时成功率为51%（22/43），矢状面最大面积小于7.5 cm²时成功率为72%（31/43）。阴道出血平均持续时间为9天（最短2天，最长14天），下腹痛平均持续时间为6天（最短0天，最长14天）。无患者记录腋温超过37℃。未观察到超声估计的子宫内内容物大小与症状持续时间之间有明显关系。
经阴道超声未见孕囊应作为孕早期稽留流产药物治疗后记录成功的标准，因为它与最高的短期和长期成功率相关，且治疗后数天症状轻微且为自限性。
