Pongsatha Saipin, Tongsong Theera
Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Thailand.
J Med Assoc Thai. 2006 Aug;89(8):1097-100.
To describe the experience of misoprostol use for pregnancy interruption in the second trimester of women with previous cesarean section.
Seventeen pregnant women with viable fetuses and with previous cesarean section indicated for second trimester pregnancy interruption attending Maharaj Nakorn Chiang Mai Hospital were recruited. All received the same regimen of 400 mcg intravaginal misoprostol every 6 hours. The data was analyzed for demographic characteristics, the adverse outcomes, success rate, and time interval to fetal expulsion.
The incidences of adverse outcomes were as follows, fever (47.1%), chill (23.5%), and nausea (17.6%). No uterine rupture occurred in this series at all. The rate of oxytocin use and analgesia requirement was 29.4%. Success rate of pregnancy interruption was 100%, though two of them had an abortion time of more than 48 hours. Time interval from misoprostol administration to fetal expulsion was 25.9 +/- 34. 1 hours (range 4.0-142.7 hours).
This case series reaffirms the efficacy of misoprostol and suggests that misoprostol may relatively be safe even in cases with previous cesarean section. Therefore, misoprostol may be an option of pregnancy interruption in the second trimester to avoid unnecessary surgical procedure including hysterotomy. However, the safety should be tested by further studies with a larger sample size.
描述米索前列醇用于有剖宫产史妇女孕中期引产的经验。
招募了17名怀有存活胎儿且有剖宫产史、因孕中期引产而就诊于清迈玛哈拉吉医院的孕妇。所有孕妇均每6小时接受400微克阴道内米索前列醇的相同给药方案。分析数据的人口统计学特征、不良结局、成功率以及胎儿排出的时间间隔。
不良结局的发生率如下：发热（47.1%）、寒战（23.5%）和恶心（17.6%）。本系列中无一例发生子宫破裂。催产素使用和镇痛需求率为29.4%。引产成功率为100%，尽管其中两人流产时间超过48小时。从米索前列醇给药到胎儿排出的时间间隔为25.9±34.1小时（范围4.0 - 142.7小时）。
本病例系列再次证实了米索前列醇的有效性，并表明即使在有剖宫产史的情况下米索前列醇可能相对安全。因此，米索前列醇可能是孕中期引产的一种选择，以避免包括子宫切开术在内的不必要手术。然而，其安全性应通过更大样本量的进一步研究来验证。
