Haimov-Kochman Ronit, Arbel Revital, Sciaky-Tamir Yael, Brzezinski Amnon, Laufer Neri, Yagel Simcha
Division of Obstetrics and Gynecology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
Acta Obstet Gynecol Scand. 2007;86(4):462-6. doi: 10.1080/00016340701203632.
The aim of this study was to determine the effectiveness of medical abortions with mifepristone and misoprostol following the approval of medical abortion in Israel.
A retrospective review of 377 consecutive medical records at an ambulatory care unit of a university medical centre was performed, screening all women undergoing medical abortion with mifepristone and misoprostol. Transvaginal ultrasonographic study and serum beta hCG measurement were performed 14-20 days after the procedure. The clinical outcome was defined as complete expulsion of intrauterine contents with (failed group) or without (successful group) surgical intervention.
Surgical intervention was performed in 7.4% of patients. Residual products of conception were confirmed in 89%. Older age, previous spontaneous abortions, multigravidity, and earlier follow-up visit were independently associated with unsuccessful medical abortion. Significant differences were found in mean serum beta hCG and mean endometrial thickness in the successful versus failed procedure groups.
Medical termination of pregnancy with mifepristone and misoprostol is >90% effective. High risk group for failure of the procedure can be characterised. An algorithm of follow up using follow-up visit date, serum beta hCG and sonographic endometrial stripe is suggested to define high risk patients for failed medical abortion.
本研究的目的是确定在以色列批准药物流产后，米非司酮和米索前列醇用于药物流产的有效性。
对一所大学医疗中心门诊护理单元连续377份病历进行回顾性研究，筛查所有接受米非司酮和米索前列醇药物流产的女性。在流产手术后14 - 20天进行经阴道超声检查和血清β - hCG测量。临床结局定义为在有（失败组）或无（成功组）手术干预的情况下，子宫内内容物完全排出。
7.4%的患者接受了手术干预。89%的患者确认有残留妊娠产物。年龄较大、既往自然流产史、多胎妊娠以及随访较早与药物流产失败独立相关。在成功组与失败组之间，平均血清β - hCG和平均子宫内膜厚度存在显著差异。
米非司酮和米索前列醇用于药物终止妊娠的有效性超过90%。可以确定手术失败的高危人群。建议使用随访日期、血清β - hCG和超声子宫内膜条带的随访算法来确定药物流产失败的高危患者。
