Robledo C, Zhang J, Troendle J, Barnhart K, Creinin M D, Westhoff C, Huang X, Frederick M
National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA.
Int J Gynaecol Obstet. 2007 Oct;99(1):46-51. doi: 10.1016/j.ijgo.2007.04.031. Epub 2007 Jun 27.
To identify clinical indicators for success of misoprostol treatment after early pregnancy failure.
A total of 473 women with early pregnancy failure received 800 microg of vaginal misoprostol on treatment day 1. At the follow-up visit on day 3, a second dose was given if expulsion was incomplete. On day 8, vacuum aspiration was offered if expulsion had not occurred. Ultrasonography was used as gold standard for success. A Classification and Regression Tree analysis was undertaken to derive two decision trees for the success of misoprostol treatment on study days 3 and 8.
Heavy bleeding after the first dose and an open cervical os were identified as clinical indicators of treatment success on day 3. Treatment success occurred in 84% of women with either or both indicators. Reporting passage of tissue after a second misoprostol dose and old blood in the vagina were potential indicators of treatment success or failure on day 8. A woman with either of these indicators has a 65% chance of treatment success after the second dose. Conversely, a woman with neither indicator on day 8 has a 94% chance of treatment failure.
Standard clinical findings may be useful as indicators for success or failure of medical management of early pregnancy failure in settings with limited or no access to ultrasonography. More research to identify even better indicators is warranted.
确定早期妊娠失败后米索前列醇治疗成功的临床指标。
共有473例早期妊娠失败的女性在治疗第1天接受800微克阴道米索前列醇治疗。在第3天的随访中，如果排出不完全，则给予第二剂。在第8天，如果尚未排出，则进行真空吸引。超声检查被用作成功的金标准。进行分类与回归树分析，以得出米索前列醇治疗在第3天和第8天成功的两个决策树。
首次用药后大量出血和宫颈口开放被确定为第3天治疗成功的临床指标。有其中一个或两个指标的女性中，84%治疗成功。报告第二次米索前列醇用药后有组织排出以及阴道内有陈旧性血液是第8天治疗成功或失败的潜在指标。有这些指标之一的女性在第二次用药后有65%的治疗成功机会。相反，第8天没有任何指标的女性有94%的治疗失败机会。
在无法进行或难以进行超声检查的情况下，标准临床发现可作为早期妊娠失败药物治疗成功或失败的指标。有必要开展更多研究以确定更好的指标。
