Parashar Pooja, Iversen Ole Erik, Midbøe Grete, Myking Ole, Bjørge Line
Institute of Clinical Medicine, Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway.
Eur J Contracept Reprod Health Care. 2007 Dec;12(4):366-71. doi: 10.1080/13625180701536300.
The combination of mifepristone and misoprostol is an established method for induction of early first trimester abortion, but there is no consensus about the best evaluation of treatment outcome. We assessed endometrial thickness, determined by ultrasound and serum-human chorionic gonadotropin (s-hCG) as markers of successful management.
Prospective trial involving 255 women, with a gestation of 62 days or less, who were to undergo medical abortion. In addition to our established routines of performing clinical and ultrasound examinations, we also determined the s-hCG level prior to treatment and at follow-up.
Of the 255 subjects treated during the study, 20 (7.8%) were lost to follow-up. The overall complete abortion rate was 94.0%. Fourteen subjects required vacuum aspiration, nine of them prior to the scheduled follow-up and five thereafter. None of the pregnancies were ongoing. A decrease of 99% in s-hCG levels was noted in 99% of the women, when levels determined prior to mifepristone intake and those measured 15-71 days post-abortion were compared.
This study confirms that s-hCG levels drop sharply after medical abortion. To assess the completeness of medical abortion, we recommend that clinical examination to be combined with determination of s-hCG. Ultrasonography should be carried out only when indicated.
米非司酮与米索前列醇联合使用是孕早期人工流产的一种既定方法，但对于治疗效果的最佳评估尚无共识。我们评估了通过超声测定的子宫内膜厚度以及血清人绒毛膜促性腺激素（s-hCG），将其作为成功治疗的标志物。
对255名妊娠62天及以内准备接受药物流产的女性进行前瞻性试验。除了我们常规的临床和超声检查外，我们还在治疗前及随访时测定了s-hCG水平。
在研究期间接受治疗的255名受试者中，20名（7.8%）失访。总体完全流产率为94.0%。14名受试者需要行负压吸引术，其中9名在预定随访前进行，5名在随访后进行。无一例妊娠持续存在。比较米非司酮服用前测定的s-hCG水平与流产后15 - 71天测定的水平，99%的女性s-hCG水平下降了99%。
本研究证实药物流产后s-hCG水平急剧下降。为评估药物流产的完整性，我们建议临床检查与s-hCG测定相结合。仅在有指征时进行超声检查。
