Chitaishvili D, Asatiani T
Department of Reproductive Health, Institute of Postgraduate Education and Continious Professional Development, Tbilisi State Medical University, Tbilisi, Georgia.
Georgian Med News. 2007 Nov(152):26-30.
Aim of the study was to evaluate effect of sublingual misoprostol given prior to manual vacuum termination (MVA) of gestation. 349 healthy women with a normal intrauterine pregnancy at 8 and 12 weeks of gestation were studied. 175 women were randomly allocated to misoprostol group and 174 women to placebo group. The patients received 400 microg misoprostol sublingually or the same amount placebo approximately one hour before the procedure. The mean gestational age were 9,9 (SD 1,4) in the intervention group and 9,8 weeks (SD 1,3) in the control group. The mean age of patients was 27,3 years in both groups. The parity and abortion frequency were 5,7 (SD 4,3) and 3,2 (SD 3,8) in the intervention group and 4,9 (SD 2.8) and 2,5 (SD 2,4) in the control group respectively. The preoperative cervical dilatation were 8,9 mm (SD 1,8) in misoprostol group vs. 6,2 mm (SD 1,5) in placebo group (p<0,001). The amount of blood loss were - 95,0+/-89,3 in misoprostol group vs. 149,0+/-82,1 in placebo group (p<0,001). Need for oxytocin was less common in misoprostol group - 29 (16,6%) vs. 63 (36,2%). The duration of the procedure - 7,3 min (SD 2,7) in misoprostol group vs. 7,7 min (SD 2,2) in placebo group (p=NS). There was no significant difference in terms of visual analogue scores during the procedure, patient satisfaction, and rate of side effects among the groups. Obtained results has shown that sublingual administration of 400 microg misoprostol at least an hour before MVA for termination of pregnancy facilitates the abortion procedure by decreasing the need for cervical dilatation, reducing blood loss and need for oxytocin use. However there was no significant difference in operating time between the two groups. Sublingual misoprostol has the advantage of being more convenient to administer and may be more suitable for day surgery. Further studies could assess optimal route, dose, time interval of misoprostol administration which would provide a faster and a higher effect required for blood loss decrease and cervical priming before abortion.
本研究的目的是评估在人工负压终止妊娠（MVA）前舌下含服米索前列醇的效果。对349名妊娠8至12周、宫内妊娠正常的健康女性进行了研究。175名女性被随机分配到米索前列醇组，174名女性被分配到安慰剂组。患者在手术前约一小时舌下含服400微克米索前列醇或等量安慰剂。干预组的平均孕周为9.9周（标准差1.4），对照组为9.8周（标准差1.3）。两组患者的平均年龄均为27.3岁。干预组的产次和流产次数分别为5.7（标准差4.3）和3.2（标准差3.8），对照组分别为4.9（标准差2.8）和2.5（标准差2.4）。米索前列醇组术前宫颈扩张为8.9毫米（标准差1.8），安慰剂组为6.2毫米（标准差1.5）（p<0.001）。米索前列醇组的失血量为-95.0±89.3，安慰剂组为149.0±82.1（p<0.001）。米索前列醇组使用催产素的需求较少——29例（16.6%），而安慰剂组为63例（36.2%）。手术时间——米索前列醇组为7.3分钟（标准差2.7），安慰剂组为7.7分钟（标准差2.2）（p=无显著性差异）。两组在手术过程中的视觉模拟评分、患者满意度和副作用发生率方面无显著差异。获得的结果表明，在MVA终止妊娠前至少一小时舌下含服400微克米索前列醇，可通过减少宫颈扩张需求、减少失血量和使用催产素的需求来促进流产手术。然而，两组之间的手术时间无显著差异。舌下含服米索前列醇具有给药更方便的优点，可能更适合日间手术。进一步的研究可以评估米索前列醇给药的最佳途径、剂量、时间间隔，这将为流产前减少失血量和宫颈预处理提供更快、更高的效果。
