Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan 250012, People's Republic of China.
Contraception. 2010 Jan;81(1):62-6. doi: 10.1016/j.contraception.2009.09.013.
Termination of pregnancy is an important and necessary back-up method for family planning services in many countries. The combination of mifepristone and misoprostol is a widely used alternative to surgical evacuation of the uterus in early pregnancy; however, there are few reports about medical abortion in women with a prior uterine incision and few studies have described curettage occurring as part of the procedure and an indication for the intervention. Curettage in a prior uterine incision can increase operative complications. The purpose of this study was to investigate whether vaginal bleeding intervals, routine ultrasound scan and serum beta-hCG test after medical abortion could accurately identify women with uterine scars who would require curettage.
Six hundred sixty-eight women with a uterine scar and at up to 49 days of gestation underwent a medical abortion with mifepristone and misoprostol. Each woman took 50 mg and 25 mg of mifepristone orally in the morning and in the evening, respectively, for 2 days and 600 mcg of misoprostol orally on the third day.
Of the 668 women, 6 (0.9%) were lost to follow-up. The overall complete abortion rate was 91.7%; 55 women underwent curettage, including 2 women with heavy bleeding, 3 women with ongoing pregnancy and 34 women with incomplete abortion. The incomplete abortion rate was significantly greater in women with persistent bleeding lasting 21 days than in women with persistent bleeding lasting 14 days (p<.001), and the overall sensitivity and specificity of vaginal bleeding interval (21 days) were 97.1% and 75%, respectively. The incomplete abortion rate was also greater in women whose serum beta-hCG was >or=500 IU/L than in women whose serum beta-hCG was <500 IU/L (p<.001), and the overall sensitivity and specificity of serum beta-hCG (>or=500 IU/L) were 97.1% and 62.5%, respectively. Moreover, the incomplete abortion rate was greater in women with an endometrial thickness >or=15 mm than in women with an endometrial thickness <15 mm (p<.001), and the overall sensitivity and specificity of endometrial thickness (>or=15 mm) were 94.1% and 75%, respectively. No complication occurred.
The combination of mifepristone and misoprostol was found to be a safe and effective method to terminate early pregnancy in women with a previous cesarean delivery. If a woman with a prior uterine incision experienced vaginal bleeding intervals >or=21 days and/or had a bilayer endometrial thickness >or=15 mm and/or serum beta-hCG >or=500 IU/L after a medical abortion, then she should undergo curettage.
在许多国家，终止妊娠是计划生育服务中一种重要且必要的后备方法。米非司酮和米索前列醇联合使用是替代早期妊娠子宫排空术的广泛应用方法；然而，关于有子宫切口的妇女药物流产的报道很少，很少有研究描述刮宫术作为该程序的一部分和干预的指征。在先前的子宫切口处刮宫术会增加手术并发症的风险。本研究旨在探讨药物流产后阴道出血间隔、常规超声扫描和血清β-HCG 检测是否能准确识别需要刮宫的有子宫瘢痕的妇女。
668 名有子宫瘢痕且妊娠时间不超过 49 天的妇女接受了米非司酮和米索前列醇药物流产。每位妇女连续 2 天分别在早上和晚上口服 50mg 和 25mg 米非司酮，第 3 天口服 600μg 米索前列醇。
668 名妇女中，有 6 名（0.9%）失访。总体完全流产率为 91.7%；55 名妇女接受了刮宫术，其中 2 名妇女出血量大，3 名妇女妊娠持续，34 名妇女流产不完全。持续出血 21 天的妇女流产不完全发生率明显高于持续出血 14 天的妇女（p<.001），阴道出血间隔（21 天）的整体灵敏度和特异性分别为 97.1%和 75%。血清β-HCG >or=500IU/L 的妇女流产不完全发生率也高于血清β-HCG <500IU/L 的妇女（p<.001），血清β-HCG >or=500IU/L 的整体灵敏度和特异性分别为 97.1%和 62.5%。此外，子宫内膜厚度 >or=15mm 的妇女流产不完全发生率高于子宫内膜厚度 <15mm 的妇女（p<.001），子宫内膜厚度 >or=15mm 的整体灵敏度和特异性分别为 94.1%和 75%。未发生并发症。
米非司酮和米索前列醇联合使用是一种安全有效的方法，可用于有剖宫产史的妇女终止早期妊娠。如果有子宫切口的妇女药物流产后阴道出血间隔 >or=21 天，且/或经阴道超声检查双层子宫内膜厚度 >or=15mm，和/或血清β-HCG >or=500IU/L，则应行刮宫术。
