Division of Obstetrics and Gynaecology, Department of Women's and Children's Health, Karolinska Institutet/Karolinska University Hospital, 171 76 Stockholm, Sweden.
Hum Reprod. 2010 May;25(5):1153-7. doi: 10.1093/humrep/deq037. Epub 2010 Feb 19.
Home use of misoprostol for termination of pregnancy is still controversial in many countries. Acceptability of home use of misoprostol has been investigated in pregnancies below 49 days gestation. In this study, we aimed to assess efficacy, feasibility and acceptability of home use of vaginal misoprostol for medical termination of pregnancy at 50-63 days compared with gestation of below 50 days among women who chose to administer misoprostol at home.
In this prospective study, mifepristone 200 mg was given in hospital under nursing supervision in the university hospital outpatient family planning clinic. Women self-administered misoprostol 800 microg vaginally 36-48 h later at home. Follow-up was 2 weeks later. Women with gestation of 50-63 days on the day of mifepristone administration were compared with women with gestation of below 50 days. Efficacy and feasibility were assessed by review of patient records and questionnaires. Acceptability was assessed using questionnaires where women reported on future choice of abortion method were they to have another abortion.
Among the 2992 women who had a medical abortion during the study period, 395 women chose to administer misoprostol at home and were included in the study. A total of 203 women were below 50 days gestation and 192 were between 50 and 63 days gestation. Efficacy was 97.5% and did not differ between the groups. Surgical intervention was needed in 10 patients, of whom four were in the lower gestational band (P = 0.36). No serious adverse events or blood transfusions were reported. Preference for home administration of misoprostol, were they to have another induced abortion in the future, was high, 92.3 and 86.6% respectively, and did not differ between the groups (P = 0.097). Need for extra analgesia significantly influenced women's experiences in both gestational groups.
Medical abortion with mifepristone followed by home administration of vaginal misoprostol is safe and highly acceptable also to women with gestational length of 50-63 days as compared with shorter gestations. Efficacy, acceptability and preference for future place of administration of misoprostol, were women to have another abortion, did not differ between women with gestation below 50 days or between 50 and 63 days.
在家中使用米索前列醇终止妊娠在许多国家仍存在争议。在妊娠 49 天以下时，已经对在家中使用米索前列醇的可接受性进行了研究。在这项研究中，我们旨在评估在选择在家中使用米索前列醇的女性中，与妊娠 50 天以下的妊娠相比，50-63 天妊娠使用阴道米索前列醇进行药物流产的疗效、可行性和可接受性。
在这项前瞻性研究中，米非司酮 200mg 在大学医院门诊计划生育诊所的护士监督下在医院内给予。女性在服药后 36-48 小时在家中自行阴道给予米索前列醇 800μg。2 周后进行随访。在给予米非司酮的当天，将妊娠 50-63 天的女性与妊娠 50 天以下的女性进行比较。通过回顾病历和问卷调查评估疗效和可行性。通过问卷调查评估可接受性，询问女性如果再次进行流产，她们将来会选择哪种流产方法。
在研究期间进行药物流产的 2992 名女性中，有 395 名选择在家中使用米索前列醇，并纳入研究。共有 203 名女性妊娠不足 50 天，192 名女性妊娠 50-63 天。疗效为 97.5%，两组之间无差异。需要手术干预的患者有 10 例，其中 4 例处于较低的妊娠组（P=0.36）。没有报告严重不良事件或输血。如果再次进行人工流产，92.3%和 86.6%的女性分别非常愿意在家中使用米索前列醇，两组之间没有差异（P=0.097）。需要额外的镇痛会显著影响两组女性的体验。
米非司酮联合阴道米索前列醇药物流产安全且高度可接受，即使对于妊娠 50-63 天的女性也是如此，与妊娠较短的女性相比。疗效、可接受性和对未来米索前列醇给药地点的偏好，如果女性再次流产，在妊娠不足 50 天或 50-63 天的女性之间没有差异。
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