NPFPC Key Laboratory of Contraceptives and Devices Shanghai Institute of Planned Parenthood Research, Shanghai, China.
Eur J Obstet Gynecol Reprod Biol. 2011 Dec;159(2):247-54. doi: 10.1016/j.ejogrb.2011.06.034. Epub 2011 Jul 8.
Medical regimens using mifepristone in combination with prostaglandins have been widely available for women undergoing termination of pregnancy (TOP) at 10-16 weeks' gestation in China. We undertook a systematic review to compare different regimens of mifepristone with prostaglandins for TOP at 10-16 weeks' gestation.
We searched multiple electronic databases for English and Chinese language reports (1990-2007) including MEDLINE, the Cochrane Library and the Chinese Biomedical Literature Database. Included were trials comparing mifepristone with prostaglandins (misoprostol, gemeprost or carboprost (PG05)) to each other for women at 10-16 weeks' gestation. Outcomes were successful abortion rates, induction-to-expulsion time, blood loss and side effects. Data were processed with RevMan 5 software.
Nineteen trials comparing mifepristone with prostaglandin (misoprostol and PG05) were found of which 14 contributed to meta-analyses (4206 women). The quality of reports was poor. The effectiveness of vaginal mifepristone/misoprostol was super than mifepristone/PG05 (RR 1.14, 95%CI 1.05-1.22) as was induction-to-expulsion time, blood loss and side effects. When comparing misoprostol/mifepristone 150mg to misoprostol/mifepristone 200mg, no difference in TOP success rates were found (RR 0.98, 95%CI 0.96-1.01). Misoprostol vaginally compared to orally significantly increased the TOP success rate (RR 1.12, 95%CI 1.01-1.24). Gastrointestinal symptoms and fever occurred more often in misoprostol oral group (RR 1.67, 95%CI 1.46-1.91).
Medical regimens of mifepristone/prostaglandins were effective and safe for TOP at 10-16 weeks' gestation. Misoprostol was super than PG05, and misoprostol vaginally was found to have better effectiveness than misoprostol orally. Further research should evaluate the relative effectiveness of medical methods compared to surgery.
米非司酮联合前列腺素用于终止妊娠（TOP）在我国已广泛应用于 10-16 周妊娠的妇女。我们进行了一项系统评价，比较了米非司酮联合前列腺素在 10-16 周妊娠时用于 TOP 的不同方案。
我们检索了多个电子数据库的英文和中文报告（1990-2007 年），包括 MEDLINE、Cochrane 图书馆和中国生物医学文献数据库。纳入的试验比较了米非司酮与前列腺素（米索前列醇、吉美前列醇或卡前列甲酯（PG05））在 10-16 周妊娠的妇女中的疗效。结局指标为流产成功率、诱导至排出时间、出血量和不良反应。采用 RevMan 5 软件进行数据分析。
共检索到 19 项比较米非司酮联合前列腺素（米索前列醇和 PG05）的试验，其中 14 项试验纳入meta 分析（4206 例妇女）。报告的质量较差。阴道米非司酮/米索前列醇的疗效优于米非司酮/PG05（RR 1.14，95%CI 1.05-1.22），诱导至排出时间、出血量和不良反应也更少。比较米索前列醇/米非司酮 150mg 与米索前列醇/米非司酮 200mg，TOP 成功率无差异（RR 0.98，95%CI 0.96-1.01）。与口服相比，阴道给予米索前列醇显著提高了 TOP 成功率（RR 1.12，95%CI 1.01-1.24）。口服米索前列醇组胃肠道症状和发热发生率更高（RR 1.67，95%CI 1.46-1.91）。
米非司酮/前列腺素方案用于 10-16 周妊娠的 TOP 是有效和安全的。米索前列醇优于 PG05，阴道给予米索前列醇的疗效优于口服。应进一步评估与手术相比，药物方法的相对有效性。
