即刻与延迟治疗早期流产的随机试验。
Immediate versus delayed medical treatment for first-trimester miscarriage: a randomized trial.
机构信息
EA 2493, Paris Ile de France Ouest School of Medicine, University Versailles Saint-Quentin en Yvelines, Guyancourt, France.
出版信息
Am J Obstet Gynecol. 2012 Mar;206(3):215.e1-6. doi: 10.1016/j.ajog.2011.12.009. Epub 2011 Dec 16.
OBJECTIVE
To compare immediate vs delayed medical treatment for first-trimester miscarriage.
STUDY DESIGN
Randomized open-label trial in a university hospital gynecologic emergency department. Between April 2003 and April 2006, 182 women diagnosed with spontaneous abortion before 14 weeks' gestation were assigned to immediate medical treatment (oral mifepristone, followed 48 hours later by vaginal misoprostol, n = 91) or sequential management (1 week of watchful waiting followed, if necessary, by the above-described medical treatment, n = 91). Vacuum aspiration was performed in case of treatment failure, hemorrhage, pain, infection, or patient request.
RESULTS
Compared with immediate medical treatment, sequential management resulted in twice as many vacuum aspirations overall (43.5% vs 19.1%; P < .001), 4 times as many emergent vacuum aspirations (20% vs 4.5%; P = .001), and twice as many unplanned visits to the emergency department (34.1% vs 16.9%; P = .009).
CONCLUSION
Delaying medical treatment of first-trimester miscarriage increases the rate of unplanned surgical uterine evacuation.
目的
比较早期流产的即刻治疗与延迟治疗。
研究设计
在一所大学医院妇科急诊部门进行的随机、开放标签试验。2003 年 4 月至 2006 年 4 月期间，182 名被诊断为先兆流产且妊娠 14 周之前的女性被分为即刻治疗组（口服米非司酮，48 小时后阴道给予米索前列醇，n = 91）或序贯治疗组（1 周观察等待，如果需要，采用上述治疗方法，n = 91）。如果治疗失败、出血、疼痛、感染或患者要求，采用真空抽吸术。
结果
与即刻治疗相比，序贯治疗导致整体上需要更多次的真空抽吸术（43.5% vs. 19.1%；P <.001），紧急真空抽吸术增加了 4 倍（20% vs. 4.5%；P =.001），且需要更多次非计划就诊于急诊部门（34.1% vs. 16.9%；P =.009）。
结论
延迟治疗早期流产会增加非计划的子宫排空手术率。
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