妊娠21 - 23周时，米索前列醇口腔含服联合海藻棒用于扩张和清宫术前宫颈准备：一项随机对照试验
Buccal misoprostol plus laminaria for cervical preparation before dilation and evacuation at 21-23 weeks of gestation: a randomized controlled trial.
作者信息
Drey Eleanor A, Benson Lyndsey S, Sokoloff Abby, Steinauer Jody E, Roy Geneviève, Jackson Rebecca A
机构信息
Department of Obstetrics, Gynecology, and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, USA.
Department of Obstetrics and Gynecology, University of Montreal, Montréal, Québec, Canada.
出版信息
Contraception. 2014 Apr;89(4):307-13. doi: 10.1016/j.contraception.2013.10.013. Epub 2013 Nov 4.
OBJECTIVE
To describe the effectiveness of buccal misoprostol as an adjunct to laminaria for cervical ripening before later second-trimester abortion by dilation and evacuation (D&E).
METHODS
A randomized, double-blinded, placebo-controlled trial of 196 women undergoing D&E between 21 and 23 weeks of gestation. Subjects had overnight laminaria and 400 mcg buccal misoprostol or placebo 3-4 h before the abortion. We used logarithmic transformation of the primary outcome--D&E procedure duration--to achieve a normal distribution.
RESULTS
Mean D&E duration was 1.7 min shorter with misoprostol (p=.02). The median duration was 9.7 versus 10.4 min in the misoprostol and placebo groups, respectively (p=.09). Cervical dilation was slightly greater with misoprostol (median 75 mm vs. 73 mm, p=.04); however, physicians did not find the misoprostol D&Es easier to complete. Half of subjects reported severe pain after misoprostol vs. 11% with placebo (p<.001).
CONCLUSION
Adjuvant buccal misoprostol results in slightly shorter D&Es at the cost of more side effects.
目的
描述米索前列醇口腔给药作为海藻棒辅助用药在孕中期（妊娠21至23周）扩张刮宫术（D&E）流产前宫颈成熟中的有效性。
方法
一项针对196名妊娠21至23周接受扩张刮宫术妇女的随机、双盲、安慰剂对照试验。受试者术前一晚放置海藻棒，并在流产前3至4小时口服400微克米索前列醇或安慰剂。我们对主要结局指标——扩张刮宫术持续时间进行对数转换以使其呈正态分布。
结果
米索前列醇组的平均扩张刮宫术持续时间缩短了1.7分钟（p = 0.02）。米索前列醇组和安慰剂组的中位持续时间分别为9.7分钟和10.4分钟（p = 0.09）。米索前列醇组宫颈扩张略大（中位值75毫米对73毫米，p = 0.04）；然而，医生并未发现米索前列醇组的扩张刮宫术更容易完成。米索前列醇组有一半受试者报告有剧痛，而安慰剂组为11%（p < 0.001）。
结论
辅助使用口腔米索前列醇可使扩张刮宫术时间略缩短，但代价是副作用增多。
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