Ipas, P.O Box 9990, Chapel Hill, NC 27701.
Ipas, P.O Box 9990, Chapel Hill, NC 27701.
Contraception. 2019 Feb;99(2):77-86. doi: 10.1016/j.contraception.2018.11.002. Epub 2018 Nov 13.
To describe the efficacy, safety, and acceptability of medical abortion in the late first trimester.
We searched PubMed and Cochrane databases for articles in any language that examined the success of medical abortion at gestational ages (>63 to≤84 days gestation). We sought articles that compared: medical abortion with surgical abortion at this gestational age, combination mifepristone and misoprostol and/or misoprostol alone); different dosages of misoprostol; different routes of misoprostol administration; frequency of dosing; and location of medical abortion (in health care facility vs. outpatient management). Our primary outcome was complete abortion. Data was independently abstracted by two authors, graded for evidence quality, and assessed for risk of bias.
The search strategy returned 3384 articles, nine of which met inclusion criteria. Medical abortion, as compared with surgical abortion, was effective in the late first trimester (94.6% versus 97.9% complete abortion). A combined regimen of mifepristone and misoprostol was significantly more effective than misoprostol alone (90.4 versus 81.6% complete abortion). Complete abortion rates for all regimens investigated ranged from 78.6% to 94.6%. Success rates were higher with repeat dosing of misoprostol both in combination regimens and alone, and with vaginal compared with oral administration for repeat dosing.
A limited body of evidence indicates a range of efficacy of medical abortion in the late first trimester and highlights the need for well-designed trials in this gestational age range.
This review highlights the need for research focused on the late first trimester to strengthen the body of evidence. The available evidence is limited but offers reassurance that adverse events are rare for later first trimester abortion. Importantly, new research demonstrates that efficacy remains unchanged in the 10th gestational week regardless of whether the medication is taken in a facility or at a woman's home.
描述在妊娠早期晚期进行药物流产的疗效、安全性和可接受性。
我们在任何语言的文献数据库中搜索了关于在此孕龄（>63 至≤84 天妊娠）下药物流产成功率的文章。我们寻找了比较以下内容的文章：在此孕龄下药物流产与手术流产的比较、米非司酮联合米索前列醇和/或单独使用米索前列醇、米索前列醇不同剂量、米索前列醇不同给药途径、给药频率以及药物流产的地点（在医疗机构与门诊管理）。我们的主要结局是完全流产。由两名作者独立提取数据、对证据质量进行分级，并评估偏倚风险。
搜索策略共返回 3384 篇文章，其中 9 篇符合纳入标准。与手术流产相比，药物流产在妊娠早期晚期是有效的（完全流产率分别为 94.6%和 97.9%）。米非司酮联合米索前列醇方案明显比单独使用米索前列醇更有效（完全流产率分别为 90.4%和 81.6%）。所有研究方案的完全流产率在 78.6%至 94.6%之间。米索前列醇重复剂量无论是联合方案还是单独使用，阴道给药还是口服给药，效果都更好。
有限的证据表明，在妊娠早期晚期，药物流产的疗效范围不同，这突出表明需要在这一孕龄范围内进行精心设计的试验。
本综述强调了需要专注于妊娠早期晚期的研究，以加强证据基础。现有证据有限，但令人安心的是，晚期妊娠流产的不良事件罕见。重要的是，新的研究表明，无论药物是在医疗机构还是在女性家中服用，在第 10 孕周，疗效都保持不变。
