Blum Jennifer, Karki Chanda, Tamang Anand, Shochet Tara, Shrestha Achala, Tuladhar Heera, Karki Aruna, Sharma Jyotsna, Abbas Dina F, Dragoman Monica, Winikoff Beverly
Gynuity Health Projects, USA.
Kathmandu Medical College, Nepal.
Contraception. 2019 Dec;100(6):451-456. doi: 10.1016/j.contraception.2019.08.007. Epub 2019 Sep 3.
To evaluate the safety, acceptability and feasibility of a one-day outpatient medication abortion service at gestations 13-18 weeks.
Open-label prospective study in which participants received mifepristone 200 mg orally to swallow at home or at the clinic followed 24 h later by misoprostol 400 mcg buccally. They presented to the outpatient clinic 24-48 h after mifepristone for misoprostol 400 mcg buccally every three hours (no maximum dose). The primary outcome was successful abortion without transfer to overnight inpatient care. Secondary outcomes included time to abortion from initial misoprostol dose, safety, additional interventions and side effects.
We enrolled 230 women from December 2017 to November 2018. Approximately nine of ten (n = 206, 89.6%) achieved a successful abortion without transfer to overnight care. Twenty-four were transferred to overnight inpatient care; of these 18 were to manage a complication, five for incomplete abortion and two by choice. Among these 24, three women experienced an SAE. The median time to successful abortion from time of the first misoprostol dose was 7.2 h (range: 0.75-92.3), with an average of three misoprostol doses. Most participants expelled the fetus and the placenta at or around the same time; median time between fetal and placental expulsion was 15 minutes (range: 0-4.5 h). Fifteen participants (6.6%) received more than five misoprostol doses and were transferred to inpatient care. Administration of more than five doses of misoprostol was associated with nulliparity. Provision of antibiotics (27.9%, n = 64), manual removal of placenta (15.3%, n = 35), uterotonics (4.4%, n = 10) and surgical interventions (4.4%, n = 10) were also reported. About one in four participants experienced nausea, vomiting and chills; fever was infrequent (2.5%, n = 5).
For gestations 13-18 weeks, an outpatient day process for medication abortion is safe, effective and feasible.
Medication abortion in 13 - 18 weeks need not be limited to inpatient care; nine of ten cases can be managed as an outpatient day service.
评估孕13 - 18周门诊一日药流服务的安全性、可接受性及可行性。
开放标签前瞻性研究，参与者在家或诊所口服200mg米非司酮，24小时后口腔含服400μg米索前列醇。服用米非司酮24 - 48小时后，他们到门诊每三小时口腔含服400μg米索前列醇（无最大剂量限制）。主要结局是药流成功且无需转为过夜住院治疗。次要结局包括从首次服用米索前列醇到流产的时间、安全性、额外干预措施及副作用。
2017年12月至2018年11月，我们招募了230名女性。约十分之九（n = 206，89.6%）药流成功且无需转为过夜治疗。24人转为过夜住院治疗；其中18人是为了处理并发症，5人因流产不全，2人是出于个人选择。在这24人中，3名女性发生了严重不良事件。从首次服用米索前列醇到药流成功的中位时间为7.2小时（范围：0.75 - 92.3小时），平均服用三次米索前列醇。大多数参与者在同一时间或前后排出胎儿和胎盘；胎儿与胎盘排出的中位间隔时间为15分钟（范围：0 - 4.5小时）。15名参与者（6.6%）服用米索前列醇超过五次并被转为住院治疗。服用超过五剂米索前列醇与未生育有关。还报告了使用抗生素（27.9%，n = 64）、人工剥离胎盘（15.3%，n = 35）、宫缩剂（4.4%，n = 10）及手术干预（4.4%，n = 10）的情况。约四分之一的参与者出现恶心、呕吐和寒战；发热情况不常见（2.5%，n = 5）。
对于孕13 - 18周，门诊一日药流流程安全、有效且可行。
孕13 - 18周的药流无需局限于住院治疗；十分之九的病例可作为门诊日间服务处理。
