Henkel Andrea, Lerma Klaira, Blumenthal Paul D, Shaw Kate A
Division of Family Planning Services & Research, Department of Obstetrics & Gynecology, Stanford University, Stanford, CA, USA.
Division of Family Planning Services & Research, Department of Obstetrics & Gynecology, Stanford University, Stanford, CA, USA.
Contraception. 2020 Nov;102(5):327-331. doi: 10.1016/j.contraception.2020.06.009. Epub 2020 Jun 25.
To assess shorter mifepristone-misoprostol intervals compared to current guidelines for second trimester medical abortion on total abortion time (mifepristone to fetal expulsion) and induction time (first misoprostol to fetal expulsion).
This retrospective cohort study included women who elected for a second trimester medical abortion with mifepristone and misoprostol at an academic tertiary medical center in the United States from January 2008 to June 2018. We abstracted times of mifepristone administration, first dose of misoprostol, and fetal expulsion from the medical record. We assessed outcomes based on the shorter intervals <12 h and 12 to 24 h compared to the guideline mifepristone-misoprostol interval (24-48 h).
The study population included eighty-nine women, 47, 28, and 14 women in the <12 h, 12 24 h, guideline (24-48 h) groups, respectively. The cohort had a median gestational age of 22 weeks (range: 15-27) and parity of 1 (range: 0-5) with no differences observed between groups. Total abortion times were 20.7 h (range: 3.7-46.9), 30.6 h (16.7-48.0), and 42.8 h (32.7-62.6), respectively (p < 0.001). Induction times were 12.9 h (range: 1.2-36.6), 11.7 h (2.0-35.2), and 9.3 h (5.3-16.5), respectively. Fetal expulsion within 12 h of first misoprostol dose occurred in 22 (47%), 14 (50%), and 9 (64%), respectively (p = 0.52).
Shorter mifepristone-misoprostol intervals (less than 24 h) significantly decrease the total abortion time while maintaining a clinically similar induction time.
Shortening the mifepristone-misoprostol interval in second trimester medical abortion significantly decreases the total abortion time which may be preferable to some women or health systems.
评估与当前中期妊娠药物流产指南相比，缩短米非司酮-米索前列醇间隔时间对总流产时间（从米非司酮给药至胎儿排出）和引产时间（从首次米索前列醇给药至胎儿排出）的影响。
这项回顾性队列研究纳入了2008年1月至2018年6月在美国一家学术性三级医疗中心选择使用米非司酮和米索前列醇进行中期妊娠药物流产的女性。我们从病历中提取了米非司酮给药时间、首次米索前列醇给药时间和胎儿排出时间。我们根据与指南中米非司酮-米索前列醇间隔时间（24 - 48小时）相比更短的间隔时间<12小时和12至24小时来评估结局。
研究人群包括89名女性，<12小时组、12 - 24小时组、指南组（24 - 48小时）分别有47名、28名和14名女性。该队列的中位孕周为22周（范围：15 - 27周），产次为1（范围：0 - 5），各组间未观察到差异。总流产时间分别为20.7小时（范围：3.7 - 46.9小时）、30.6小时（16.7 - 48.0小时）和42.8小时（32.7 - 62.6小时）（p < 0.001）。引产时间分别为12.9小时（范围：1.2 - 36.6小时）、11.7小时（2.0 - 35.2小时）和9.3小时（5.3 - 16.5小时）。首次米索前列醇给药后12小时内胎儿排出的情况分别发生在22例（47%）、14例（50%）和9例（64%）（p = 0.52）。
缩短米非司酮-米索前列醇间隔时间（小于24小时）可显著缩短总流产时间，同时维持临床相似的引产时间。
在中期妊娠药物流产中缩短米非司酮-米索前列醇间隔时间可显著缩短总流产时间，这对一些女性或卫生系统可能更有利。
