Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
Chalmers Centre for Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK.
BMJ Sex Reprod Health. 2023 Apr;49(2):97-104. doi: 10.1136/bmjsrh-2022-201677. Epub 2022 Nov 9.
Abortion providers may be reluctant to commence abortion before ultrasound evidence of intrauterine pregnancy (IUP) due to concerns of missed ectopic pregnancy. In 2017, very early medical abortion (VEMA) was introduced at an abortion service in Edinburgh, UK. Following ultrasound, patients without confirmed IUP, and without symptoms or risk factors for ectopic pregnancy, could commence treatment immediately after baseline serum-human chorionic gonadotrophin (hCG) measurement, and return for follow-up serum-hCG a week later to determine treatment success (≥80% decline from baseline). This study aimed to compare clinical outcomes between two pathways: (1) VEMA; and (2) standard-of-care delayed treatment where treatment is only commenced on IUP confirmation by serial serum-hCG monitoring and/or repeat ultrasound.
A retrospective database review was conducted of VEMA eligible patients from July 2017 to December 2021. Study groups were determined by patient preference. Records were searched for abortion outcomes, duration of care, number of appointments (clinic visits, ultrasounds, serum-hCG) and clinical data entries.
Of 181 patients included, 77 (43%) chose VEMA and 104 (57%) chose delayed treatment. 11/181 (6.1%) were lost to follow-up. Cohort ectopic prevalence was 4.4% and was not statistically different between groups (2.6% vs 5.8%, VEMA vs delayed group, respectively, p=0.305), as with complete abortion rates (93.3% vs 97.6%, p=0.256). All VEMA group ectopics were detected on the seventh day (from initial visit) while time-to-diagnosis for delayed group ectopics ranged from 7 days to 3 weeks. VEMA patients had significantly reduced duration of care (12 vs 21 days, p<0.001), number of visits (2 vs 3, p<0.001), ultrasounds (1 vs 2, p<0.001) and data entries (6 vs 9, p<0.001).
VEMA is safe, effective and reduces the duration of care, number of appointments and clinical administrative time. It should be offered to medically eligible patients.
由于担心错过宫外孕，堕胎提供者可能不愿意在超声证据显示宫内妊娠 (IUP) 之前开始堕胎。2017 年，英国爱丁堡的一家堕胎服务机构引入了早期药物流产 (VEMA)。在进行超声检查后，对于没有确认 IUP 的患者，且没有宫外孕的症状或危险因素，可以在基线血清人绒毛膜促性腺激素 (hCG) 测量后立即开始治疗，并在一周后返回进行随访血清 hCG，以确定治疗是否成功（与基线相比下降≥80%）。本研究旨在比较两种途径的临床结果：(1) VEMA；(2) 标准护理延迟治疗，仅在通过连续血清 hCG 监测和/或重复超声确认 IUP 后开始治疗。
对 2017 年 7 月至 2021 年 12 月期间符合 VEMA 条件的患者进行了回顾性数据库审查。根据患者的偏好确定研究组。检索记录以获取堕胎结局、护理持续时间、就诊次数（就诊、超声、血清 hCG）和临床数据条目。
在 181 名患者中，77 名（43%）选择了 VEMA，104 名（57%）选择了延迟治疗。181 名患者中有 11 名（6.1%）失访。队列宫外孕的患病率为 4.4%，两组之间无统计学差异（分别为 2.6%和 5.8%，VEMA 组和延迟组，p=0.305），完全流产率也无统计学差异（分别为 93.3%和 97.6%，p=0.256）。所有 VEMA 组宫外孕均在第 7 天（从初次就诊）检测到，而延迟组宫外孕的确诊时间从第 7 天到第 3 周不等。VEMA 患者的护理持续时间明显缩短（12 天 vs 21 天，p<0.001），就诊次数（2 次 vs 3 次，p<0.001）、超声次数（1 次 vs 2 次，p<0.001）和数据条目数（6 次 vs 9 次，p<0.001）均减少。
VEMA 是安全有效的，可缩短护理时间、就诊次数和临床管理时间。应向符合医学条件的患者提供 VEMA。
