Shimels Tariku, Getnet Melsew, Shafie Mensur, Belay Lemi
Research Directorate, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Department of Pharmacology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Front Glob Womens Health. 2023 Mar 6;4:1112392. doi: 10.3389/fgwh.2023.1112392. eCollection 2023.
To compare mifepristone plus a misoprostol-combined regimen with misoprostol alone in the medical abortion of first trimester pregnancy.
An internet-based search of available literature was performed using text words contained in titles and abstracts. PubMed/Medline, Cochrane CENTRAL, EMBASE, and Google scholar were used to locate English-based articles published until December 2021. Studies fulfilling the inclusion criteria were selected, appraised, and assessed for methodological quality. The included studies were pooled for meta-analysis, and the results were presented in risk ratio at a 95% confidence interval.
Nine studies comprising 2,052 participants (1,035 intervention and 1,017 controls) were considered. Primary endpoints were complete expulsion, incomplete expulsion, missed abortion, and ongoing pregnancy. The intervention was found to more likely induce complete expulsion irrespective of gestational age (RR: 1.19; 95% CI: 1.14-1.25). The administration of misoprostol 800 mcg after 24 h of mifepristone pre-treatment in the intervention group more likely induced complete expulsion (RR: 1.23; 95% CI: 1.17-1.30) than after 48 h. The intervention group was also more likely to experience complete expulsion when misoprostol was used either vaginally (RR: 1.16; 95% CI: 1.09-1.17) or buccally (RR: 1.23; 95% CI: 1.16-1.30). The intervention was more effective in the subgroup with a negative foetal heartbeat at reducing incomplete abortion (RR: 0.45; 95% CI: 0.26-0.78) compared with the control group. The intervention more likely reduced both missed abortion (RR: 0.21; 95% CI: 0.08-0.91) and ongoing pregnancy (RR: 0.12; 95% CI: 0.05-0.26). Fever was less likely to be reported (RR: 0.78; 95% CI: 0.12-0.89), whereas the subjective experience of bleeding was more likely to be encountered (RR: 1.31; 95% CI: 1.13-1.53) by the intervention group.
The review strengthened the theory that a combined mifepristone and misoprostol regimen can be an effective medical management for inducing abortions during first trimester pregnancy in all contexts. Specifically, there is a high-level certainty of evidence on complete expulsion during the early stage and its ability to reduce both missed and ongoing pregnancies.
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019134213, identifier CRD42019134213.
比较米非司酮加米索前列醇联合方案与单用米索前列醇用于早期妊娠药物流产的效果。
利用标题和摘要中包含的文本词对现有文献进行基于互联网的检索。使用PubMed/Medline、Cochrane CENTRAL、EMBASE和谷歌学术搜索截至2021年12月发表的英文文章。选择符合纳入标准的研究，对其方法学质量进行评估。将纳入的研究进行汇总以进行荟萃分析，并以95%置信区间的风险比呈现结果。
共纳入9项研究，涉及2052名参与者（1035名干预组和1017名对照组）。主要终点为完全排出、排出不全、稽留流产和持续妊娠。结果发现，无论孕周如何，干预组更有可能诱导完全排出（风险比：1.19；95%置信区间：1.14 - 1.25）。干预组在米非司酮预处理24小时后给予800微克米索前列醇比48小时后更有可能诱导完全排出（风险比：1.23；95%置信区间：1.17 - 1.30）。当经阴道使用米索前列醇（风险比：1.16；95%置信区间：1.09 - 1.17）或经口腔使用米索前列醇（风险比：1.23；95%置信区间：1.16 - 1.30）时，干预组也更有可能实现完全排出。与对照组相比，干预组在胎儿心跳为阴性的亚组中减少排出不全更有效（风险比：0.45；95%置信区间：0.26 - 0.78）。干预组更有可能减少稽留流产（风险比：0.21；95%置信区间：0.08 - 0.91）和持续妊娠（风险比：0.12；95%置信区间：0.05 - 0.26）。干预组报告发热的可能性较小（风险比：0.78；95%置信区间：0.12 - 0.89），而出血的主观感受更有可能出现（风险比：1.31；95%置信区间：1.13 - 1.53）。
该综述强化了以下理论，即米非司酮和米索前列醇联合方案在所有情况下均可作为早期妊娠引产的有效药物治疗方法。具体而言，在早期完全排出及其减少稽留流产和持续妊娠的能力方面，有高水平的确凿证据。
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019134213，标识符CRD42019134213 。
