Barghazan Saeed Husseini, Hadian Mohamad, Rezapour Aziz, Nassiri Setare
Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
J Educ Health Promot. 2023 Apr 28;12:132. doi: 10.4103/jehp.jehp_582_22. eCollection 2023.
The surgical and medical options for management of pregnancy termination procedures are acceptable in practice but differ in clinical efficacy, costs, and patient experiences, and deciding what the best method is not clear always. This study aimed to compare clinical efficacy, outcomes, and patient acceptance of dilatation and curettage (D and C) versus medical abortion using misoprostol for first trimester of gestation in Iranian context.
A prospective, multicenter, quasi-experimental research conducted from July 2021 to January 2022. The primary outcomes were the rate of composite complications or complete abortion. Data were analyzed with SPSS 18 using descriptive statistics, independent t-test, analysis of variance and non-parametric tests. Secondary outcomes were quality of life using EQ5D questionnaire, estimated blood loss, pelvic infection, pain level, hospital stay, and acceptability of intervention and relative risk as the effect size.
Finally, 168 patients were included in this study. The composite complication rate among medical abortion patients is significantly more than that of surgical abortion patients (39.3% vs. 4.76%). The relative risk calculated 8.25 (3.05-22.26 CI). Medical abortion patients have experienced higher levels of ongoing bleeding, pain, and symptoms of pelvic infection. The higher level of acceptance has been reported by surgical group patients in comparison to the medical group patients (85.7% vs. 59.5%). Quality of life scores for surgical and medical group estimated 0.6605 and 0.5419, respectively.
Surgical method of abortion using D and C is a very safe and highly successful option in comparison to the medical method using misoprostol alone and is associated with better clinical outcomes, acceptance, and quality of life in first trimester of pregnancy among Iranian women.
在实际操作中，终止妊娠手术和药物治疗的选择都是可行的，但在临床疗效、成本和患者体验方面存在差异，而且确定哪种方法是最佳方法往往并不明确。本研究旨在比较在伊朗背景下，妊娠早期使用米索前列醇进行药物流产与刮宫术（D和C）的临床疗效、结局及患者接受度。
2021年7月至2022年1月进行了一项前瞻性、多中心、准实验研究。主要结局是复合并发症发生率或完全流产率。使用SPSS 18对数据进行描述性统计、独立t检验、方差分析和非参数检验。次要结局是使用EQ5D问卷评估的生活质量、估计失血量、盆腔感染、疼痛程度、住院时间、干预措施的可接受性以及作为效应大小的相对风险。
最终，本研究纳入了168例患者。药物流产患者的复合并发症发生率显著高于手术流产患者（39.3%对4.76%）。计算得出的相对风险为8.25（95%置信区间为3.05 - 22.26）。药物流产患者出现持续出血、疼痛和盆腔感染症状的水平更高。与药物流产组患者相比，手术组患者的接受度更高（85.7%对59.5%）。手术组和药物流产组的生活质量评分分别为0.6605和0.5419。
与单独使用米索前列醇的药物流产方法相比，采用刮宫术的手术流产方法非常安全且成功率很高，并且在伊朗女性妊娠早期与更好的临床结局、接受度和生活质量相关。
