Sharvit Merav, Yagur Yael, Shams Rebecca, Daykan Yair, Klein Zvi, Schonman Ron
Department of Obstetrics and Gynecology, Assuta Ashdod University Hospital, Ashdod, Israel.
Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
Arch Gynecol Obstet. 2023 Nov;308(5):1543-1548. doi: 10.1007/s00404-023-07182-7. Epub 2023 Aug 31.
This study evaluated the differences in treatment outcomes between misoprostol and surgical evacuation for the management of incomplete abortion.
This retrospective cohort study compared patients with a clinical diagnosis of incomplete abortion who underwent surgical or pharmaceutical (misoprostol) intervention, 2014-2017. Demographics, sonographic results, treatment follow-up, and post-intervention data on retained products of conception were retrieved. Women with incomplete abortion who underwent surgical versus pharmaceutical intervention were compared.
Among 589 spontaneous abortions, 198 were included in the study, of which 123 (62.1%) underwent surgical evacuation and 75 (37.9%) pharmaceutical intervention with misoprostol. Baseline characteristics were similar between groups. During 130.8 ± 91.7 days of follow-up, no patient who underwent surgical evacuation had retained products of conception or needed surgical hysteroscopy. Four cases (5.3%) in the misoprostol group had retained products of conception and needed hysteroscopy (p = 0.02). Patients who underwent surgical evacuation had higher hemoglobin levels during follow-up (12.1 mg/dL vs. 11.7 mg/dL, p = 0.05). There were no differences in post-treatment pregnancy rates between groups.
Long-term follow-up after incomplete abortion showed that hemodynamically stable patients treated with misoprostol achieved the desired results in 95% of cases without significant differences in pregnancy intervals compared to surgical management. Further prospective studies with larger sample sizes are required to confirm the outcomes described in this study.
本研究评估米索前列醇与手术清宫治疗不全流产的疗效差异。
这项回顾性队列研究比较了2014年至2017年期间临床诊断为不全流产并接受手术或药物（米索前列醇）干预的患者。收集了人口统计学资料、超声检查结果、治疗随访情况以及干预后关于妊娠物残留的数据。对接受手术与药物干预的不全流产女性进行了比较。
在589例自然流产患者中，198例纳入研究，其中123例（62.1%）接受了手术清宫，75例（37.9%）接受了米索前列醇药物干预。两组的基线特征相似。在130.8±91.7天的随访期间，接受手术清宫的患者均无妊娠物残留或需要进行宫腔镜手术。米索前列醇组有4例（5.3%）出现妊娠物残留并需要进行宫腔镜检查（p = 0.02）。接受手术清宫的患者在随访期间血红蛋白水平较高（12.1mg/dL对11.7mg/dL，p = 0.05）。两组治疗后的妊娠率无差异。
不全流产后的长期随访表明，血流动力学稳定的患者使用米索前列醇治疗，95%的病例取得了预期效果，与手术治疗相比，妊娠间隔无显著差异。需要进一步进行更大样本量的前瞻性研究来证实本研究中描述的结果。
