Friedman Matan, Mor Liat, Shazar Rotem, Paul Natalie, Kerner Ram, Keidar Ran, Sagiv Ron, Gluck Ohad
Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, and the School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Obstet Gynecol. 2025 Feb 1;145(2):204-209. doi: 10.1097/AOG.0000000000005800. Epub 2024 Dec 5.
To compare the rates of treatment failure in cases of early pregnancy loss between mifepristone-misoprostol and misoprostol only.
This retrospective cohort study included patients who received medical treatment for early pregnancy loss between 2016 and 2023 at a single medical center. Patients returned for a follow-up ultrasonogram after 1 week and were treated again with misoprostol if needed. Finally, they were instructed to obtain an ultrasonogram after menstruation and to return for evaluation in case retained product of conception was suspected. We defined treatment failure as needing any surgical intervention because of retained product of conception, including cases when retained product of conception was diagnosed and treated after menstruation. In May 2022, we changed our protocol for treating early pregnancy loss from misoprostol to mifepristone and misoprostol. We compared the failure rate between patients who received mifepristone-misoprostol and those treated with misoprostol only.
A total of 999 patients were included: 224 in the mifepristone-misoprostol group and 775 in the misoprostol-only group. The rate of treatment failure was significantly lower in the mifepristone-misoprostol group compared with the misoprostol-only group (17.8% vs 25.1%, P =.002). After multivariant analysis was performed, the use of mifepristone and misoprostol was associated with a reduction of 34% in the odds ratio for treatment failure compared with misoprostol alone (adjusted odds ratio 0.661, 95% CI, 0.44-0.97, P =.038). In addition, prior vaginal delivery was associated with a lower risk for treatment failure, and increasing gestational age (according to ultrasonogram) was correlated with a higher risk for treatment failure.
The addition of mifepristone to misoprostol was associated with a significantly lower rate of treatment failure, including late surgical intervention for early pregnancy loss, compared with misoprostol alone.
比较米非司酮 - 米索前列醇与单纯米索前列醇用于早期妊娠流产时的治疗失败率。
这项回顾性队列研究纳入了2016年至2023年在单一医疗中心接受早期妊娠流产药物治疗的患者。患者在1周后返回进行超声复查，如有需要则再次使用米索前列醇治疗。最后，他们被要求在月经后进行超声检查，若怀疑有妊娠物残留则返回进行评估。我们将治疗失败定义为因妊娠物残留而需要任何手术干预，包括月经后诊断并治疗妊娠物残留的情况。2022年5月，我们将早期妊娠流产的治疗方案从单纯使用米索前列醇改为米非司酮 - 米索前列醇。我们比较了接受米非司酮 - 米索前列醇治疗的患者与仅接受米索前列醇治疗的患者的失败率。
共纳入999例患者：米非司酮 - 米索前列醇组224例，单纯米索前列醇组775例。米非司酮 - 米索前列醇组的治疗失败率显著低于单纯米索前列醇组（17.8%对25.1%，P = 0.002）。进行多变量分析后，与单独使用米索前列醇相比，使用米非司酮和米索前列醇使治疗失败的比值比降低了34%（调整后的比值比为0.661，95%可信区间为0.44 - 0.97，P = 0.038）。此外，既往阴道分娩与较低的治疗失败风险相关，而（根据超声检查）孕周增加与较高的治疗失败风险相关。
与单纯使用米索前列醇相比，米非司酮联合米索前列醇治疗早期妊娠流产的治疗失败率显著降低，包括减少了早期妊娠流产的晚期手术干预。
