Jain J K, Mishell D R
Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles 90033.
N Engl J Med. 1994 Aug 4;331(5):290-3. doi: 10.1056/NEJM199408043310502.
The most widely used medical method of terminating second-trimester pregnancy is the intravaginal administration of prostaglandin E2 (dinoprostone [PGE2]). This treatment is highly effective but is associated with severe gastrointestinal side effects and hyperpyrexia.
We conducted a prospective, randomized trial comparing the efficacy and safety of misoprostol, a prostaglandin E1 analogue (200 micrograms intravaginally every 12 hours), with the efficacy and safety of PGE2 (20 mg intravaginally every 3 hours). The study population included 55 pregnant women between 12 and 22 weeks' gestation who were undergoing termination of pregnancy for either intrauterine fetal death (37 women) or medical or genetic reasons (18 women).
The rate of successful abortions within 24 hours was 81 percent (22 of 27 women) with PGE2 and 89 percent (25 of 28 women) with misoprostol (P = 0.47). All the women who received misoprostol had successful abortions within 38 hours. Among those who had an abortion within 24 hours, the mean interval from treatment to abortion was similar in both groups (10.6 hours with PGE2 and 12.0 hours with misoprostol, P = 0.33). The rate of complete abortion, defined as the passage of the fetus and the placenta simultaneously, was 32 percent for PGE2 and 43 percent for misoprostol (P = 0.56). Certain side effects were more frequent in the women receiving PGE2 than in those receiving misoprostol: pyrexia (63 percent vs. 11 percent; P < 0.001), uterine pain (67 percent vs. 57 percent, P = 0.58), vomiting (33 percent vs. 4 percent, P = 0.005), and diarrhea (30 percent vs. 4 percent, P = 0.012). The average cost per treatment was $315.30 for PGE2, as compared with $0.97 for misoprostol.
Misoprostol is at least as effective as PGE2 for the termination of second-trimester pregnancy involving either a dead or a living fetus, but it is less costly, is easier to administer, and is associated with fewer adverse effects.
孕中期终止妊娠最常用的医学方法是阴道内给予前列腺素E2（地诺前列酮[PGE2]）。这种治疗方法非常有效，但会伴有严重的胃肠道副作用和高热。
我们进行了一项前瞻性随机试验，比较了前列腺素E1类似物米索前列醇（每12小时阴道内给予200微克）与PGE2（每3小时阴道内给予20毫克）的有效性和安全性。研究人群包括55名妊娠12至22周的孕妇，她们因宫内胎儿死亡（37名妇女）或医学或遗传原因（18名妇女）而接受终止妊娠。
PGE2组24小时内成功流产率为81%（27名妇女中的22名），米索前列醇组为89%（28名妇女中的25名）（P = 0.47）。所有接受米索前列醇治疗的妇女在38小时内均成功流产。在24小时内流产的妇女中，两组从治疗到流产的平均间隔相似（PGE2组为10.6小时，米索前列醇组为12.0小时，P = 0.33）。完全流产率（定义为胎儿和胎盘同时排出），PGE2组为32%，米索前列醇组为43%（P = 0.56）。接受PGE2治疗的妇女中某些副作用比接受米索前列醇治疗的妇女更常见：发热（63%对11%；P < 0.001）、子宫疼痛（67%对57%，P = 0.58）、呕吐（33%对4%，P = 0.005）和腹泻（30%对4%，P = 0.012）。PGE2每次治疗的平均费用为315.30美元，而米索前列醇为0.97美元。
米索前列醇在终止涉及死胎或活胎的孕中期妊娠方面至少与PGE2一样有效，但成本更低，给药更容易，且不良反应更少。
