Costa S H, Vessey M P
Department of Epidemiology and Quantitative Methods, National School of Public Health Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
Lancet. 1993 May 15;341(8855):1258-61. doi: 10.1016/0140-6736(93)91156-g.
We report on the determinants and consequences of induced abortion among 803 women admitted to hospital with abortion complications in Rio de Janeiro, Brazil, in 1991. 458 (57%) women reported using misoprostol to induce abortion, 74% in the first 4 months of pregnancy. Doses of 200-16,800 micrograms were reported, with a median of 800 micrograms. 65% of the women took the drug orally, 29% used a combination of oral and vaginal routes, and 6% administered it intravaginally. Vaginal bleeding and uterine cramps were the commonest reasons for seeking hospital care. Only 8% of women reported gastrointestinal side-effects. Misoprostol induced vaginal bleeding within 12 h of administration in 52% of the women, but 16% waited 10 days or more for onset of bleeding. 4% were admitted to hospital with complete abortion. The likelihood of bleeding starting within 12 h increased with duration of gestation and it was greater when the drug was used both orally and intravaginally. A significantly smaller proportion of women taking misoprostol than of those who induced abortion by catheter insertion presented signs of infection or physical injuries or required blood transfusion (< 0.0005). Among 803 women interviewed at delivery as controls, 6% had taken misoprostol but abortion had not ensued. Misoprostol has an important role as an abortifacient among the women studied.
我们报告了1991年在巴西里约热内卢因流产并发症住院的803名妇女中人工流产的决定因素及后果。458名（57%）妇女报告使用米索前列醇进行人工流产，其中74%在妊娠的前4个月使用。报告的剂量为200 - 16800微克，中位数为800微克。65%的妇女口服该药物，29%采用口服和阴道联合用药途径，6%经阴道给药。阴道出血和子宫绞痛是寻求住院治疗的最常见原因。只有8%的妇女报告有胃肠道副作用。米索前列醇在给药后12小时内导致52%的妇女出现阴道出血，但16%的妇女等待10天或更长时间才出现出血。4%的妇女因完全流产入院。出血在12小时内开始的可能性随妊娠时间延长而增加，且当药物经口服和阴道联合使用时更大。与通过插入导管进行人工流产的妇女相比，服用米索前列醇的妇女出现感染迹象、身体损伤或需要输血的比例显著更小（<0.0005）。在803名作为对照在分娩时接受访谈的妇女中，6%服用了米索前列醇但未发生流产。在所研究的妇女中，米索前列醇作为堕胎药发挥着重要作用。
