Schaff E A, Wortman M, Eisinger S H, Franks P
Department of Family Medicine, University of Rochester, NY, USA.
Obstet Gynecol. 1996 Mar;87(3):450-2. doi: 10.1016/0029-7844(95)00406-8.
To describe the use of methotrexate and misoprostol to induce abortion in pregnancies up to 8 weeks when uterine or cervical anomalies make suction curettage difficult or impossible.
Four consecutive women, 8 weeks pregnant or less and with failed suction curettage, were given methotrexate 50 mg per square meter intramuscularly followed by a misoprostol 800-microgram suppository 72 hours later. A repeat dose of a misoprostol 800-microgram vaginal suppository was administered on day 4 if there was no bleeding, and an additional dose was given if the repeat beta-hCG titer had not decreased by at least 50%. Subjects were followed-up with serum or urine hCG assays. Complete abortion was defined by vaginal bleeding and a negative urine pregnancy test. Subjects completed a daily symptom log and a satisfaction questionnaire when the abortion was complete.
The four women referred after failed suction curettage had the following anatomic problems: a uterus bicornis bicollis, a bicornuate uterus, uterine leiomyomas, and cervical stenosis resulting from previous laser surgery. All subjects had a complete abortion from methotrexate and misoprostol. Mild gastrointestinal side effects were reported by all four subjects: nausea (two subjects), vomiting (two), and diarrhea (two). The satisfaction questionnaire revealed that all subjects agreed with the statements that "Overall, the procedure went well" and "I would recommend this procedure over a surgical abortion."
Methotrexate and misoprostol can induce an abortion when uterine or cervical anomalies make suction curettage difficult or impossible.
描述当子宫或宫颈异常导致吸刮术困难或无法进行时，使用甲氨蝶呤和米索前列醇诱导妊娠8周及以内的流产。
连续4例妊娠8周及以内且吸刮术失败的女性，给予甲氨蝶呤50mg/m²肌肉注射，72小时后给予800μg米索前列醇栓剂。若4天后仍无出血，则给予重复剂量的800μg米索前列醇阴道栓剂；若重复β-hCG滴度未至少下降50%，则再给予一剂。通过血清或尿hCG检测对受试者进行随访。完全流产定义为阴道出血且尿妊娠试验阴性。流产完成后，受试者完成每日症状记录和满意度调查问卷。
4例吸刮术失败后转诊的女性有以下解剖学问题：双子宫双宫颈、双角子宫、子宫平滑肌瘤以及既往激光手术导致的宫颈狭窄。所有受试者均通过甲氨蝶呤和米索前列醇实现了完全流产。4例受试者均报告有轻度胃肠道副作用：恶心（2例）、呕吐（2例）和腹泻（2例）。满意度调查问卷显示，所有受试者均同意“总体而言，手术进展顺利”以及“比起手术流产，我会推荐这个手术”的说法。
当子宫或宫颈异常导致吸刮术困难或无法进行时，甲氨蝶呤和米索前列醇可诱导流产。
