Martin C W, Brown A H, Baird D T
Department of Obstetrics and Gynaecology, University of Edinburgh, Scotland.
Contraception. 1998 Aug;58(2):99-103. doi: 10.1016/s0010-7824(98)00072-9.
Although a combination of mifepristone and a prostaglandin is a safe, acceptable alternative to vacuum aspiration for inducing abortion in early pregnancy, the longer period of vaginal bleeding after medical abortion is a disadvantage. The present study investigated whether administration of the combined oral contraceptive pill (COC) or the injection of methotrexate at the time of abortion would shorten the period of vaginal bleeding after medical abortion. After having a medical abortion induced with mifepristone (200 mg) and 0.5 mg gemeprost pessary, 80 women were randomized to four groups of 20 women each; Group A, COC; Group B, control; Group C, 50 mg/m2 methotrexate; and Group D, placebo injection. There was no significant difference in the duration of bleeding between Groups A and B (median 14 and 17 days) or between Groups C and D (18 and 15 days), or in the amount of bleeding (4 days of heavy bleeding in each group). The first period occurred sooner in Group A who took the COC (median/range: 25/15-54 control group versus 32/16-46 days, p < 0.04). The administration of methotrexate was associated with a temporary elevation in liver enzyme concentration in one woman. It is concluded that women who wish to use COC can start immediately after medical abortion. Addition of methotrexate after abortion has no significant beneficial effect on patterns of bleeding and cannot be recommended.
虽然米非司酮和前列腺素联合使用是早期妊娠人工流产时一种安全、可接受的替代真空吸引术的方法，但药物流产后阴道出血时间较长是一个缺点。本研究调查了流产时服用复方口服避孕药（COC）或注射甲氨蝶呤是否会缩短药物流产后的阴道出血时间。在用米非司酮（200mg）和0.5mg吉美前列素阴道栓进行药物流产后，80名妇女被随机分为四组，每组20名妇女；A组，服用COC；B组，对照组；C组，50mg/m²甲氨蝶呤；D组，注射安慰剂。A组和B组之间（中位数分别为14天和17天）、C组和D组之间（分别为18天和15天）的出血持续时间以及出血量（每组均为4天大量出血）均无显著差异。服用COC的A组月经初潮出现得更早（中位数/范围：对照组为25/15 - 54天，A组为32/16 - 46天，p < 0.04）。有一名妇女注射甲氨蝶呤后出现肝酶浓度暂时升高。结论是，希望使用COC的妇女在药物流产后可立即开始服用。流产后加用甲氨蝶呤对出血模式无显著有益影响，不建议使用。
