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早期妊娠丢失药物治疗中米非司酮预治疗的应用
Mifepristone Pretreatment for the Medical Management of Early Pregnancy Loss


Courtney A. Schreiber ... 围产医学和儿科 • 2018.06.07
相关阅读
• 米索前列醇联合后续米非司酮治疗早期妊娠丢失

如何提高稽留流产药物成功率——米非司酮配伍米索前列醇的研究

 

侯磊

首都医科大学附属北京妇产医院产科

 

在早期妊娠流产的处理中,药物流产是吸宫术的替代方法之一,但常规的米索前列醇药流往往以失败而告终。不过,《新英格兰医学杂志》(NEJM)6月7日发表的一项随机对照研究(PreFaiR)结果显示,在米索前列醇治疗前给予米非司酮预处理,能显著提高早期妊娠流产时的胚胎完全排除率1

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摘要


背景

早期妊娠丢失的药物治疗是吸宫术的一种替代方案,但使用米索前列醇的标准药物治疗常导致治疗失败。我们比较了米非司酮预治疗联合后续米索前列醇治疗与单用米索前列醇治疗早期妊娠丢失的疗效和安全性。

 

方法

我们将300例发生无胚胎妊娠或者已证实胚胎死亡或死胎的女性随机分组,分别接受200 mg米非司酮口服给药预治疗联合后续800 μg米索前列醇阴道给药治疗(米非司酮预治疗组),或单独800 μg米索前列醇阴道给药治疗(米索前列醇单独治疗组)。在米索前列醇给药后1~4日,参与者返回研究中心,由对治疗分组不知情的研究者对其进行评估,包括超声检查。对于孕囊未排出的女性,给予期待治疗(expectant management)、第2剂米索前列醇或吸宫术治疗。在随机分组后,我们对所有参与者随访30日。主要结局是在第1次随访前,使用1剂米索前列醇将孕囊排出,并且在治疗后30日内没有其他干预。

 

结果

米非司酮预治疗组148例女性中的124例(83.8%;95%置信区间[CI],76.8~89.3)和米索前列醇单独治疗组149例女性中的100例(67.1%;95% CI,59.0~74.6)使用1剂米索前列醇后孕囊完全排出(相对危险度,1.25;95% CI,1.09~1.43)。与米索前列醇单独治疗组相比,在米非司酮预治疗组中,较少行吸宫术(8.8% vs. 23.5%;相对危险度,0.37;95% CI,0.21~0.68)。米非司酮预治疗组2.0%的女性和米索前列醇单独治疗组0.7%的女性发生了需要输血的出血(P=0.31);每组中有1.3%的女性被诊断为盆腔感染。

 

结论

与米索前列醇单独治疗相比,使用米非司酮预治疗联合后续米索前列醇治疗,妊娠前3个月妊娠丢失获得成功治疗的概率较高(由美国国立儿童健康与人类发育研究所[National Institute of Child Health and Human Development]资助;PreFaiR在ClinicalTrials.gov注册号为NCT02012491)。





作者信息

Courtney A. Schreiber, M.D., M.P.H., Mitchell D. Creinin, M.D., Jessica Atrio, M.D., Sarita Sonalkar, M.D., M.P.H., Sarah J. Ratcliffe, Ph.D., and Kurt T. Barnhart, M.D., M.S.C.E.
From the Pregnancy Early Access Center (PEACE), Division of Family Planning (C.A.S., S.S.), Department of Obstetrics and Gynecology (C.A.S., S.S., K.T.B.), University of Pennsylvania, Philadelphia; the Department of Public Health Sciences, University of Virginia, Charlottesville (S.J.R.); the Department of Obstetrics and Gynecology, University of California, Davis, Sacramento (M.D.C.); and the Department of Obstetrics and Gynecology, Montefiore Hospital and Albert Einstein College of Medicine, Bronx, NY (J.A.). Address reprint requests to Dr. Schreiber at the Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA 19104, or at schreibe@upenn.edu.

 

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