Clinical effects of mifepristone combined with oxytocin in the treatment of patients with intrauterine residual after artificial termination of pregnancy

Abstract

Objective To investigate the clinical effects of mifepristone combined with oxytocin in treatment of intrauterine residual after artificial termination of pregnancy (ATP). Methods From July 1, 2016 to October 31, 2017, a total of 116 patients with intrauterine residual after the first time of ATP in the Department of Obstetrics, Harrison International Peace Hospital of Hengshui City were selected as research subjects. They were divided into observation group (n=58, treated by mifepristone and oxytocin) and control group (n=58, only treated by oxytocin) by bock randomization method. The total effective rate, vaginal bleeding condition, serum β-human chronic gonadotropin (hCG) concentration, diameter of residues and adverse reactions in two groups were observed after treatment. Chi-square test was performed to compare the total effective rate between two groups. Independent-samples t test was performed to compare the differences of the duration and volume of vaginal bleeding, and the recovery time of serum β-hCG concentration between two groups. Wilcoxon rank sum test was used to compare the diameter reduction of intrauterine residues between two groups in different treatment periods. Clinical informed consent was obtained from each subject before ATP. The procedures in this study were in line with the requirements of the World Medical Association Declaration of Helsinki revised in 2013. Results ①There were no significant differences between two groups in the aspects of age, gravidity, weight, gestational age at the time of ATP, serum β-hCG concentration before treatment, diameter of intrauterine residues before treatment, incidence of uterine fibroids, and constituent ratio of ATP methods (P>0.05). ②The total effective rate in observation group was 93.1% (54/58), which was obviously higher than that in control group 79.3% (46/58), and the difference was statistically significant (χ2=4.702, P=0.041). ③The duration and volume of vaginal bleeding in observation group both were significantly shorter and lower than those in control group, which were (6.3±1.2) d vs (8.1±1.4) d, and (53.2±10.3) mL vs (62.7±13.1) mL, respectively, and both the differences were statistically significant (t=2.256, 3.167; P=0.046, 0.021). ④The recovery time of serum β-hCG concentration in observation group was (8.3±3.3) d, which was significantly shorter than tfhat in control group (9.8±4.0) d, and the difference was statistically significant (t=2.376, P=0.041). ⑤The diameter reductions of intrauterine residues during the treatment of the 1st to the 6th day, the 7th to the 12th day, the 13th to the 18th day, and the 19th to the 24th day in observation group all were bigger than those in control group, which were 10.2 mm (3.7-14.6 mm) vs 6.3 mm (2.7-12.4 mm), 8.5 mm (3.6-13.9 mm) vs 5.8 mm (2.8-10.1 mm), 7.2 mm (3.1-12.0 mm) vs 5.5 mm (2.4-10.0 mm), and 5.8 mm (2.8-10.1 mm) vs 4.9 mm (2.3-9.8 mm), respectively, and all the differences were statistically significant (Z=5.122, 5.340, 5.788, 6.011, P<0.001). Conclusions The use of mifepristone combined with oxytocin in treatment of intrauterine residues after ATP can promote the discharge of residues, shorten the duration of vaginal bleeding, reduce the amount of vaginal bleeding, and promote the recovery of serum β-hCG concentration. Because the sample size is relatively small in this study, whether mifepristone combined with oxytocin in treatment of intrauterine residues after ATP is worthy of clinical promotion remains to be confirmed by large sample, multi-center, randomized controlled studies. Key words: Mifepristone; Oxytocin; Artificial termination of pregnancy; Intrauterine residual; Bleeding time; Chorionic gonadotropin, beta subunit, human; Female