Abstract
Currently, medication abortion is widely used in clinical practice in China. The aim of this study was to investigate the effect of mifepristone with misoprostol treatment on the efficacy of patients with missed abortion (MA) and the safety of this drug regimen. 95 patients with MA treated in our hospital from February 2019 to April 2021 were collected as the subjects of this study, and the patients were divided into the control and the research groups according to different treatment modalities. Among them, 46 cases in the control group were treated by diethylstilbestrol combined with oxytocin and 49 cases in the research group were treated by mifepristone combined with misoprostol, and both groups underwent curettage after medication. The rates of complete abortion, time of embryo expulsion, time of operation, intraoperative bleeding, time of postoperative vaginal bleeding, amount of vaginal bleeding, rate of one-time curettage, the levels of serum estradiol (E2), progesterone (P), β-chorionic gonadotropin (β-hCG), and interleukin-18 (IL-18), and the incidence of adverse effects in the two groups were examined and compared. Alanine transaminase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), and serum creatinine (Scr) were used as indicators to evaluate the safety of the drug. The results showed that the rates of complete abortion and one-time curettage were significantly higher in the study group than in the control group, while the time of embryo expulsion, operation time, intraoperative bleeding, postoperative vaginal bleeding time, and vaginal bleeding were significantly lower than in the control group. The serum E2, P, and β-hCG levels before curettage in both groups were significantly higher, and IL-18 levels were significantly lower than those at the time of admission, with E2, P, and β-hCG levels increasing more and IL-18 levels decreasing more in the research group. After drug treatment, no abnormal changes in liver and kidney functions were observed in both groups, and the incidence of adverse reactions was at a similar and lower level in both groups. This shows that mifepristone with misoprostol is a safer and more effective drug regimen for the treatment of MA, which can regulate the levels of serum sex hormones and inflammatory factors in the body, promote the shedding of placental tissue, and create conditions for improving the rate of curettage.
Highlights
Missed abortion (MA) is a special case of spontaneous abortion in which an embryo or a dead fetus is retained in the uterus and cannot be expelled in time [1]. e incidence of MA in China has been on the rise in recent years due to factors such as rising life stress and deterioration of living environment [2]
Clearance is the main treatment for MA, but the death of the embryo absorbs a large amount of amniotic fluid causing organization of the tissue, and the necrotic tissues may form a tight connection with the uterine wall and cannot be completely detached from the uterine wall, which can lead to difficulty in scraping or hemorrhage after the scraping procedure [3]
Evidence-Based Complementary and Alternative Medicine or other treatments to promote the release of mechanized placental tissue from the uterine wall prior to cleansing surgery becomes crucial in the treatment of MA
Summary
Missed abortion (MA) is a special case of spontaneous abortion in which an embryo or a dead fetus is retained in the uterus and cannot be expelled in time [1]. e incidence of MA in China has been on the rise in recent years due to factors such as rising life stress and deterioration of living environment [2]. If the pregnancy tissue remains in the uterine cavity for a longer period of time, it can lead to tissue lysis and release of large amounts of hemolysin into the blood circulation of the pregnant woman, causing a coagulation disorder, which can cause massive uterine bleeding and even lead to diffuse intravascular coagulation [4]. Evidence-Based Complementary and Alternative Medicine or other treatments to promote the release of mechanized placental tissue from the uterine wall prior to cleansing surgery becomes crucial in the treatment of MA. Along with the improvement of the clinical medication level, the clinical management protocol of MA has been improved in recent years. Mifepristone is a progesterone receptor antagonist with antiendometrial proliferation, menopause, and ovulation inhibition, which is widely used in the clinical myoma uterus and dysfunctional uterine bleeding [7]. It can soften the cervix to facilitate embryo expulsion by inhibiting the synthesis of collagen fibers [8]
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