医疗辅助与非辅助早期受孕丢失中药物治疗成功率比较

To compare the success rates of medical management using a combined mifepristone and misoprostol protocol in cases of early pregnancy loss (EPL) between women who conceived without medical assistance and those who conceived through in vitro fertilization (IVF), after fresh or frozen embryo transfer, and evaluate for the predictive factors of success, time to first passage of tissue, and time to complete resolution of pregnancy.

通过比较米非司酮配伍米索前列醇方案治疗无医疗辅助受孕和通过体外移植新鲜或冷冻胚胎受孕患者早期妊娠丢失的成功率，并评估成功的预测因素、妊娠组织首次排出时间和妊娠完全终止的时间。

Retrospective cohort study.

回顾性队列研究。

University hospital.

大学医院。

Women who presented with EPL below 13 weeks of gestation between June 2013 and July 2021 who were managed medically with mifepristone 200 mg orally and misoprostol 800 mcg vaginally were included in the study.

本研究纳入了在2013年6月至2021年7月期间妊娠13周以下的早期妊娠丢失就诊并接受治疗的女性，她们接受了口服米非司酮200毫克和阴道用米索前列醇800微克的药物治疗。

Medical management with mifepristone and misoprostol; conception without medical assistance vs. post-IVF, after fresh or frozen embryo transfer.

使用米非司酮和米索前列醇进行药物流产；比较无医疗辅助受孕与通过体外移植新鲜或冷冻胚胎受孕的女性。

We evaluated overall success and performed subgroup analysis according to the mode of conception and compared fresh vs. frozen-thawed embryo transfers for IVF pregnancies. In all groups, we also calculated success according to gestational age and compared the time to first passage of tissue. The potential predictive factors of treatment success were analyzed. The side effects and complications of treatment were recorded.

我们计算总体治疗成功率，并根据受孕方式进行了亚组分析，比较IVF妊娠中新鲜胚胎移植和冻融胚胎移植的治疗成功率。在所有组中，我们还根据胎龄计算成功率，并比较组织物第一次排出的时间。分析治疗成功的潜在预测因素。记录治疗期间的不良反应和并发症。

A total of 930 women were included in the study, 99 (11%) of whom achieved pregnancy after IVF. The overall success of medical treatment was 89% with no statistically significant difference according to the mode of conception (89% vs. 89%) or type of transfer (fresh 89% vs. frozen 89%). Only lower gestational age by sonography was independently predictive of treatment success, showing a negative regression coefficient of β = −0.333 and an odds ratio of 0.717. The mean time to first passage of tissue was 5.0 ± 2.1 hours. Altogether, 666 women (72%) showed pregnancy resolution on the day of medication administration, an additional 110 women at 1-week follow-up, and a further 74 women after ≥4 weeks on ultrasound.

本研究共纳入930例女性，其中99例(11%)IVF后妊娠。药物治疗的总体成功率为89%，不同受孕方式(89% vs. 89%)或移植胚胎类型(新鲜89% vs.冷冻89%)之间的差异无统计学意义。只有超声检查发现的较低胎龄是治疗成功的独立预测因素。负回归系数β＝-0.333，比值比为0.717。第一次组织物排出的平均时间为5.0 ±2.1小时。此外，共有666名女性(72%)在服药当日妊娠终止。110名女性是在1周超声随访时确认，另外74名女性在4周后超声检查时确认。

Medical management of EPL with mifepristone and misoprostol is a highly successful treatment option that results in completed abortion in a timely fashion in both pregnancies conceived without medical assistance and those conceived after IVF.

米非司酮配伍米索前列醇用于治疗早期妊娠丢失是一种非常成功的选择，无论是在非医疗辅助下受孕还是在体外受精胚胎移植后受孕，都能够及时且完全妊终止妊娠。

参考文献：

Retrospective cohort study comparing success of medical management of early pregnancy loss in pregnancies conceived with and without medical assistance Colleselli-Türtscher, Valeria et al.Fertility and Sterility, Volume 121, Issue 5, 824 - 831