Clinical Efficacy and Safety Study of Mifepristone with Misoprostol Treatment in Patients with Missed Abortion

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.

The method for termination of mid-trimester pregnancy with placenta previa: A case study

“…At present, the common methods for termination of pregnancy in China include Mifepristone and Misoprostol for the patients with the gestational age less than and equal to 16 weeks, intraamniotic injection of Ethacridine Lactate for those with gestational age over 16 weeks. [16,17] For pregnant women with placenta previa, Mifepristone + Misoprostol and Mifepristone + Ethacridine Lactate are effective and safe methods for termination of mid-trimester pregnancy. [6] As an acceptable method of labor induction, CDB can be safely applied to pregnant women who undergo vaginal delivery with term pregnancy, [18] or to those with history of cesarean section.…”

The effects of mifepristone on the structure of human decidua and chorion and Bax and Bcl-2 expression at early stage of pregnancy

“…These observations indicate that due to the action of mifepristone and the inhibition of progesterone, cells of the chorionic and decidual tissues show features of apoptosis and autophagy. It is commonly accepted that mifepristone terminates pregnancy by antagonizing the physiological effects of progesterone, which has multiple effects on the metabolism and morphological structure of the embryo and its supporting tissues [ 18 , 19 ], including decidual cell degeneration and necrosis, decidual and villus tissue stripping, enhanced uterine contractions and apoptosis of decidual tissue in early pregnancy [ 20 – 22 ].…”

How many missed abortions are caused by embryonic chromosomal abnormalities and what are their risk factors?

“…As a special type of spontaneous abortion, missed abortions account for 10%–20% of spontaneous abortions, while 25% of women undergo spontaneous abortion ( Practice Committee of the American Society for Reproductive, 2012 ; Shahine and Lathi, 2015 ; Mohammad-Akbari et al, 2022 ). The incidence rate of missed abortions has shown an obvious upward trend in recent years ( Alnafisah and Alalfy, 2018 ; Zhao et al, 2021 ; Torres-Miranda et al, 2022 ), which has seriously affected the physical and mental health of the patients, family, and social happiness.…”