The Study Of Mifepristone In The Treatment Of Incomplete Abortion After Induced Abortion

Objective:To study the clinical application of using different medication program of mifepristone in the treatment of incomplete abortion after induced abortion.Methods:The study was divided into two parts.Experiment 1,We selected 64 cases of women who had incomplete abortion after induced abortion for early pregnancy to the birth control clinic of the Institute of Family Planning Science in Shenyang,and divided them into 4 groups randomly,each group consisted of 16 cases.Experimental group A,B and C were administered with different doses of mifepristone.Group A was administered with mifepristone 100 mg per day for consecutive 6 days,totaling at 600mg;group B with mifepristone 50 mg per day for 6 days in a row,amounting to 300mg;while group C with mifepristone 25 mg per day for 6 continuous days,150 mg in total.All groups take two times a day.Group D was the control group.Group D was performed with curettage directly,while the other 3 groups received such curettage after stopping using drugs.Immunohistochemical staining was conducted to the residual decidual tissues,and method was adopted to semi-quantitatively measure the levels of ER and PR.Compare the change of blood ?-hCG before and after taking mifepristone in the experimental groups.Experiment 2,We selected 48 cases of women who had incomplete abortion after induced abortion to the Gynecologic outpatient clinic of the Institute of Family Planning Science in Shenyang and were diagnosed of incomplete abortion by ultrasonography and blood ?-hCG.The patients were divided into two groups by random way and each group consisted of 24 cases.The treatment group was taking at a draught,taking 100 mg daily and lasting 6 days;the control group was be taken separately(25mg,Bid�12d).The total amount of medicine was 600 mg.All patients were treated with oral antibiotics medicine for one week.ultrasonography and blood ?-hCG were detected at 1 and 2 weeks after treatment.Follow up once a week,and to the end of the forth week,the cure was recorded,the bleeding time of the vagina and the menstrual recovery time were observed.Results:1.Results of experiment 1: the level of blood ?-hCG of group A was significantly lower than that of group B and C(P < 0.05);as for the experimental group and the control group,the expression of ER and PR in cell nucleus of decidua cells decreased,also in the expression of ER and PR in cell nucleus of decidua glandular epithelial cells(P < 0.05).Then make pairwise rank sum test,the expression of ER in cell nucleus of decidua cells of Group A was obviously lower than other groups(P < 0.05),and the expression level in three experimental groups decreased than Group D(P < 0.05);the expression of ER in cell nucleus of decidua glandular epithelial cells of Group A was significantly lower than that of Group C and Group D(P < 0.05),and the expression level in three experimental groups decreased than control group(P < 0.05);the PR expression in cell nucleus of decidua cells of Group A was obviously lower than other groups(P < 0.05),and the expression level of Group B was lower than Group C and Group D(P < 0.05),the PR expression in cell nucleus of decidua glandular epithelial cells of Group A,B and C was lower than Group D(P < 0.05),and there were no significant differences in other groups(P > 0.05).2.Results of experiment 2: After mifepristone treatment,the cure rate of the treatment group was higher than that of the control group,there was statistical significance between test groups and control group(P <0.05).After one or two week of treatment,by comparing the blood ?-hCG,the decrease of blood ?-hCG in the treatment group was all significantly higher than that in the control group,and there was significant statistical difference(P <0.05).Compared with the results of ultrasonography examination,the contrast of abnormal echo in the uterus was significantly different at 1 and 2 weeks(P < 0.05).There was statistical significance in the time of homeostasis of vaginal bleeding and menstrual recovery between the treatment group and the control group(P > 0.05),the incidence of adverse reaction also had no statistically significant differences(P > 0.05).Compared with the uncured group,patients in cured group had lower level of blood ?-hCG,smaller abnormal echo of ultrasonography,higher blood flow resistance index of abnormal echo tissue(P < 0.05).Logistic regression analysis method showed that clinical effect was related to the doses of drugs,the level of blood ?-hCG,the size of abnormal echo and the blood flow resistance index of abnormal echo tissue(P < 0.05).Conclusions:Experiment 1: taking large doses of mifepristone in the same time,the level of blood ?-hCG for patients was the most significantly reduction and the inhibitory effect of ER and PR on decidua cells and glandular epithelial cells was the most obvious,this inhibition might be one of the mechanisms of mifepristone in the treatment of incomplete abortion after induced abortion.The maximum dose of the experimental group was 600 mg,and the effect was the most singnificant.Experiment 2: using total dose of 600 mg mifepristone in the treatment of incomplete abortion after induced abortion,taken at a draught for short time and high dose was better treatment effect than separately for long time and low dose,and didn't increase the adverse reaction,high safety,and the procedure was simple and easy to operate;the doses of drugs,the level of blood ?-hCG,the size of abnormal echo and the blood flow resistance index of abnormal echo tissue were the main factors affecting the effect of treatment.