| Background and ObjectiveEarly pregnancy loss,or loss of an intrauterine pregnancy within the first trimester,refers to the cessation of early pregnancy embryo development and retention in the uterine cavity,also known as missed abortion.In clinical work,we often choose medical or surgical management to promote the abortion of embryo..However,due to the long time of embryo suspension and pregnancy organization adhesion of missed abortion patients,the position of embryo in some patients is close to the uterine horn,and the uterine structure of some patients is congenital abnormal,which increases the probability of complications such as incomplete aspiration,missed aspiration and uterine perforation.In addition,uterine cleaning is an invasive operation,which is easy to cause follow-up problems such as uterine infection,cervical adhesion,uterine adhesion and secondary infertility,which seriously affects the physiological health and reproductive needs of women of childbearing age.In recent years,the successful treatment of missed abortion with drug abortion has been reported by many parties.Drug abortion is a non-invasive operation,does not affect endometrial receptivity,has little impact on subsequent pregnancy,costs less,and is more easily accepted by patients.The expert consensus on the treatment of missed abortion in early pregnancy released issued by the family planning branch of Chinese Medical Association in January 2020 also affirmed the value of drug abortion.Increasing the success rate of medical abortion has become a hot topic in the field of medicine.The dead embryo remained in the uterine cavity for a long time,adhered to the uterine wall which affected the discharge of pregnancy.However,when the missed abortion occurs,the body can automatically recognize the dead embryo,and then secrete a series of substances to promote the contraction of the uterus and expel it from the body.It has been reported that the success rate of expectant treatment for patients with early pregnancy loss is nearly 80%.The purpose of this study is to explore the correlation between the time of embryo termination and the effect of the drug abortion,so as to provide scientific basis for improving the success rate of medical abortion in embryo abortion patients.Materials and Methods1.MaterialsWe randomly selected the patients with a pregnancy loss who were admitted to the Second Affiliated Hospital of Zhengzhou University from September 2017 to October 2019 to terminate pregnancy with medical treatment during the early pregnancy.We calculate the actual last menstrual period according to the menstrual cycle,the day of ovulation or the time of the first discovery of the pregnancy sac,and the actual embryo size {embryo days=mean gestational sac diameter(mm)+30 or[embryo length(cm)+6.5]*7} according to the transvaginal ultrasound at the time of embryo abortion.Embryo stopping time=the number of days of stopping menstruation when using medication-the actual number of days of embryo.They were divided into three groups:group 1(n=104 cases)with embryo suspension time?7 days;group 2(n=89 cases)with embryo suspension time is between 8-14 days;group 3(n=163 cases)with embryo suspension time>14 days.2.MethodsAll the patients in the three groups were treated with mifepristone 150mg in several times and misoprostol 600 ?g in sequence.The treatment effect was observed on the day the embryo is discharged.After 3 days,1 month and 3 months,the color Doppler ultrasound was reexamined to understand the residual condition of uterine cavity.Statistical analysisAll data were analyzed by SPSS 22.0 software.The measurement data were represented as "x±s".For the measured data,the normal test was first carried out.The t test was used for the normal distribution,and F test was used for the non-normal distribution.The counting data were expressed by rate and ?2 test was used.There was a significant difference in P<0.05.Results1.Analysis and comparative of general data between three groups of patients:there was no significant difference between the three groups in age,menopause time and number of pregnancies(P>0.05).2.Comparison of the efficiency of the day on which the embryo was discharged:the effective rates of medical treatment were 98.1%,94.3%and 94.4%,respectively,on the day when the pregnancy tissue was discharged,with no statistically significant difference(P>0.05).3.Comparison of pregnancy delivery process after medication:the delivery time of the first group and the second group was 2.42±1.576h,2.73±1.245h,respectively,with no significant difference(P>0.05);the delivery time of the third group was 4.68±1.943h,significantly longer than that of the former two groups(P<0.05).The duration of vaginal bleeding in three groups was 11.51±5.085d,12.76±3.044d,17.44±7.222d,respectively,the difference was statistically significant(P<0.05).The pain index of three groups was 4.62±2.325points,5.51±1.683 points,5.79±2.742 points,respectively,and the index of the second group and the third group was similar,which was higher than that of the first group(P<0.05).4.Comparison of adverse reactions after medication:nausea,vomiting,fatigue and other adverse reactions occurred in all the three groups,with no statistically significant difference in incidence(P>0.05).5.Comparison of residual condition of uterine cavity 3 days after embryo excretion:the residual rate of uterine cavity in the first group and the second group was 23.5%,27.4%,respectively,with no significant difference(P>0.05).The residual rate of uterine cavity in the third group was 44.8%,which was significantly higher than that in the first two groups,and the difference was statistically significant(P<0.05).6.Comparison of residual condition of uterine cavity 1 month after embryo excretion:the uterine cavity residual rate of the first group and the second group was 10.8%,20.5%,respectively,with no statistically significant difference(P>0.05).The residual rate of uterine cavity in group 3 was 28,7%,which was significantly higher than that in group 1,and the difference was statistically significant(P<0.05).7.Comparison of residual condition of uterine cavity 3 months after embryo excretion:the residual rate of uterine cavity in the three groups was 7.8%,7.2%,12.7%,respectively,and the difference was not statistically significant(P>0.05).8.Comparison of uterine cavity residue at different time after drug induced abortion in the first group:compared with the three days after the drug abortion,the uterine cavity residual rate 1 month after the drug abortion and 3 months after the drug abortion was significantly lower,the difference was statistically significant(P<0.05).9.Comparison of uterine cavity residue at different time after drug induced abortion in the second group:the residual rate of uterine cavity 1 month after drug abortion was similar to that of 3 days after drug abortion,with no statistically significant difference(P>0.05).The rate of incomplete abortion 3 months after drug abortion was lower than 3 days after drug abortion and 1 month after drug abortion,the difference was statistically significant(P<0.05).10.Comparison of uterine cavity residue at different time after drug induced abortion in the third group:in the third group,the residual rate of uterine cavity decreased successively in 3 days,1 month and 3 months after drug abortion respectively(P<0.05).Conclusions1.Medical abortion is an effective means to treat missed abortion.2.The time of embryo stopping does not affect the effective rate of drug abortion.3.Embryo arrest time affects the residual rate of uterine cavity after drug abortion:the longer the embryo stop time,the higher the residual rate of uterine cavity after drug abortion.4.Mifepristone can effectively treat the residual in uterine cavity after drug abortion. |
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