Clinical Study Of Terminating Biochemical Pregnancy And Early Clinical Pregnancy With Two Mifepristone-misoprostol Regimens

Objective:To compare the efficacy,side effects and the level ofβ-HCG and E2 of using mifepristone in combination with sublingual and oral administrations of misoprostol to terminate the pregnancy(menstrual delay≤7days), further confirmed that reduced the dose and changed the regimen of misoprostol to terminat biochemical and early pregnancy is feasibility and superiority.To survey the effect of mifepristone on the transcription levels of PR-mRNA and PR-mRNA in the villus from women in early pregnancy.Methods:In trial one:80 healthy pregnant women coming from the second hospital of TianJin medical university requesting medical abortion at 37 days＇gestation were randomly assigned into two treatment groups:Mifepristone(150mg) combined with Misoprostol (400μg) sublingually or Misoprostol (600μg) orally 36-48 hours later. All need return 4 times for assessment.The former 40case need blood before given Mifepristone and 7days after given Misoprostol,at last to measur the serum levels of human chorionic gonadotropin(β-HCG) and estradiol(E2) levels with the chemiluminescence immunoassay method using magnetic microparticle.In trial two:nine normal women requesting abortion were randomized to study and control groups. Four Women in the study group took 150mg of mifepristone 12-24h before vacuum aspiration. Five women in the control group experienced directly vacuum aspiration. Real-time quantitative PCR (RT-PCR) was used to detect the gene expression of Estrogen receptor (ER) and Progesterone receptor(PR) in the villus from the women of both groups.Results:In trial one:The complete abortion's rates of the two groups were 95.24% and 86.84% (p> 0.05). The mean bleeding days in the first group was (8.18±2.66) and (12.52±3.20) in the other, and the difference was significant (p<0.05).Negative of urine HCG time:study group(10.05±3.52) days, the time for the other group(12.52±3.20) days.and the difference was significant, p<0.01.A total of 25 cases of study group (59.52%,25/42) can be seen from sac, waiting time was (3.96±4.64) hours; the control group there were 24 cases (63.16%,24/38) sac can be seen discharge, emission time (3.75±2.84)hours, and there had no significant differences, p> 0.05.Other side efects including abdominal pain,nausea,vomiting and diarrhea were low and light in each group.Examination of hormones:we analysis the complete abortion cases being 36.We found that the decline rate of P-HCG is low in study group,p<0.01,and at ten day the level of P-HCG is low in study,p<0.05.The change of the level of E2 had no different in both group.In trial two:The expression of PR mRNA in the villus in the study group was significantly higher than that in the control group(p<0.01=.There was no statistical difference of the expression of ER mRNA in the villus between the two groups(p> 0.05).Conclusion:150mg mifepristone with misoprostol 400μg sublingual administration for the termination of 37 days' gestation, compared with the conventional method, side-effects of medication had no significant increase and the satisfaction were high. The program is safe and reliable for termination biochemical pregnancy or early clinical pregnancy.Mifepristone can act directly on villus tissues, and its resistance mechanism of early pregnancy may be related to the impact of the level of PR and ERmRNA transcription.