Value Of Mifepristone In Treatment Of Abortive Remnants Of Induced Abortion

Abortive remnants is one of the complications of induced abortion. Although the incidence rate is very low, in a certain extent, it cannot be avoided completely. In recent years, with increases of repeated induced abortion rate and missed abortion rate, abortive remnants increases and the difficulty of its treatment is also very high. The repetitive curettage operation not only brings physical pain to women but also the psychological pressure. As consequence, increasing complications lead to heavier burden to the society and families. Mifepristone as drug for early pregnancies termination is widely used in the clinical application. Its effectiveness and safety has been fully affirmed. Currently, the most acceptable anti-early pregnant mechanism of mifepristone is:as antagonist for progesterone receptor (PR), mifeprestone impacts the balance between PR and estrogen receptor (ER) in decidual tissue, thus make the embryo stop growing; it also has direct impact on the villi trophoblastic cell to terminate pregnancies; etc. In recent years, clinical attention was given gradually to mifepristone in treatment of abortive remnants of induced abortion. But its mechanism is not yet clear, as well as the missing of the standard of proper dosage and method in terms of safety of its clinical application. This topic is divided into two parts:(1) Impact on β-hCG (Human Chorionic Gonadotrophin)、ER and PR by using mifepristone in treatment of abortive remnants of induced abortion;(2) Effectiveness, safety and influence factors in using mifepristone in treatment of abortive remnants of induced abortion.Part1Impact on β-hCG、ER and PR by using mifepristone in treatment of abortive remnants of induced abortionObjectiveTo study the impact on β-hCG、ER and PR expression in abortive remnants by using different dosage of mifepristone in treatment of induced abortion. MethodsData collected from women after abortion who received treatment in family planning clinic of Obstetrics&Gynecology hospital of FUDAN university from Jan,2009till Sept,2009.60patients diagnosed as with abortive remnants were randomly classified to3groups with different dosages of mifepristone (350mg as25mg,bid×7d,700mg as50mg,bid×7d、1400mg as100mg, Bid×7d) and1control group,15patients per group. In addition to group D which do curettage directly, the other groups were dilatation and curettage after stop mifepristone.β-hCG、ER and PR expression level in the remnants were half quantitative measured by application of immunohistochemistry EnVision method dyeing. And measure the changes of blood β-hCG of experimental groups.ResultsThere is no significant statistical difference (P>0.05) in the expression of β-hCG in villous trophoblast cytoplasmic amongst4groups. Blood β-hCG of Group A is reduced much more than that of Group B and C, there is significant statistical difference (P<0.05). Compared with control group, the expression of ER, PR in decidual epithelial cells and interstitial cell nuclei in experimental groups are all reduced, there is significant statistical difference (P<0.05). Pairwise comparison of rank sum test (adjust α=0.05) shows Group A is significantly reduced than Group C, D in expression of ER in decidual epithelial cells, there is significant statistical difference (P<α); experimental groups are significantly reduced than control group in expression of ER in interstitial cell nuclei (P<α); experimental groups are significantly reduced than control group in expression of PR in decidual epithelial cells, there is significant statistical difference(P<α); Group A is significantly reduced than other groups in expression of PR in interstitial cell nuclei, there is significant statistical difference (P <α); Group B is reduced than Group C and D in expression of PR in interstitial cell nuclei, there is significant statistical difference (P <α)ConclusionsDifferent dosage of mifepristone on abortive remnants of induced abortion in β-hCG expression effect is not obvious. But it significantly reduced blood levels of β-hCG. It has inhibition to expression of ER, PR in decidual cell. This inhibition might be one of the mechanisms in using mifepristone in treatment of abortive remnants of induced abortion. The most effective dosage we found is1400mg.Part2Effectiveness, safety and influence factors in using mifepristone in treatment of abortive remnants of induced abortionObjectiveTo evaluate the effectiveness and safety of treatment of abortive remnants of induced abortion with different dosages of mifepristone. To analyze the correlation factors to healing by comparing the medical effect of different dosage plans.MethodsData collected from women after abortion who received treatment in family planning clinic of Obstetrics&Gynecology hospital of FUDAN university from Oct,2009till Feb,2011. They were diagnosed as abortive remnants by ultrasound and blood level of β-hCG.101cases were collected and randomly divided into four groups. Three test groups are supplied with different dosages of mifepristone (0,50mg/d×28d,100mg/d×14d,200mg/d×7d), and one control group. We evaluated the effectiveness and safety of these four groups by clinic observation and monitoring on ultrasound and blood level of β-hCG. Based on the treatment effect, cured group and untreated group are classified based on below factors to analyze:age, weight, gravidity, parity, bleeding time after treatment, and blood level of β-hCG before the study, size of abortive remnants by B-mode ultrasonic diagnostic equipment. Rank sum test and logistic regression method are used to analyze the correlation factors on successful treatment of abortive remnants of induced abortion with mifepristone.Results1. Effective power of mifepristone test group is61.60%, effective power of control group is21.40%, there was statistical significance between test groups and control group (P<0.01). After two weeks of treatment, changes of blood level of β-hCG and reduction of residual size tested by ultrasound were better than the control group, and there was significant statistical difference (P<0.01), the group with high dose in short term got the best result. After four weeks of treatment, blood level of β-hCG of test groups had no statistical significance (P>0.05).There was statistical significance in pair wise comparison on reduction of residual size tested by ultrasound among test groups (P<0.05), the group with high dose in short term got the most reduction. There was statistical significance in the time of homeostasis of vaginal bleeding and menstrual recovery between three test groups and the control group (P<0.05). There was no statistical significance in healing time among these3test groups (P>0.05) and so as the occurrence of adverse reaction.2. Compared with not cured group, cured group has lower level of blood β-hCG, smaller abortive remnants, shorter bleeding time after treatment, bigger resistance index of blood flow (P<0.05for all above factors). Logistic regression analysis shows the below factors have the correlation with the curing result (P<0.05):dosage of mifepristone, base line level of β-hCG, the average size of the abortive remnants by B-mode ultrasonic diagnostic equipment, resistance index of blood flow status of the remnants tissue.Conclusions1. Using mifepristone to treat induced incomplete abortion is effective, and when used in short term and high dose is more effective.2. Following indicators can be major correlation factors to evaluate the treatment result:base line level of β-hCG, size of the abortive remnants and resistance index of bleed flow of the abortive remnants.