| Objective: Missed abortion belongs to a special type of spontaneous abortion, but it is common clinically. Its treatment is comparatively complicated, because encyesis organism can organiz, closely adherence with uterine wall, and will lead to difficult in curettage. There is a risk of disseminated intravascular coagulation (DIC) with a long standing missed abortion that has remained in the uterus for four weeks or more. The objective of this study was to analyze the effective treatment with easy approach , and to direct the traditional method of dealing with missed abortion and its complications.Methods: The study was conducted in Ji lin university, First hospital from January 1995 to December 2006. 215 cases were analyzed with final diagnosis of missed abortion according to history, gynecologic examination, urine pregnancy test and Doppler ultrasound. Of these 215 cases, 120 cases were treated with mifepristone and misoprostol, 84 cases had curettage, 18 cases with hysteroscope in them, 7 cases had refused to undergo treatment, 3 cases had uterine aspiration, and 1 case had treatment for infection and bleeding.Results: To choose the preferred way for the treatment methods of missed abortion, to decrease patients'difficulty after the treatment, and to increase the achievement ratio of treatment. This research found that among 215 patients, 204 cases(94.88%) were treated with (mifepristone and misoprostole) and direct curettage, and 9 cases with mifepristone and misoprostole alone. 195 cases curettage frequency of two sets analysis contrast. Among 111 cases treated with mifepristone and misoprostole 101(90.99%) cases had curettage once, and 10 (9.01%)cases had≥2 times. Of the 84 cases with direct curettage, 68 cases (80.95%) had curettage one times and 16 cases(19.05 %) had≥2 times. The scraping ratio of drug treatment group compared with direct curettage group have significant difference (P<0.05). In patients treated with mifepristone and misoprostole had frequency of curettage lower than that of direct curettage group.Comparative analysis of effectiveness of treatment among patient with different clinical presentation, treated with mifepristone and misoprostole, and curettage. Comparision of various kinds of clinical presentation, influence of drug treatment and direct curettage was performed. 112 cases had irregular vaginal bleeding among them, 12 patients didn't perform curettage or had other treatment, and in remaining 100 patients, comparative study in patient with medical treatment and curettage group and patient with curettage alone were performed. Of 56 cases treated with drug treatment, 52 cases (92.86%) had currettage once, 4 cases had curettage≥2 times. Of 44 cases with direct curettage alone, 39 cases (88.64%) had currettage once, 5 cases(11.36 %) had≥2 times.The frequency of curettage in two groups have no significant difference(P>0.05). 65 cases of irregular vaginal bleeding accompanied with lower abdominal pain, of which 5 cases didn't perform curettage or had other treatment. The remaining 27 cases had taken drug treatment, among these 23 cases (85.19%) had curettage once, 4 cases(14.81%)≥2 times. Of the 33 cases with direct curettage, 25 cases (75.76%) had curettage once, 8 cases(24.24 %) had≥2 times. The curettage ratio of two groups have no significant difference(P>0.05). Patients with no specific clinical presentation and diagnosis of missed abortion was made in 38 cases by Doppler ultrasound. Of these 38 cases, 3 cases didn't perform curettage or had other treatment, rest 28 cases underwent drug treatment, of which 26 cases(92.86%) had curettage once, 2 cases(7.14%)≥2 times. Of the 7 cases with direct curettage alone, 4 cases (57.14%) had currettage once, 3 cases(42.86%) had≥2 times. The curettage ratio of two groups have significant difference(P<0.05).On the basis of Doppler ultrasound examination, analysis was performed to compare the effectiveness of drug treatment and direct curettage treatment in missed abortion. In 155 cases with visible gestation sac, 14 cases didn't perform curettage or had other treatment. In remaining 93 cases with drug treatment, 83 cases (89.25%) had curettage once, 10 cases(10.75%)≥2 times. Among 48 cases with direct curettage alone, 41 cases (85.42%) had curettage once, 7 cases(14.58%)≥2 times. The curettage ratio of two groups have significant difference(P<0.05). Among 60 cases with mixed type, 6 cases didn't perform curettage or had other treatment. In remaining 54 cases, frequency of curettage was compared in two type of treatment group. Of the 54 cases, 18 cases with drug treatment had curettage once, and among 36 cases with direct curettage, 27 cases(75.00%)had curettage once, 9 cases(25.00%)≥2 times. The curettage ratio of two groups have no significant difference (P>0.05). This numerical data displays that 18 patients with curettage under hysteroscopy the had curettage once, among these 2 cases had a submucous myoma operation.Conclusions: Combination of mifepristone and misoprostol is very effective in the treatment of missed abortion. Many studies have found that it has high success rate. It has minimal blood loss and few side effects. From our results, we conclude that it is safe, effective, and reliable treatment method in missed abortion. Using drug followed by curettage not only decrease the distress of expanding cervix, shorten time of operation and lower incidence ratio of artificial abortion syndrome, but also reduce the volume of blood loss significantly, reduce the postoperative vaginal bleeding, shorten the operation time and prevents the complications. Because of short operation time, it may reduce the chances of infection and complications. Curettage under hysteroscopy, increases the chances of successful treatment due to complete removal of intrauterine products. Moreover, it can treat submucous myoma with hysteroscope at the same time if present.
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