生殖医学杂志

目的 初步探讨以雌孕激素序贯疗法为基础的联合药物方案治疗不全流产的安全性和可行性。方法 回顾性分析2021年3月至2022年5月于南京医科大学附属常州第二人民医院确诊为不全流产的9例患者的临床资料。所有患者曾接受人工流产或引产术，术后经阴道超声检查提示宫腔内部分妊娠物残留，均进行雌孕激素序贯疗法联合米非司酮及中成药血府逐瘀胶囊治疗。观察9例患者用药期间血β-HCG水平变化，经阴道超声检查宫腔妊娠物残余物大小，记录阴道流血、腹痛及药物不良反应发生情况等。结果 9例患者在治疗期间均无明显的阴道流血及严重腹痛。7例患者在用药1个周期(4周)药物撤退性出血干净后行经阴道超声检查，提示宫腔内未见妊娠残余物，血β-HCG下降至正常范围；另2例患者分别于用药2个周期、4个周期后治愈。用药期间9例患者中2例患者出现轻度恶心症状，1例患者在用药第4周期时出现轻度乳房胀痛，其余6例患者均未见明显药物不良反应。1例患者在治愈1个月后自然妊娠。结论 以雌孕激素序贯疗法为基础的联合药物方案治疗不全流产可能是安全可行的。

Objective:To explore the safety and feasibility of combined medication regimen based on sequential estrogen and progesterone therapy for treating incomplete abortion.Methods:The clinical data of 9 patients who received induced abortion or induced labor in the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University from March 2021 to May 2022 were retrospectively analyzed. All the patients had a postoperative transvaginal ultrasound examination, and the result revealed partial pregnancy residue in the uterine cavity. All the patients received the sequential therapy of estrogen and progesterone combined with mifepristone and traditional Chinese patent medicine Xuefu Zhuyu capsule. Nine patients' blood β-HCG levels were observed during medication period, and the size of pregnancy residue in the uterine cavity was examined by transvaginal ultrasound, and vaginal bleeding, abdominal pain, and adverse drug reactions were recorded.Results:None of 9 patients had obvious vaginal bleeding or severe abdominal pain during the treatment period. Seven patients received transvaginal ultrasound examination 1 cycle(4 weeks) after drug withdrawal and bleeding ended, and no pregnancy residue was found in the uterine cavity, with their blood HCG decreasing to the normal range. Two other patients were cured after treatment of 2 cycles and 4 cycles, respectively. During the treatment period, 2 patients had mild nausea, 1 patient had mild breast pain in the 4^th cycle, and the other 6 patients had no obvious adverse drug reactions. One patient became pregnant naturally 1 month after being cured.Conclusions:The combined medication regimen based on sequential estrogen and progesterone therapy may be safe and feasible for treating incomplete abortion.