PDF(Pubmed)
Abstract：
UNASSIGNED: Evidence strongly supports the use of mifepristone-misoprostol combination treatment for early pregnancy loss (EPL) among pregnancies conceived without assisted reproductive technologies. No literature exists, however, regarding the efficacy of this treatment in the medical management of EPL among pregnancies after in vitro fertilization and embryo transfer (IVF-ET). These patients differ as some use exogenous hormonal supplementation to provide pregnancy support. Thus, the management for EPL may differ between unassisted conceptions and those after ET. Mifepristone, a progesterone receptor antagonist, may demonstrate an altered treatment effect when used with misoprostol to manage EPL in assisted reproductive technologie-conceived pregnancies.
UNASSIGNED: To describe our institution\'s experience using mifepristone-misoprostol to manage EPL after in vitro fertilization with embryo transfer IVF-ET.
UNASSIGNED: Retrospective case series.
UNASSIGNED: Single academic institution from 2020 to 2022.
UNASSIGNED: Nine patients with ultrasound confirmed EPL after IVF-ET.
UNASSIGNED: All 9 patients underwent in vitro fertilization followed by fresh or frozen embryo transfer. All 9 received 200 mg of mifepristone 24 hours before 800 μg of misoprostol.
UNASSIGNED: Incomplete abortion, need for surgical management, number of days to negative serum human chorionic gonadotropin (hCG).
UNASSIGNED: Of the 9 subjects included, one had a programmed frozen embryo transfer cycle, 6 had modified natural frozen embryo transfer cycles, and 2 underwent fresh ET. Eight subjects had successful expulsion of tissue with one dose of treatment, and one required uterine aspiration. No subjects required additional dosing of misoprostol. The mean number of days elapsed from mifepristone treatment to tissue expulsion was 4.89 ± 11.30 days and the mean days to negative-range serum hCG was 36.89 ± 18.59 days. At the initial ultrasound, all pregnancies had one gestational sac seen; 5/9 had a yolk sac; only 3 had fetal cardiac activity. The mean gestational age at the time of EPL diagnosis was 55.22 ± 8.77 days, with the majority (8/9) having completed 7 weeks gestation.
UNASSIGNED: Mifepristone-misoprostol combination treatment appears to be a reasonable option for those with EPL after IVF-ET. Future, larger-scale studies are needed comparing combination treatment with misoprostol only among various ET protocols.
UNASSIGNED: To describe our institution\'s experience using mifepristone-misoprostol to manage EPL after in vitro fertilization with embryo transfer IVF-ET.
UNASSIGNED: Retrospective case series.
UNASSIGNED: Single academic institution from 2020 to 2022.
UNASSIGNED: Nine patients with ultrasound confirmed EPL after IVF-ET.
UNASSIGNED: All 9 patients underwent in vitro fertilization followed by fresh or frozen embryo transfer. All 9 received 200 mg of mifepristone 24 hours before 800 μg of misoprostol.
UNASSIGNED: Incomplete abortion, need for surgical management, number of days to negative serum human chorionic gonadotropin (hCG).
UNASSIGNED: Of the 9 subjects included, one had a programmed frozen embryo transfer cycle, 6 had modified natural frozen embryo transfer cycles, and 2 underwent fresh ET. Eight subjects had successful expulsion of tissue with one dose of treatment, and one required uterine aspiration. No subjects required additional dosing of misoprostol. The mean number of days elapsed from mifepristone treatment to tissue expulsion was 4.89 ± 11.30 days and the mean days to negative-range serum hCG was 36.89 ± 18.59 days. At the initial ultrasound, all pregnancies had one gestational sac seen; 5/9 had a yolk sac; only 3 had fetal cardiac activity. The mean gestational age at the time of EPL diagnosis was 55.22 ± 8.77 days, with the majority (8/9) having completed 7 weeks gestation.
UNASSIGNED: Mifepristone-misoprostol combination treatment appears to be a reasonable option for those with EPL after IVF-ET. Future, larger-scale studies are needed comparing combination treatment with misoprostol only among various ET protocols.
摘要：
■证据强烈支持使用米非司酮-米索前列醇联合治疗在没有辅助生殖技术的怀孕中早期妊娠丢失（EPL）。没有文学存在，然而,关于这种治疗在体外受精和胚胎移植（IVF-ET）后妊娠中EPL的医学管理中的功效。这些患者不同，因为有些患者使用外源性激素补充剂来提供妊娠支持。因此，在无辅助概念和ET后，EPL的管理可能会有所不同。米非司酮,孕激素受体拮抗剂,与米索前列醇一起用于辅助生殖技术怀孕的EPL治疗时，可能会显示出改变的治疗效果。
■描述我们机构在体外受精和胚胎移植IVF-ET后使用米非司酮-米索前列醇管理EPL的经验。
■回顾性病例系列。
■2020年至2022年的单一学术机构。
■9例IVF-ET后超声证实EPL。
■所有9例患者都接受了体外受精，然后进行新鲜或冷冻胚胎移植。所有9人在800μg米索前列醇之前24小时接受200mg米非司酮。
■不完全流产,需要手术管理，血清人绒毛膜促性腺激素（hCG）阴性的天数。
■在包含的9个科目中，一个人的冷冻胚胎移植周期，6人修改了自然冷冻胚胎移植周期，2例接受新鲜ET。八名受试者通过一次剂量的治疗成功排出了组织，还有一个需要进行子宫抽吸.没有受试者需要额外剂量的米索前列醇。从米非司酮治疗到组织排出的平均天数为4.89±11.30天，阴性范围血清hCG的平均天数为36.89±18.59天。在最初的超声检查中，所有妊娠均有1个妊娠囊;5/9有一个卵黄囊;只有3个有胎儿心脏活动.EPL诊断时的平均胎龄为55.22±8.77天,大多数（8/9）完成了7周的妊娠。
■米非司酮-米索前列醇联合治疗似乎是IVF-ET后EPL患者的合理选择。未来,需要进行更大规模的研究,仅在各种ET方案中比较米索前列醇联合治疗.
■描述我们机构在体外受精和胚胎移植IVF-ET后使用米非司酮-米索前列醇管理EPL的经验。
■回顾性病例系列。
■2020年至2022年的单一学术机构。
■9例IVF-ET后超声证实EPL。
■所有9例患者都接受了体外受精，然后进行新鲜或冷冻胚胎移植。所有9人在800μg米索前列醇之前24小时接受200mg米非司酮。
■不完全流产,需要手术管理，血清人绒毛膜促性腺激素（hCG）阴性的天数。
■在包含的9个科目中，一个人的冷冻胚胎移植周期，6人修改了自然冷冻胚胎移植周期，2例接受新鲜ET。八名受试者通过一次剂量的治疗成功排出了组织，还有一个需要进行子宫抽吸.没有受试者需要额外剂量的米索前列醇。从米非司酮治疗到组织排出的平均天数为4.89±11.30天，阴性范围血清hCG的平均天数为36.89±18.59天。在最初的超声检查中，所有妊娠均有1个妊娠囊;5/9有一个卵黄囊;只有3个有胎儿心脏活动.EPL诊断时的平均胎龄为55.22±8.77天,大多数（8/9）完成了7周的妊娠。
■米非司酮-米索前列醇联合治疗似乎是IVF-ET后EPL患者的合理选择。未来,需要进行更大规模的研究,仅在各种ET方案中比较米索前列醇联合治疗.
