OBJECTIVE: To evaluate the therapeutic methods and their effects on patients with cornual pregnancies.
 METHODS: A retrospective study was performed on 83 patients, who were diagnosed as cornual pregnancy at Drum Tower Hospital from June 2010 to April 2015. The patients were divided into 5 groups: a laparoscope group, angle resection and uterine repair guided by laparoscope (n=16); a surgery group, operated with angle resection and uterine repair (n=49); an abortion group, guided by ultrasound or laparoscope (n=6); a drug group, treated by methotrexate and mifepristone (n=8) and a pregnancy bursal puncture group (n=4). We compared the general conditions, surgery circumstances and average days in hospital among the laparoscope group, the surgery group, and the abortion group. Moreover, we also investigated the outcomes of the drug group and pregnancy bursal puncture group.
 RESULTS: Compared with the surgery group, the intraoperative blood loss in the laparoscope group and abortion group was less (P<0.05). The length of procedure and average days in hospital between the surgery group and the laparoscope group were not statistically significant (P>0.05). The length of procedure in the abortion group was less than that in the laparoscope group or the surgery group (P<0.05). The cure rate was 100%.
 CONCLUSION The therapeutic methods based on patient's condition can improve the curative effect and prognosis in cornual pregnancy, which can keep the integrity of generative organs with less injury. The laparoscope might be a main therapeutic method for cornual pregnancy due to its safety, effectiveness, and minimal invasion.
Abortion, Induced ; Female ; Humans ; Laparoscopy ; Methotrexate ; therapeutic use ; Mifepristone ; therapeutic use ; Pregnancy ; Pregnancy, Cornual ; drug therapy ; surgery ; Retrospective Studies

OBJECTIVETo find a simpler, effectiver with less side-effect method for treatment of ectopic pregnancy.

METHODSOne hundred and fourteen patients of ectopic pregnancy were divided into two groups, the 56 patients in Group A were treated with Mifepristone and Chinese herbal medicine (CHM), and 58 patients in Group B were treated with Methotrexate and CHM. The therapeutic effect in both groups was observed and compared.

RESULTSThe rate of success in Group A was 82.14% and in Group B 70.69%, comparison between them showed no significance (P > 0.05). Time for successful treatment was 14.54 +/- 5.87 days in Group A and 9.00 +/- 5.09 days in Group B, comparison of them showed significant difference (P < 0.01). Insignificance revealed in comparison between the occurrence of side-effects for the groups, such as nausea, vomiting, diarrhea, liver dysfunction and lowering of white blood cells, but significance was shown in re-menstruation time (43.43 +/- 1.77 days vs 38.38 +/- 1.13 days, P < 0.05).

CONCLUSIONTreatments of combined CHM with Mifepristone or Methotrexate showed similar therapeutic effect in treating ectopic pregnancy, but the latter showed a quicker initiation and less side-effects in delaying the re-menstruation time.

Abortifacient Agents ; therapeutic use ; Adult ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Methotrexate ; therapeutic use ; Mifepristone ; therapeutic use ; Phytotherapy ; Pregnancy ; Pregnancy, Ectopic ; drug therapy

Adult ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Medicine, Chinese Traditional ; Methotrexate ; therapeutic use ; Mifepristone ; therapeutic use ; Phytotherapy ; Pregnancy ; Pregnancy, Ectopic ; diagnosis ; drug therapy

BACKGROUNDThe rate of cesarean delivery has significantly increased in China in the last decade. Women with prior cesarean history tend to have a higher risk of uterine rupture during termination of the pregnancy in mid-trimester than those without such a history. The aim of our study was to evaluate the influences of the potential risk factors on uterine rupture in women with prior cesarean.

METHODSWe conducted this retrospective study of women with prior cesarean section, who underwent mid-trimester pregnancy termination between January 2006 and December 2013 in Peking Union Medical College Hospital. The protocol was oral administration of mifepristone and misoprostol for the patients with the gestational ages below 16 weeks or intra-amniotic injection of ethacridine lactate (EL) for those with at least 16 weeks of gestational ages. The thickness of the lower uterine segment (LUS) was measured before the termination of pregnancy. Logistic regression was used to study the risk factors of uterine rupture.

RESULTSThe total rate of successful abortion was 93.9% (62/66). Four patients failed in induction, and one of them received curettage, whereas the other three experienced uterine rupture (4.5%). The successful rates of abortion were 85.7% (30/35) for women treated with mifepristone-misoprostol and 86.1% (31/36) for those treated with EL. There was a significant difference in the mean LUS thickness between the uterine rupture group (3.0 ± 2.0 mm) and the nonrupture group (7.0 ± 3.0 mm) (P < 0.05). The LUS thickness of <3 mm was associated with uterine rupture during mid-trimester pregnancy termination in women with prior cesarean (odds ratio, 94.0; 95% confidence interval 4.2-2106.1) after adjusted maternal age, gestational age, interdelivery interval and prior cesarean section. Severe bleeding that required transfusion occurred in one case (1.5%).

CONCLUSIONSBoth the mifepristone-misoprostol and the EL regimens were effective and safe for the termination of mid-trimester pregnancy in women with prior cesarean. A thinner LUS is associated with a relatively high risk of uterine rupture.

Abortion, Induced ; adverse effects ; methods ; Cesarean Section ; Ethacridine ; therapeutic use ; Female ; Humans ; Mifepristone ; therapeutic use ; Misoprostol ; therapeutic use ; Pregnancy ; Pregnancy Trimesters ; Retrospective Studies ; Uterine Rupture ; etiology

Adult ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Methotrexate ; therapeutic use ; Mifepristone ; therapeutic use ; Phytotherapy ; Pregnancy ; Pregnancy, Ectopic ; drug therapy

OBJECTIVETo evaluate the value of the combination of methotrexate(MTX) injection through hysteroscopic tubal catheterization and mifepristone per os in the conservative treatment of tubal pregnancy.

METHODSForty patients who met the criteria of conservative treatment were enrolled in this study and received the combined therapy of MTX 50 mg/d injection through hysteroscopic tubal catheterization and oral mifepristone 100mg/d for 5 days.

RESULTSOf these 40 patients, 38 (95.0%) were cured. The human chorionic gonadotropin decreased to normal level within 3-48 days. The masses disappeared within 16-65 days. The menstruation returned normal within 28-42 days. No obvious side effect was observed. Of 30 patients who underwent hydrotubation through hysteroscopy three months later, 12 patients were unobstructed, 2 patients were completely obstructed, and 16 patients were partially obstructed. Five patients had full-term deliveries up to this report.

CONCLUSIONThe combination of MTX injection through hysteroscopic tubal catheterization and mifepristone per os is safe and effective for early tubal pregnancy.

Adult ; Drug Therapy, Combination ; Female ; Humans ; Hysteroscopy ; Injections ; Methotrexate ; administration & dosage ; therapeutic use ; Mifepristone ; therapeutic use ; Pregnancy ; Pregnancy, Tubal ; drug therapy ; Young Adult

Animals ; Brain ; metabolism ; Dehydroepiandrosterone ; therapeutic use ; Depressive Disorder, Major ; drug therapy ; metabolism ; physiopathology ; Humans ; Metyrapone ; therapeutic use ; Mifepristone ; therapeutic use ; Psychotic Disorders ; drug therapy ; metabolism ; physiopathology ; Pyrimidines ; therapeutic use ; Receptors, Corticotropin-Releasing Hormone ; antagonists & inhibitors ; Receptors, Glucocorticoid ; antagonists & inhibitors ; metabolism

Objective: To evaluate different methods' efficacy of controlling acute bleeding and managing long-term menstruation in patients with heavy menstrual bleeding (HMB) associated with antithrombotic therapy. Methods: The clinical data of 22 cases with HMB associated with antithrombotic therapy admitted to Peking University People's Hospital from January 2010 to August 2022 were analyzed, aged 39 years old (26-46 years). Changes in menstrual volume, hemoglobin (Hb), and quality of life were collected after control of acute bleeding and long-term menstrual management. Menstrual volume was assessed by pictorial blood assessment chart (PBAC), and quality of life was assessed by menorrhagia multi-attribute scale (MMAS). Results: (1) Treatment of acute bleeding: of the 22 cases with HMB associated with antithrombotic therapy, 16 cases were treated in our hospital and 6 in other hospital for emergency bleeding; of the 16 cases treated in our hospital, 3 underwent emergency intrauterine Foley catheter balloon compression due to severe bleeding (Hb decreased by 20 to 40 g/L within 12 hours). Of the 22 cases with antithrombotic therapy-related HMB, 15 (including 2 cases with severe bleeding) underwent emergency aspiration or endometrial resection, and intraoperative placement of levonorgestrel-releasing intrauterine system (LNG-IUS) followed by a significant reduction in bleeding volume; 3 cases had controlled acute bleeding after rivaroxaban dose reduction and continued observation; 2 cases were given gonadotropin-releasing hormone agonists to control acute bleeding in other hospital, of which 1 case was temporarily treated with periodic blood transfusion, and the other one patient underwent total hysterectomy; and 2 cases had temporary amenorrhea with oral mifepristone after intrauterine balloon compression or oral norethindrone. (2) Long-term menstrual management: of the 22 cases with antithrombotic therapy-related HMB, 15 had LNG-IUS placement and 12 had LNG-IUS placement for 6 months, and menstrual volume was significantly reduced [PBAC scores were 365.0 (272.5-460.0) vs 25.0 (12.5-37.5), respectively; Z=4.593, P<0.001], Hb was significantly increased [91.5 g/L (71.8-108.2 g/L) vs 128.5 g/L (121.2-142.5 g/L); Z=4.695, P<0.001], and quality of life was significantly improved [MMAS scores were 415.0 (327.5-472.5) vs 580.0 (570.0-580.0), respectively; Z=-3.062, P=0.002] before placement compared with 6 months after placement. Three rivaroxaban dose reduction patients' PBAC scores decreased by 20 to 35 but remained >100, and perceived quality of life did not change significantly. Two cases with temporary amenorrhea treated with oral mifepristone felt significantly improved quality of life, and the MMAS scores increased by 220 and 180, respectively. Conclusion: Intrauterine Foley catheter balloon compression, aspiration or endometrial ablation could be used to control acute bleeding in patients with antithrombotic therapy-related HMB, and LNG-IUS for long-term management could reduce menstrual volume, increase hemoglobin, and improve the quality of life of patients.
Female ; Humans ; Adult ; Menorrhagia/etiology* ; Fibrinolytic Agents/adverse effects* ; Levonorgestrel/adverse effects* ; Amenorrhea/drug therapy* ; Mifepristone/therapeutic use* ; Quality of Life ; Rivaroxaban/therapeutic use* ; Hemoglobins ; Intrauterine Devices, Medicated/adverse effects* ; Contraceptive Agents, Female

OBJECTIVETo probe into the clinical manifestation, diagnosis, as well as treatment of pregnancy on the cicatrix of a previous cesarean section at the uterine isthmus in the first trimester.

METHODSAnalysis of 14 patients with pregnancy on the cicatrix of a previous cesarean section at the uterine isthmus in the first trimester was made after conservative treatment by drugs from January 1996 to December 1999.

RESULTSThe 14 patients with a pregnancy on the cicatrix of a previous cesarean section at the uterine isthmus in the first trimester were painless, had slight vaginal bleeding, and concurrently had increased serum beta-subunit human chorionic gonadotropin (beta-HCG). Doppler ultrasonic examination revealed an obvious enlargement of the previous cesarean section cicatrix in the uterine isthmus, and found a gestational sac or mixed mass attached to the cicatrice, with a very thin myometrium between the gestational sac and bladder walls. Among the 14 patients, 12 patients had crystalline trichosanthes injected into the cervix, mifepristone taken orally, or methotrexate in the form of intramuscular injection. Following this procedure, their serum beta-HCG dropped to normal. The other 2 patients had a total hysterectomy.

CONCLUSIONSPregnancy on the cicatrix of a previous cesarean section at the uterine isthmus in the first trimester is a complication of cesarean section. Early diagnosis and effective conservative treatment by drugs are instrumental in decreasing the potential occurrence of uterine rupture, which is also conducive to preserving the patient's future fertility.

Adult ; Cesarean Section ; Chorionic Gonadotropin, beta Subunit, Human ; blood ; drug effects ; Cicatrix ; complications ; diagnostic imaging ; pathology ; Female ; Humans ; Methotrexate ; therapeutic use ; Mifepristone ; therapeutic use ; Myometrium ; diagnostic imaging ; Phytotherapy ; Plant Preparations ; therapeutic use ; Postoperative Complications ; etiology ; prevention & control ; Pregnancy ; Trichosanthes ; Ultrasonography ; Uterine Rupture ; etiology ; prevention & control ; Uterus ; diagnostic imaging

To investigate the expression and implication of survivin protein and mRNA in decidua and villus and the effects of mifepristone on its expression, survivin levels in decidua and villus collected from 15 normal early pregnant women and 15 early pregnant women pretreated with 150 mg mifepristone and 400 micrograms misoprostol were assessed by immuno-histochemical techniques and reverse transcriptional-polymerase chain reaction (RT-PCR). Our results showed that survivin proteins were stained in the cytoplasm of trophoblasts and decidual cells and in the nuclei of some of the decidual glandular epithelial cells. The expression was strongest in the trophoblasts and decidual glandular epithelial cells. The expression values in the villus and decidua were (14.56 +/- 2.44) and (10.46 +/- 2.81) respectively for normal pregnant and (8.45 +/- 2.08), (7.33 +/- 1.91) for those pretreated with mifepristone respectively (P < 0.05). The transcription of survivin mRNA in villus and decidua of those pretreated with mifepristone decreased significantly compared with those in the normal pregnant women (P < 0.05). It is concluded that survivin can be expressed in the decidua and villus and mifepristone inhibits its mRNA transcription and protein expression, which could possibly be one of the factors inducing decidual and villous apoptosis.
Apoptosis ; Chorionic Villi ; metabolism ; Decidua ; metabolism ; Female ; Gene Expression Regulation ; Humans ; Inhibitor of Apoptosis Proteins ; Microtubule-Associated Proteins ; biosynthesis ; genetics ; Mifepristone ; therapeutic use ; Neoplasm Proteins ; Pregnancy ; Proto-Oncogene Proteins c-bcl-2 ; biosynthesis ; genetics ; RNA, Messenger ; biosynthesis ; genetics ; Random Allocation ; Reverse Transcriptase Polymerase Chain Reaction ; Trophoblasts ; metabolism