Evidence-Based Evaluation and Selection of Essential Medicine for Township Health Centre in China: 20. Abortion_Chinese Journal of Evidence-Based Medicine

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Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu 610041, China;

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Keywords：

Township health center; Essential medicine; Evidence-based evaluation and selection; Abortion

DOI：

10.7507/1672-2531.20120159

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Objective 　To evaluate and select essential medicine for abortion using evidence-based approaches based on the burden of disease.
Methods 　By means of the approaches, criteria, and workflow set up in the second article of this series, we referred to the recommendations of evidence-based or authority guidelines from inside and outside China, collected relevant evidence from domestic clinical studies, and recommended essential medicine based on evidence-based evaluation. Data were analyzed by Review Manager (RevMan) 5.1 and GRADE profiler 3.6 to evaluate quality of evidence.
Results 　(1) Four guidelines on medicine for abortion were included, two of which are based on evidence. (2) Included guidelines referred to eight essential medicines used in drug abortion and four antibiotics used after abortion surgery. (3) According to WHOEML (2011), NEML (2009), CNF (2010), other guideline and the quantity and quality of evidence, we offered a b recommendation for misoprostol, mifepristone, oxytocin except prostaglandins used in abortion. (4) Published literature on oxytocin, misoprostol and mifepristone were found. Oxytocin with the dosage form and specification corresponding to guidelines has been marketed in China. Oxytocin (in vial, 10 U∶1 mL) cost 1.5 yuan/injection. Mifepristone (tablet, 25 mg×1) cost 13.0 to 27.5 yuan/tablet. Misoprostol (0.2 mg×3) cost 2.8 to 3.7 yuan/ tablet. (5) Results of domestic studies indicated that mifepristone combined with misoprostol and oxytocin was safe, efficient, convenient and applicable to the treatment of abortion.
Conclusion 　For abortion: (1) We make a recommendation for mifepristone plus misoprostol. Mifepristone (25 to 50 mg/tablet) is orally taken twice a day, continually for 2 to 3 days, the total dose of 150 mg for three days. Misoprostol (0.2 mg/ tablet) 0.6 mg is orally given on an empty stomach within 36 to 48 hours after the intake of mifepristone. (2) Oxytocin (5 to 10 U in vial) injected after delivering the placenta can reduce the volume and time of vaginal bleeding. In future, clinical study should be standardized in order to improve design and implementation quality.

Citation： LI Cuicui,LI Xianglian,LI Youping,YANG Xiaoyan,LI Honghao,WANG Yingqiang,WANG Li,SHEN Jiantong,Li Xiao,YANG Zongxia. Evidence-Based Evaluation and Selection of Essential Medicine for Township Health Centre in China: 20. Abortion. Chinese Journal of Evidence-Based Medicine, 2012, 12(8): 1024-1029. doi: 10.7507/1672-2531.20120159 Copy

1.	WHO recommendations for Induction of labour. 2011.
2.	叶寒. 紧急避孕的研究现状与发展方向. 中国妇幼保健, 2001, 16(2): 119-211.
3.	李鸿浩, 王应强, 李幼平, 等. 循证评价与遴选中国东中西部乡院基本药物系列之一: 我国东中西部8家示范乡院2010年住院疾病构成分析. 中国循证医学杂志, 2012, 12(3): 260-266.
4.	李鸿浩, 李幼平, 王莉, 等. 循证评价与遴选中国东中西部乡院基本药物系列之二: 评价标准、方法与流程研究. 中国循证医学杂志, 2012, 12(3): 347-356.
5.	乐杰. 妇产科学. 7版. 北京: 人民卫生出版社, 2008, 1: 269-272.
6.	张永芬. 药物流产与人工流产的疗效对比分析. 2012, 19(7): 49-50.
7.	文隽. 2010年人工流产手术后患者应用抗生素的调查与分析. 中国社区医师·医学专业, 2012, 14, 2: 20-21.
8.	Induced Abortion Guidelines. 2006.
9.	The Primary Health Care Standard Treatment Guidelines and Essential Medicines List. 2008.
10.	妇产科常见疾病诊疗指南. 2009.
11.	邹燕, 李幼平, 干昌平, 等. 米非司酮配伍米索前列醇行早期妊娠药物流产的有效性评价. 中国循证医学杂志, 2005, 5(8): 619-630.
12.	邹燕, 梁艳, 吴尚纯, 等. 药物流产与手术流产比较可接受性的Meta分析. 中华流行病学杂志, 2006, 27(1): 68-71.
13.	邹燕, 李幼平, 雷贞武, 等. 米非司酮配伍米索前列醇行药物流产的安全性评价. 中华妇产科杂, 2004, 39(1): 39-42.
14.	郭燕, 徐厚明, 孙晓如. 米非司酮联合米索前列醇终止妊娠Meta分析. 药物流行病学杂志, 2009, 18(4): 242-244.
15.	吴丽芳, 王小玲, 艾婷华, 等. 缩宫素在药物流产后的临床作用. 中国民族民间医药, 2008, 5: 51-52.
16.	张静, 齐鑫. 缩宫素预防药物流产后出血的临床观察. 宁夏医学杂志, 2000, 27(12): 863-864.
17.	雷瑞兰. 缩宫素用于减少药物流产后出血的疗效观察. 临床合理用, 2009, 2(10): 46.
18.	张海燕, 周桂芳. 药物流产后肌注缩宫素与阴道流血的临床研究. 中国自然医学杂志, 2008, 10(3): 219-220.
19.	Kahn JG, Becker BJ, MacIsaa L, et al. The efficacy of medical abortion: A Meta-analysis. Contraception, 2000, 61(1): 29-40.
20.	Creinin MD, Schwartz JL, Pymar HC, et al. Efficacy of mifepristone followed on the same day by misoprostol for early termination of pregnancy: report of a randomised trial. BJOG, 2001, 108(5): 469-473.
21.	Zhou R, Elul B, Winikoff B. Medical abortion in China: Results of a Fact Finding Mission. CriticalIssues in Reproductive Health, Population Council New York, 2002, 1.
22.	邱涛. 药流后阴道流血时间过长的原因研究进展. 中国计划生育学杂志, 1998, 6: 329-330.
23.	杜明昆, 朱煜, 杨福恩. 1010例妊娠11～14周人工流产的临床分析. 生殖与避孕, 1983, 3: 59.
24.	高红燕. 米非司酮配伍米索前列醇终止14～24周妊娠的临床观察. 中国计划生育学杂志, 2003, 11: 417.
25.	张碧云, 叶玲玲. 药物流产和手术流产对输卵管通畅性影响. 中国计划生育学杂志, 2003, 11: 427-429.
26.	郭艺红, 史惠荣, 荆建红. 未产妇药物流产致输卵管梗阻性不孕144例临床分析. 实用妇产科杂志, 2001, 17(1): 46-47.
27.	任凤荣, 宫玉花. 基层医院药物流产妇女生殖健康知识认知程度的调查. 护理研究, 2004, 18(6): 1049-1050.

1. WHO recommendations for Induction of labour. 2011.
2. 叶寒. 紧急避孕的研究现状与发展方向. 中国妇幼保健, 2001, 16(2): 119-211.
3. 李鸿浩, 王应强, 李幼平, 等. 循证评价与遴选中国东中西部乡院基本药物系列之一: 我国东中西部8家示范乡院2010年住院疾病构成分析. 中国循证医学杂志, 2012, 12(3): 260-266.
4. 李鸿浩, 李幼平, 王莉, 等. 循证评价与遴选中国东中西部乡院基本药物系列之二: 评价标准、方法与流程研究. 中国循证医学杂志, 2012, 12(3): 347-356.
5. 乐杰. 妇产科学. 7版. 北京: 人民卫生出版社, 2008, 1: 269-272.
6. 张永芬. 药物流产与人工流产的疗效对比分析. 2012, 19(7): 49-50.
7. 文隽. 2010年人工流产手术后患者应用抗生素的调查与分析. 中国社区医师·医学专业, 2012, 14, 2: 20-21.
8. Induced Abortion Guidelines. 2006.
9. The Primary Health Care Standard Treatment Guidelines and Essential Medicines List. 2008.
10. 妇产科常见疾病诊疗指南. 2009.
11. 邹燕, 李幼平, 干昌平, 等. 米非司酮配伍米索前列醇行早期妊娠药物流产的有效性评价. 中国循证医学杂志, 2005, 5(8): 619-630.
12. 邹燕, 梁艳, 吴尚纯, 等. 药物流产与手术流产比较可接受性的Meta分析. 中华流行病学杂志, 2006, 27(1): 68-71.
13. 邹燕, 李幼平, 雷贞武, 等. 米非司酮配伍米索前列醇行药物流产的安全性评价. 中华妇产科杂, 2004, 39(1): 39-42.
14. 郭燕, 徐厚明, 孙晓如. 米非司酮联合米索前列醇终止妊娠Meta分析. 药物流行病学杂志, 2009, 18(4): 242-244.
15. 吴丽芳, 王小玲, 艾婷华, 等. 缩宫素在药物流产后的临床作用. 中国民族民间医药, 2008, 5: 51-52.
16. 张静, 齐鑫. 缩宫素预防药物流产后出血的临床观察. 宁夏医学杂志, 2000, 27(12): 863-864.
17. 雷瑞兰. 缩宫素用于减少药物流产后出血的疗效观察. 临床合理用, 2009, 2(10): 46.
18. 张海燕, 周桂芳. 药物流产后肌注缩宫素与阴道流血的临床研究. 中国自然医学杂志, 2008, 10(3): 219-220.
19. Kahn JG, Becker BJ, MacIsaa L, et al. The efficacy of medical abortion: A Meta-analysis. Contraception, 2000, 61(1): 29-40.
20. Creinin MD, Schwartz JL, Pymar HC, et al. Efficacy of mifepristone followed on the same day by misoprostol for early termination of pregnancy: report of a randomised trial. BJOG, 2001, 108(5): 469-473.
21. Zhou R, Elul B, Winikoff B. Medical abortion in China: Results of a Fact Finding Mission. CriticalIssues in Reproductive Health, Population Council New York, 2002, 1.
22. 邱涛. 药流后阴道流血时间过长的原因研究进展. 中国计划生育学杂志, 1998, 6: 329-330.
23. 杜明昆, 朱煜, 杨福恩. 1010例妊娠11～14周人工流产的临床分析. 生殖与避孕, 1983, 3: 59.
24. 高红燕. 米非司酮配伍米索前列醇终止14～24周妊娠的临床观察. 中国计划生育学杂志, 2003, 11: 417.
25. 张碧云, 叶玲玲. 药物流产和手术流产对输卵管通畅性影响. 中国计划生育学杂志, 2003, 11: 427-429.
26. 郭艺红, 史惠荣, 荆建红. 未产妇药物流产致输卵管梗阻性不孕144例临床分析. 实用妇产科杂志, 2001, 17(1): 46-47.
27. 任凤荣, 宫玉花. 基层医院药物流产妇女生殖健康知识认知程度的调查. 护理研究, 2004, 18(6): 1049-1050.

Chinese Journal of Evidence-Based Medicine

Evidence-Based Evaluation and Selection of Essential Medicine for Township Health Centre in China: 20. Abortion

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