Abortifacient efficiency of 15 (S) 15-methyl-prostaglandin F2alpha-methyl ester administered vaginally during early pregnancy

Ectopic pregnancy among early abortion patients: does prostaglandin reduce the incidence?

The availability and efficacy of prostaglandin (PG) F2 alpha and E series analogues has prompted their frequent use for pregnancy interruption. In the course of evaluating our experience with PGs for interrupting early first trimester gestations, we became increasingly impressed by the absence of any with extrauterine pregnancy. A review of 63 reports encompassing 2,965 patients whose pregnancies were less than 8 weeks' gestational age dating from the last menstrual period and who were similarly treated yielded only 2 cases of ectopic pregnancy. When compared with the generally accepted ectopic gestation rates of the order of 1 in 200 pregnancies, this frequency of 1 in 1,483 is unexpectedly low. Preselection does not appear to explain this impressive discrepancy. If the observation proves correct, it implies that PGs have some form of therapeutic effect in eradicating extrauterine pregnancy by nonoperative means. The implications are obvious in terms of its potential therapeutic benefits.

Termination of early first trimester pregnancy with 16,16-dimethyl trans delta 2 prostaglandin E1 methyl ester

Thirty healthy women with early first trimester pregnancy applying for legal abortion were given five vagitories containing 1 mg 16,16-dimethyl-trans delta 2 prostaglandin E1 (16,16-dimethyl PGE1). They were instructed to take one vagitory every third hour. The treatment was evaluated at follow-up visits after one, two and four weeks. Complete abortion was recorded in 27 cases. The pregnancy test was still positive after two weeks in three women, who underwent surgical termination, and were recorded as failures. The most common side-effects were bleeding, pain and gastrointestinal symptoms. No serious side-effects were recorded. Repeated administration of vagitories containing 1 mg 16,16-dimethyl PGE1 seems to be a safe and effective method of "menstrual extraction". The efficacy should be increased and the rate and intensity of side effects decreased if "menstrual extraction" is to compete with conventional dilatation and curettage.

Termination of very early pregnancy by vaginal suppositories-(15S)-15-methyl prostaglandin F2 alpha methyl ester

A new approach to terminate very early pregnancy was tried on 49 healthy women who were proven to be pregnant from 31 to 47 days from their last menstrual period. All pregnancies were confirmed either by UCG or serum HCG-B subunit. (15S)-15-Methyl PGF2 alpha Methyl Ester in a suppository form was administered in two separate doses: 1.0 mg initial dose followed by 3.0 mg one hour later. Patients were kept under observation for 8 hours. Blood sampling for progesterone, HCG-B, and prostaglandin levels were assayed at 0 degree, 30', 1 degree, 4 degrees, 8 degrees and 14 days. Patients were re-examined at a two week follow-up visit. Pelvic examination and pregnancy tests were performed to confirm whether the pregnancy was successfully terminated. There were no significant changes in serums progesterone and HCG-B levels during the 8-hour observation period. Both levels declined significantly to very low levels at 14 days post-therapy, confirming the clinical impression of successful termination of pregnancy. Plasma prostaglandin levels rose as early as 30 minutes after initiation of therapy, peaked at 4 hours and declined gradually afterwards. Most side effects such as nausea, vomiting, diarrhea and cramps, although clinically manageable, were still bothersome. One patient experienced an episode of vasovagal syncope. The majority of patients required medical observation up to 6 hours. Clinical implications of this new approach of termination of very early pregnancy are discussed.

The use of prostaglandin E1 analogue pessaries in patients having first trimester induced abortions

A new prostaglandin analogue, 16,16-dimethyl=trans-delta 2-PGE1 methyl ester (16 me E1) was used for preoperative cervical dilatation in 23 pregnant women who had abortion induced for socio-economical reasons in the first trimester of pregnancy. A single vaginal pessary containing 1 mg 16 me E1 was inserted into the posterior fornix at 3-hour intervals. Thirteen (56.5 per cent) of the 23 patients had complete abortions and two patients (8.7 percent) had incomplete abortions. In six patients (26.1 per cent) the cervix was dilated to at least 10 mm and the remaining two patients (8.7 per cent) required mechanical dilatation at the time of vacuum evacuation. Apart from mild gastrointestinal symptoms, no serious side effects were noted. It is concluded that the new prostaglandin analogue, 16 me E1, could be used safely and effectively for preoperative dilatation of the cervix before surgical abortion in early pregnancy.

Ultrasonic assessment of uterine emptying in first-trimester abortions induced by intravaginal 15-methyl prostaglandin F2 alpha methyl ester

Early first-trimester abortions were induced by a single intravaginal pessary containing 3 mg of 15 methyl prostaglandin F2 alpha methyl ester in 17 patients. The procedure was successful in 16 patients (94%). Intrauterine events were observed by means of serial ultrasonic B scans. Pain, bleeding, and dislodgement of the gestational sac had commenced within 6 hours. Significant gastrointestinal side effects occurred in the majority of patients despite medication but they were usually of short duration. Vaginal bleeding, which was not heavy, continued for about 10 days and during most of this time the uterus contained products of conception. It is concluded that the method is effective during the first 7 weeks of gestation.

Termination of early pregnancy by a single-dose 3.0 mg 15-methyl PGF2alpha methyl ester vaginal suppository

The abortifacient effect of a single-dose, long-acting vaginal suppository containing 3.0 mg of 15-methyl PGF2 alpha methyl ester was investigated in 104 early pregnancies. The pregnancy was terminated in 91 per cent of the cases. The abortion was uncomplicated in 79 patients, while 12 patients experienced prolonged bleeding. In 21 uncomplicated cases, VabraR curettage done 4 weeks after therapy revealed necrotic residual tissue in 16 patients and nonspecific endometritis in 20 patients. Residual tissue was found in about 50 per cent of the patients curettaged after 1st menstruation, but no residua was found after 2nd menstruation. In patients with prolonged bleeding, substantial amounts of necrotic residual tissue was found in all patients curettaged 4 weeks after therapy. The decline of serum hCg and plasma progesterone levels was significantly slower in these patients as compared with uneventful abortions.

15(S)15-methyl prostaglandin F2alpha for termination of very early human pregnancy. A comparative study of a single intramuscular injection and vaginal suppositories

The results of a comparative study of the efficacy and acceptability of 15(S)15-methyl prostaglandin F2alpha (15-Me-PGF2alpha) administered as a single i.m. injection or vaginal suppositories (15-Me-PGF2alpha methyl ester) every 3rd hr for termination of very early human pregnancy is reported. The amenorrhoic period varied from 37 to 60 days. Group I (30 cases) received 0.6 mg as a single i.m. injection without any pretreatment. Retrospectively 24 of the 30 women were in fact pregnant and 22 of them aborted. Group II received suppositories (1.0 or 1.5 mg per suppository). In this group all women were pregnant and they all aborted. Symptoms such as pain, bleeding, vomiting and diarrhea started in general earlier in the i.m. group and they were more marked. In the present series the efficacy and acceptability were highest for the vaginal route of administration.

Induction of abortion with 15(S)-15-methyl PGF2alpha (Tham) vaginal suppositories

The repeated administration of vaginal suppositories containing 1 mg 15(S)-15 methyl PGF2alpha (Tham) sucessfully induced abortions in 60 of 62 patients. Among patients who successfully aborted, the mean abortion time was 19.0 hours. The mean abortion time was not related to gestational age or parity. Sixty (96.8 precent) aborted within 48 hours, and 53 (85.5 percent) aborted within 24 hours. Gastrointestinal side effects occurred for 33.9 percent of the patients. Diarrhea was the most frequent side effect. The abortion was complete for 40.3 percent of the patients.