Intramuscular 16-phenoxy PGE2 ester for pregnancy termination

Cervical dilatation by sulprostone prior to vacuum aspiration for termination of early pregnancy

In the period May 1983-October 1986 we treated 335 primigravidae requesting an abortion in the first trimester. They were given 500 micrograms sulprostone (16-phenoxy-omega-tetranor-PGE2-methylsulfonylamide) i.m. 12 to 14 hours before suction termination in order to obtain adequate and atraumatic cervical dilatation and thus reduce the possible risk of cervical incompetence and its consequences. The effects of this technique on the uterine cervix were compared with those obtained in 100 primigravidae after the insertion of laminaria to induce atraumatic cervical dilatation. We also evaluated the normal degree of cervical dilatation before any intervention in a control group of 100 primigravidae. The results obtained with sulprostone encourage the use of this drug to minimize cervical injury. The incidence of side-effects was not particularly high.

Vaginal treatment with a prostaglandin F2 alpha derivative (alfaprostol) for inducing labor in pregnancy at term

The effectiveness and acceptability of Alfaprostol (an analog of PGF2 alpha) in inducing labor were assessed in 20 pregnant women at term. All subjects had no spontaneous uterine activity before treatment and the mean (M +/- SE) Bishop score was 2.45 +/- 0.21. The drug was administered by vaginal route at the dose of 10 mg every 3 hours. Regular uterine contractions appeared in all patients and delivery occurred in 85% of the patients after a mean time of 9h50min +/- 0h55min following the start of treatment. The mean dose of Alfaprostol utilized to achieve delivery was 29.4 +/- 2.0 mg. No major side effects were noted in the mothers and their fetuses at any time during treatment. Two patients exhibited vomiting. The Apgar score of all newborns at birth was 8 or more. These results suggest the usefulness of Alfaprostol to induce labor in pregnant women at term, as it has oxytocic activity without adverse effects on either the mother or the fetus.

The use of sulprostone to induce abortion in the second trimester

We have used a derivative of PGE2, sulprostone, to induce abortion in the second trimester of pregnancy in 26 women. 500 micrograms of sulprostone were administered i.m. every four or six hours and clinical rating of the efficiency of the treatment was done using a scale ranging from 20 to 100. FSH, prolactin, 17-beta-estradiol, progesterone, hPL and beta-hCG plasma levels were monitored during treatment. The drug was effective in 20 cases (79.9%) while in three cases additional administration of oxytocin was necessary and in three cases no effect was seen. Treatment was interrupted, due to the appearance of unpleasant side effects, in only one case. No specific variation in hormone levels was seen. In three cases in which only two doses of the drug were sufficient to induce abortion, hormone levels dropped more rapidly and to a greater extent than in the remaining cases. A correlation exist between the rate of decrease in progesterone and 17-beta-estradiol plasma levels and the time required for the treatment to induce abortion.

First and midtrimester abortion with intramuscular injections of sulprostone

An intramuscular injection of a newer PGE2 analogue (Sulprostone) was given to fifty-seven patients for a late first or second trimester abortion. The drug was injected in doses of 500 microgram every 6 hours for a maximum of 24 hours. Fifty-two patients aborted. The incidence of gastrointestinal side effects was similar to patients receiving intramuscular 15-methyl PGF2 alpha and there were no serious complications.

Biological action and half life in plasma or intramuscular sulprostone for termination of second trimester pregnancy

Sulprostone levels in plasma, platelet function and clinical effects were examined in four patients after intramuscular injection of 500 microgram sulprostone for induction of missed and therapeutic abortion in the second trimester of pregnancy. The half life of sulprostone in plasma was 34 (30-45) minutes. The highest sulprostone levels were found 10 to 20 minutes after injection (0.25-0.77 ng/ml) and after 120-240 minutes the values in plasma were no longer distinguishable from zero. Platelet count remained constant. 20 minutes after the injection platelet aggregation was slightly decreased, but not to a significant level. There was no correlation between sulprostone levels in plasma and pain of labour or induction abortion times. Side effects were minimal.

The use of sulprostone, a prostaglandin E2 derivative, in intrauterine fetal death and therapeutic abortion

The prostaglandin E2 derivative Sulprostone was used in the management of intrauterine fetal death and in therapeutic abortion in advanced pregnancy. While with extraamniotic administration there was a success rate of 50% after 24 hours, the rate of success was 86% after intramuscular administration. A cervix-ripening effect was not always observed by means of intracervical injection of Sulprostone. Such pre-treatment of the cervix did not improve the induction-abortion time after intramuscular administration of Sulprostone. Side effects were only slight following Sulprostone.

Abortion with sulprostone, a prostaglandin E2 derivative

Sulprostone, a prostaglandin E2 derivative, was used in a multicenter trial to terminate 478 pregnancies of 8-21 weeks' gestation. The compound was clinically well accepted without premedication in extraovular, intravenous and intramuscular routes of administration. At 24 hours after treatment, 67%-88% of the patients had aborted, with a low average incidence of side effects. Sulprostone is preferred clinically to primary prostaglandins. Intravenous infusion was found to be the safest route, but intramuscular injection proved to be the most practical.