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

The use of 16,16-dimethyl-trans-delta 2 prostaglandin E1 methyl ester vaginal suppositories for management of missed abortion and fetal death

The effect of vaginal administration of a PgE1 analogue to terminate missed abortion and fetal death in utero was evaluated in 62 women with gestation ranging from the 13th to the 37th week. Abortion occurred in 85.4% of women with missed abortion and in 86% of women with fetal death. In both groups, the mean induction time was less than 12 h. The incidence of side effects, primarily gastrointestinal symptoms, was infrequent.

Morphologic study of changes of collagenous tissue in the amnion and cervix during prostaglandin-induced abortion and delivery

Marked dissociation of the cervical collagenous tissue during prostaglandin-induced abortion is well recognized, but the response of collagenous tissue of the amnion to prostaglandin treatment is not known. A morphologic study of amniotic collagenous tissue was performed after prostaglandin-induced abortion and prostaglandin-induced term delivery. The collagenous fibers of the amnion were found to be closely packed with no ground substances and formed in a thick layer. Cervical collagenous tissue of the same patients showed a marked dissociation of fibers and abundant ground substance. The fetus was often delivered within a complete sac at midtrimester. These findings suggest differences in collagenous tissue responses to prostaglandin treatment between the amnion and cervix.

Preoperative cervical dilatation for first trimester induced abortion: comparison of two prostaglandin analogues

The present study compares two methods of local application of prostaglandins prior to surgical abortion in the first trimester. Fifty patients were treated with a vaginal tablet of Gemeprost (E1 analogue); 50 others by the intra-cervical application of PGF2 alpha gel. Gemeprost was found to be superior to the PGF2 alpha gel. Several hypotheses are formulated to explain this observation. The side effects of the two methods are compared and discussed.

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.

The effect of exogenous hormones on the resistance of the early pregnant human cervix

The force required to dilate the cervix to a diameter of 8 mm (cervical resistance index) has been measured in 355 patients undergoing suction termination in the first trimester of pregnancy. The cervical resistance index (CRI) was significantly lower in multigravid patients compared with primigravid patients. Prior treatment with prostaglandin E2 pessaries produced a consistent reduction in CRI in multigravidae but not in primigravidae. The effect of the prostaglandin was more pronounced on the compliance of the cervical tissue than on the diameter of the cervical canal. Treatment with pessaries of oestradiol, progesterone and medroxy-progesterone acetate produced no changes in the CRI.

Pre-operative cervical dilatation in termination of first trimester pregnancies using 16, 16-dimethyl-trans-delta 2 PGE1 methyl ester vaginal pessaries

The effect of a prostaglandin E1 analogue on the cervix prior to termination of first trimester pregnancy was studied in a double-blind placebo-controlled trial with 70 primigravid and 125 multigravid patients in the Hong Kong University Gynaecological Unit. One mg of 16, 16-dimethyl-trans-delta 2-prostaglandin E1 methyl ester (ONO 802) in the form of vaginal pessary was inserted 3 hours before vacuum aspiration. The cervical dilatation in patients receiving ONO 802 pessaries was significantly greater than that in patients who received no treatment or placebo pessaries but the difference in dilatation between patients who received no treatment or placebo was not significant. The blood loss during operation in patients receiving ONO 802 pessaries was also significantly less than that in patients receiving placebo pessaries. The side effects due to ONO 802 pessaries were mild and infrequent.

Abortifacient effect and uterine cervix-dilating action of 16, 16-dimethyl trans delta 2 PGE1 methyl ester (ONO 802) in the form of a vaginal suppository (a randomized, double-blind, controlled study in the second trimester of pregnancy)

A newly synthesized 16, 16-dimethyl trans delta 2 PGE1 methyl ester (ONO 802) was clinically applied in the form of a vaginal suppository for therapeutic abortion of second trimester pregnancies. Its effects were studied in a double-blind test comparing it with an inactive placebo suppository. The study was conducted at 12 Japanese university hospitals. The number of patients was 125 in total, i.e. 63 receiving ONO 802 vaginal suppository (containing 1.0 mg ONO 802) and 62 receiving inactive placebo suppository. ONO 802 was more effective than placebo with a success rate of 87% (complete (71%) and incomplete (16%) abortions). The onset of uterine contractions was observed in 154.3+/-18.1 min. and the onset of uterine bleeding in 323.6+/-41.0 min. The expulsion of the fetus and placenta was observed in 955.4+/-97.0 and 961.6+/-97.0 min., respectively. The cervix dilating effect of ONO 802 was observed in 63.5% of the patients at 3 hours after the start of administration. Nausea, vomiting, abdominal cramps, diarrhea and pyrexia were noticed. However, all these side effects were transient and mild, requiring no treatment. No abnormality was observed in the puerperal course, duration of uterine bleeding or onset of subsequent menstruation following the therapeutic abortion. Therefore, the present study demonstrated that ONO 802 vaginal suppository was an effective and valuable drug for therapeutic abortion of second trimester pregnancies.

Prostaglandin E2 pessaries to facilitate first trimester aspiration termination

Using a double blind administration protocol, the effect on the cervix of prostaglandin E2 (PGE2) vaginal pessaries inserted one to six hours before aspiration termination of pregnancy has been assessed. Pessaries containing 10 mg of PGE2 produced significant cervical softening and dilatation compared with those containing only 5 mg of PGE2 or placebo, the effect was almost as good as 15 mg of PGE2 but the lower dose caused fewer gastro-intestinal side-effects and uterine cramps. Blood loss at abortion and in the early post-abortal recovery period was significantly reduced following PGE2 treatment compared with placebo. The method described is simple and effective in reducing difficult cervical dilatation and is appropriate for day-care abortion management.