Induced abortion in the second trimester by intra-amniotic administration of PGF2 alpha

A group of 15 women between the ages of 24-45 were given intraamiotic does of 40 mg of prostagladin F2alpha (PGF2alpha; Enzaprost) in a single dose so as to terminate pregnancy. These pregnancies, between the 15th- 24th weeks, were terminated for medical reasons. 12 hours elapsed between the time of intraamniotic administration and the appearance of labor pains, with the average being 9 hours. Labor lasted between 3-19 hours, with the average being 9 hours. The authors found that the time which lapsed between PG administration and the onset of labor was longer among multiparas but the length of labor was extended in primigravidae; the difference was not statistically different. The procedure was considered successful in all cases as there was no need to use other methods. Complications were not observed and there were no side effects connected with the intravenous administration of the PGs. (author's modified)     

Priming and medical abortion induction by PGF2 alpha

In the Dept. of Obstetrics of the Gera district hospital prostaglandin F2 alpha has been applied for priming and therapeutic abortion since 1979. A total of 600 women, among them 482 primigravidae, 47 with missed abortion and 71 having been admitted on behalf of the abortion panel's decision, underwent therapeutic abortion. Age distribution, clinical course, unwanted side effects and early complications after intracervical-extraamnial instillation of 5 mg prostaglandin F2 alpha have been investigated. Application of prostaglandin F2 alpha can be considered the method of choice in particular when therapeutic abortion is indicated in younger women or in patients showing suspect findings in cervical smear cytology.     

Clostridial sepsis after abortion with PGF2alpha and intracervical laminaria tents--a case report.

A case of clostridial endomyometritis and sepsis necessitating total abdominal hysterectomy which occurred 12 hours following abortion induced with intraamniotic administration of prostaglandin F2 alpha and laminaria tent insertion is discussed. Cultures from cervical, blood, and surgical specimens all yielded Clostridium perfringens. Intrauterine contamination with this microorganism most likely followed the insertion of laminaria tents through the cervical os, which was colonized with C. perfringens. Since C. perfringens may be present in the microflora of the lower female genital tract, great care must be taken to cleanse this area prior to intracervical laminaria tent insertion.     

Induction of abortion by PGF2 alpha in the second trimester of pregnancy

The Authors evaluate the efficacy of the intravenous infusion of PGF2 alpha in the induction of abortion in the second trimester of pregnancy with live fetus (Italian Law no. 194/1978). Abortion occurred in 3 out of 11 (27.27%) nulliparous patients, and uterine curettage was necessary in 2 cases. The interval between administration of the drug and the beginning of uterine contractions was 31.42 +/- 14.15 minutes (range 10 to 35 minutes), the duration of infusion was 7.55 +/- 3.64 hours (range 7 to 9.15 hours), the interval between initiation of infusion and delivery was 8.10 +/- 2.60 hours (range 7 to 9.45 hours), and the dose administered was 20.23 +/- 3.75 mg (range 15 to 25 mg). Side effects were reported in 10 cases (90.90%), and in 5 cases these effects were caused by interruption of infusion. Abortion occurred in 7 out of 13 pluriparous patients (53.84%), and uterine curettage was necessary in 4 cases. The interval between administration of the drug and the beginning of uterine contractions was 20 +/- 12.24 minutes (range 20 to 45 minutes), the duration of infusion was 8.26 +/- 0.9 hours (range 3.10 to 16 hours), the interval between initiation of infusion and delivery was 8.40 +/- 0.8 hours (range 3.0 to 9.6 hours), and the dose administered was 19.28 +/- 5.34 mg (range 5 to 25 mg). Side effects were reported in 11 cases (84.61%), and in 6 cases these effects were caused by interruption of infusion.(ABSTRACT TRUNCATED AT 250 WORDS)     

Vaginal administration of PGE2 for induction of labor stimulates endogenous PGF2 alpha production

Prostaglandin E2 is effective for induction of labor but many preparations exist using a variety of vehicles from which the active ingredient may not be equally available. Plasma concentrations of bicyclic PGE2 metabolite (PGEM) and 13, 14-dihydro, 15-keto PGF2 alpha (PGFM) were measured following administration of a 3mg PGE2 vaginal tablet or 1mg PGE2 vaginal gel to twenty-four parous women with favorable induction features, randomly allocated to receive one or other preparation. PGEM increased rapidly following both administration of the 3mg PGE2 vaginal tablet and the 1mg PGE2 vaginal gel, reaching a peak within 40 minutes of PGE2 administration. The maximal rise in PGEM in the gel group correlated directly with the change in cervical score and inversely with the need for augmentation with oxytocin and the induction-delivery interval. A secondary rise in PGFM was noted in both groups 3-4 hours following PGE2 administration. The magnitude of the increase in PGE2 may be important in the clinical response to PGE2 administration, while PGE2 absorption may switch-on endogenous PGF2 alpha production, similar to what is seen in spontaneous labor.     

Termination of second trimester pregnancy with gemeprost vaginal pessaries and intra-amniotic PGF2 alpha. A comparative study

152 women admitted for legal abortion in the second trimester of pregnancy were included in an open, randomized, controlled six-centre study. 75 patients received gemeprost 1 mg vaginal pessaries at 3 hours intervals up to a maximum of 5 mg and 66 patients were treated with a single 40 mg intra-amniotic dose of PGF2 alpha. The 24-hour success rate was 81% (n = 61/75) in the gemeprost and 64% (n = 42/66) in the PGF2 alpha group (p less than 0.02). The mean abortion times were 14.3 and 14.8 hours in the gemeprost and the PGF2 alpha groups, respectively. The mean time to onset of pain was shorter and more patients experienced blood loss over 100 ml during the induction in the PGF2 alpha group than in the gemeprost group (p less than 0.02). Apart from that, the nature and severity of side effects were comparable between the two groups. Besides significantly better efficacy, the non-invasive gemeprost treatment was found to be easier and safer as compared to the PGF2 alpha treatment.     

Experience with intra-amniotic prostaglandin F2 alpha for abortion

132 physically health patients (aged 12-41 years; 12-21 weeks gestation) were given intraamniotic PGF2alpha (prostaglandin F2alpha) for induction of midtrimester abortion. Analgesic agents and antiemetics were administered intramuscularly as needed. The patients were grouped as follows: 1) Group A (n=48), those who were given an initial dose of 25 mg PGF2a, then as needed; 2) Group B (n=43), initial dose of 30 mg, 25 mg at hour 6-8, and 25 mg at hour 24; 3) Group C (n=17), initial dose of 40 mg, subsequent 40 mg if unaborted at hour 24; and 4) Group D (n=24), initial dose of 40 mg, 10-25 mg at hour 6-8, additional 20 mg if unaborted at hour 24. A 94.7% incidence of abortion was achieved. In Group A, 29 had complete abortion, 16 incomplete, and 3 failures. Group B had 32 complete abortions, 8 incomplete, and 3 failures. Group C had 9 complete, 7 incomplete, and 1 failure. Corresponding figures for Group D were 19, 5 and 0 respectively. Average time to abortion ranged from 13 hours 22 minutes to 25 hours 33 minutes. The primary side effects of PGF2a were gastrointestinal (vomiting, diarrhea). 70% of patients vomited and 13.6% became febrile. Serious complications included sepsis, systemic reaction to prostaglandin, and cervical laceration. Advantages of intraamniotic PGF2a include ease of administration; generally short injection-abortion time; and its ability to induce myometrial contractions regardless of gestational size. However, the safety, convenience, and acceptability of PGF2 are yet to be established. The following guidelines are suggested for minimizing complications: 1) a test dose of 2.5 mg should be administered slowly over at least 1 minute, 2) fever should not be attributed to drug reaction but considered as suggestive evidence of developing infection, 3) patients unaborted at hour 24 should be considered as high risk with respect to potential failure to abort, development of infection, or cervical laceration, and 4) cervical inspection should be performed, especially in the nulliparous patient with a later gestation and a long labor.     

The induction of midtrimester abortion with intra-amniotic prostaglandin F2alpha. A single-dose technique

30 healthy women between 14-37 and between 14-20 weeks' gestation were administered with a single injection of 40 mg of PGF2 alpha over a 5 minute period to induce abortion. 28 patients aborted within 48 hours; 14 aborted completely and 14 required surgical removal of the placenta; 1 patient required intravenous oxytocin, and 1 failed to abort within 48 hours. The mean instillation to abortion interval for multiparas was 18.6 hours, for nulliparas it was 32.2 hours. Only 1 patient had excessive bleeding, 3 had syncopal episodes, 9 experienced vomiting, 3 diarrhea, and 3 diarrhea, nausea, and vomiting. A single injection of PGF2 alpha seems superior to intraamniotic hypertonic saline solution administration alone, and is effective as administration of hypertonic saline and intravenous oxytocin. The multiple dose technique of PG administration does reduce the mean abortion time, but entails an increased incidence of gastrointestinal side effects and requires repuncture or the use of an indwelling catheter, which may increase the incidence of infection. The mode of administration described can be used in selected patients when hypertonic saline solution is contraindicated.     

A comparison of PGE2 and PGF2 alpha vaginal gel for ripening the cervix before induction of labour.

The efficacy of a vaginal gel containing either 5 mg prostaglandin E2 (PGE2) or 25 mg prostaglandin F2 alpha (PGF2 alpha) to ripen the unfavourable cervix for labour induction was assessed in a double blind trial. PGF2 alpha, compared with PGE2, had little effect upon the clinical state of the cervix, but the resultant duration of labour in each of the two groups was shorter than in a control group. While the numbers of patients requiring oxytocin stimulation of labour and regional analgesia were reduced in both groups compared with the controls, PGF2 alpha was much less effective than PGE2. Uterine hypertonus was observed using both prostaglandins during an experimental study and the implications are discussed.     

Mid-trimester therapeutic abortion by intra-amniotic prostaglandin F2 alpha and concomitant oxytocin

The routine use of intra-amniotic PGF2 alpha and concomitant intravenous oxytocin for second trimester induced abortion is evaluated in 274 consecutive cases. Eighty-five per cent of the nullipara and 90 per cent of the parous women aborted within 24 hours and all but one within 48 hours following a single intra-amniotic dose. Doses were 40 or 50 mg PGF2 alpha and the mean induction-abortion interval was not shortened by the higher dose. Neither did gestational age have any effect on abortion time. Postabortum haemorrhage occurred in 22 cases in spite of routine curettage. Parametritis was reported in eight cases. In two nullipara, cervical tears were observed, in one case forming a persisting fistula to the uterine cavity. There were no significant toxic side effects to the administration of PGF2 alpha or oxytocin. It is concluded that the method has not been superseded with regard to efficacy of abortion induction and that the rate of more serious complications is not above what can be expected from any other available method of second trimester pregnancy termination.     

Catecholamines during therapeutic abortion induced with intra-amniotic prostaglandin F2alpha

Serial plasma, amniotic fluid, and urine samples were analyzed for epinephrine (E) and norepinephrine (NE) in eight subjects during midtrimester abortion induced by intra-amniotic prostaglandin F2alpha (PGF2alpha). After PGF2alpha administration, plasma E increased and there was no change in plasma NE levels. Amniotic fluid levels of E and NE decreased initially. During the course of abortion the mean level of E in the amniotic fluid increased after fetal distress and decreased after fetal death, indicating that the midtrimester fetus of both E and NE increased following PGF2alpha. The observation that mean plasma levels and urinary excretion rate changes correlated better with the course of abortion and uterine contractility rather than with the time of PGF2alpha administration was consistent with the hypothesis that the catecholamine response may be due to the stress of labor rather than to the PGF2alpha per se.