Second trimester abortion using laminaria tents followed by 16, 16-dimethyl-trans-delta2-prostaglandin E1 methyl ester gemeprost for missed abortion and for legal abortion.

Abstract

In an effort to reduce the side effects associated with use of prostaglandins for 2nd-trimester abortion, some prostaglandin analogues with abortifacient agents have been synthesized and subjected to clinical trials. 1 such synthetic analogue, Gemeprost, is effective in 1st and 2nd-trimester abortion without cervical dilatation when laminaria tents are used. This study examined the efficacy of gemeprost in 2nd-trimester missed abortion (10 women) and in normal pregnancies selected for legal abortion (10 women). Laminaria tents were inserted for 10 hours and then removed. At this point, a vaginal pessary containing 1 mg of gemeprost was inserted in the posterior fornix every 3 hours until the uterine contents were expelled. Gemeprost was most effective in the missed abortion group (8/10 cases of complete abortion compared to 4/10 cases of complete abortion in the normal pregnancies). The mean induction-delivery interval was shorter (223 minutes) in the missed abortion group than in the legal abortion group (396 minutes), even though the mean number of laminaria tents used was smaller in the former group (3 versus 8). The total dose of gemeprost per mcg/kg of body weight was also less in the missed abortion group (mean of 26.1) than in the legal abortion group (36.4). 9 of the 20 patients reported side effects, predominantly diarrhea, but all were reversible and mild. The overall complete abortion rate in this study was 60%. It is concluded that gemeprost used after laminaria is convenient, safe, and effective for the termination of 2nd-trimester pregnancy especially in cases of missed abortion.