Termination of second trimester pregnancy with laminaria and intramuscular 15-methyl PGF 2α or 16-phenoxy-ω-17,18,19,20-tetranor PGE 2 methylsulfonylamide. A randomized multicenter study

Abstract

The present study included 592 second trimester healthy informed patients admitted to the participating hospitals for termination of pregnancy. In each patient one medium size laminaria tent was introduced into the cervical canal. The laminaria was withdrawn 12 h later and the patients were randomly allocated to either intramuscular injections of 15-methyl-PGF 2α (Prostin 15M), 0.25 mg every second hour, or 16-phenoxy-ω-17,18,19,20-tetranor PGE 2 methyl sulfonylamide (Nalodor), 0.5 mg every fourth hour. Both treatment schedules were equally effective. The success rate was 95.6% and 94.5% for the E and F analogs, respectively, within 24 h of prostaglandin treatment. The mean duration of prostaglandin treatment was for Nalodor 10.8 h and for Prostin 15M 11.3 h. The mean total dose given of the two analogs was 1.85 mg and 1.65 mg, respectively. With the E analog, the frequency of gastrointestinal side effects was significantly lower than with the F analog. With the former compound, 83.2% had no episodes of diarrhea and 58.9% no vomiting. The mean number of episodes of vomiting and diarrhea per patient was for the E analog 1.0 and 0.4, respectively. The corresponding figures for the F analog were 2.3 episodes of vomiting and 2.2 episodes of diarrhea per patient. Only in three patients (0.5%) cervical laceration was found. It may be concluded that intramuscular administration of either analog after pretreatment with laminaria would appear to be more effective than other methods presently in use for termination of second trimester pregnancy. The simplicity of the therapy is of practical importance and may result in a decreased risk of serious complications. With the E analog gastrointestinal side effects are only sightly more common than previously found with hypertonic saline administered intra-amniotically.