Administration Of Gemeprost Research Articles

Outcomes and complications of second-trimester induction of labor using laminaria and gemeprost: A single-center experience in Japan.

To document the outcomes of second-trimester induction of labor with laminaria cervical dilation followed by gemeprost vaginal tablets, with a particular emphasis on its complications. This was a single-center retrospective cohort study of women who experienced medical abortions between 12 and 21 weeks of gestation from January 2016 to July 2021. Procedures were performed with three laminaria cervical dilation for 2 days followed by the administration of gemeprost (1 mg, vaginal tablet) every 3 h with a maximum of five tablets per day. Epidural anesthesia was provided upon request. The primary outcome was successful labor induction, which was defined as fetal expulsion without assisted surgical procedures. Other maternal outcomes, complications and related interventions during and after the procedure were assessed. Among 319 women, 313 (98.1%) experienced successful labor induction with a median of one gemeprost tablet. The median blood loss during the abortion was 145 mL, and three women (0.9%) required blood transfusion. Fever was observed in 19 women (6.0%) during hospitalization, although most cases were drug fever. Thirteen women (4.1%) had abnormal uterine bleeding ~24 days after the abortion. Eleven cases (3.4%) were associated with retained products of conception, of which three cases required uterine artery embolization and three needed surgical curettage. Second-trimester induction of labor with laminaria cervical dilation and subsequent gemeprost vaginal tablets is a reliable method for completing medical abortions. Abnormal uterine bleeding several weeks after abortion is suspected to be a retained product of conception that could require invasive treatment.

Effects of a prolonged, 72 hours, interval between mifepristone and gemeprost in second trimester termination of pregnancy: a retrospective analysis

Objective: To evaluate if the 72 hours interval between mifepristone and gemeprost has a similar efficacy compared to the 48 hours interval for second trimester termination of pregnancyStudy Design: Two-hundred and fifteen consecutive pregnant women, admitted to our hospital, for second trimester TOP, were included in this retrospective analysis. Standard protocol was followed for all patients. On the first day of the procedure oral mifepristone 200 mg was administered. After 72 (group A, n = 78) or 48 hours (group B, n = 113) women were admitted for administration of gemeprost 1 mg pessary as per protocol. The induction to abortion time was defined as the interval between the insertion of the first gemeprost pessary and the expulsion of the fetus.Results: There are no significant differences in the number of pessaries in the two groups. The induction to abortion interval was longer in group A than in group B. Twenty-one women required surgical evacuation of the uterus for retained placenta or incomplete abortion without difference between groups.Conclusion: A 48-hours interval between mifepristone and gemeprost leads to better results than a 72-hours interval, with a shorter abortion length and represents the elective method for second trimester TOP.

A study of gemeprost alone, dilapan or mifepristone in combination with gemeprost for the termination of second trimester pregnancy

It is well established that abortion can be induced successfully in midtrimester of pregnancy by gemeprost vaginal pessaries. A randomised study was carried out to determine the efficacy of mifepristone and dilapan in combination with gemeprost for second trimester termination between 12–18 weeks' gestation. A contemporary group of women treated with gemeprost alone was used as a control group. A single course of 4 × 1 mg gemeprost pessaries was administered every six hours. If abortion had not occurred after 24 hours, a further course of 5 × 1 mg pessaries was administered every three hours over the next 24 hours. In the first twenty hours after administration of gemeprost, 95%, 85% and 72% of women aborted in the mifepristone, dilapan and the control group, respectively. The median induction-abortion interval in the mifepristone group (6.6h) was significantly shorter than the other two groups and fewer pessaries were required to induce abortion. The incidence of diarrhoea and vomiting was lower in the mifepristone than the other two study groups. This study demonstrated the efficacy of mifepristone in combination with gemeprost and this regimen is associated with fewer gastrointestinal side effects.

Uterine rupture in midtrimester abortion. A complication of gemeprost vaginal pessaries and oxytocin. Case report

The 1st reported case of uterine rupture in pregnancy termination associated with the administration of gemeprost and oxytocin involved a 24-year-old UK women with 3 previous uncomplicated pregnancies. Pregnancy termination, performed at 16 weeks of gestation, involved the insertion of 1 mg gemeprost vaginal pessaries into the posterior fornix at 3-hour intervals. A total dose of 5 mg of gemeprost was administered in the 1st 24 hours. Another treatment course was instituted the following day, and the patient's cervix remained closed despite the onset of contractions and slight vaginal bleeding. During the 2nd course of 5 pessaries, the patient also received 4 15 mg doses of intramuscular papaveretum. On the 3rd day, a intrauterine pregnancy was visible on ultrasound scan, but no fetal heartbeat was detected. A total dose of 50 IU of oxytocin was then administered over a 22-hour period. The diagnosis of uterine rupture was made on day 4 when vaginal examination revealed a large bulging lower uterine segment anteriorly and a closed cervix posteriorly. The patient's hemoglobin concentration had fallen from an admission value of 11.4 g/dl to 6.5 g/dl. Laparotomy revealed a large left broad ligament hematoma extending anteriorly into which the fetus had been extruded. Total abdominal hysterectomy was required. The uterine rupture is assumed to have occurred during the 2nd course of gemeprost. The absence of previously reported cases of gemeprost-associated uterine rupture may reflect the rarity of this method of pregnancy termination in the 2nd trimester.

Prostaglandins and antiprogestins.

There is considerable interest in the development of a non-surgical method to terminate early pregnancy. During the three weeks immediately following the first missed menstrual period, several prostaglandin (PG) analogs such as sulprostone, gemeprost and 9-methylene PGE2 have been used to terminate the pregnancy. Prostaglandins, however, at the doses required to induce disruption of the conceptus cause gastrointestinal side effects and uterine pain which are more severe than those subsequent to vacuum aspiration. Treatment with the antiprogestin, mifepristone counteracts the effects of progesterone in pregnancy and thus prevents maintenance of the pregnancy. Mifepristone administered alone causes termination of the pregnancy in most, but not all, cases. In addition to removing the influence of progesterone, mifepristrone also induces regular uterine contractions and significantly increased the sensitivity of the uterus to PG analogs. Mifepristone (50 mg/day) followed by an intramuscular injection of a low dose, (0.25 mg), of sulprostone (approximately 1/6 of the dose of prostaglandin necessary to induce abortion if used alone) was highly effective in terminating early pregnancy, causing complete abortion in 94% of cases. Gastrointestinal side effects were rare and uterine pain significantly less common than if PG analogs were used alone. Subsequently the combination of mifepristone and vaginal administration of gemeprost (0.5-1.0 mg) has been shown to be equally effective Ideally, the PG analog would be administered orally rather than by injection or vaginal administration. Preliminary data indicate that 9-methylene PGE2 but not PEG2 may be suitable for this purpose in combination with mifepristone.(ABSTRACT TRUNCATED AT 250 WORDS)

Sulprostone (Nalador ™) versus gemeprost (Cervagem ™) for cervical priming in the termination of pregnancy during the first trimester

The activity and side-effects of the prostaglandin derivatives, sulprostone and gemeprost were compared, 188 patients were studied, 90 receiving sulprostone 500 μg intramuscularly 16 hours pre-operatively and 98 receiving gemeprost 1 mg intravaginally 4 hours pre-operatively. Dilatation of the cervix of more than Hegar 8 was obtained in 80 per cent of the sulprostone group and in about 50 per cent in the gemeprost group. On dilatation before vacuum aspiration, little or no resistance was detected in nearly 80 per cent of both groups. Side-effects occurred in 39.3 per cent of the sulprostone group (usually abdominal pain), and in 22.6 per cent of the gemeprost group and here again abdominal pain was predominant. The results showed that with both sulprostone and gemeprost satisfactory dilatation of the cervix could be obtained. The somewhat better results with sulprostone are obtained at the expense of a higher incidence of side-effects. The administration of gemeprost was also better tolerated by the patients.

The Effect of Gemeprost on the Pressor Response to Angiotensin II in Pregnant Women

Vaginal pessaries of gemeprost were administered for evaluation of the vascular responsiveness to angiotensin II in the second trimester pregnancy. The mean arterial blood pressure and the vasosensitivity to A-II measured before and after the administration of gemeprost showed no significant change. This prostaglandin El analogue was found to be effective and convenient, and all side effects were mild and reversible. The second trimester pregnancy complicated with pregnancy-induced hypertension