Induction-abortion Interval Research Articles

Further acceptability evaluation of RU486 and ONO 802 as abortifacient agents in a Chinese population

Of 144 consecutive women who requested early induced abortion, 99 (68.7%) and 45 (31.3%) women chose RU486 combined with ONO 802 (medical method) and suction evacuation (surgical method), respectively. Logistic regression analysis of covariates showed that age and marital status were significantly correlated with the acceptability and hence the choice of the medical method. There were also more working women in this medical group. Previous experience of induced abortion had no influence on the current choice of the abortion method. This group of women appeared to have a tendency of treating their disease with medication rather than with surgery if the condition would allow. They expressed fear about surgery. The long induction-abortion interval of three days will have to be tolerated, but the duration of bleeding should be minimised in order to improve the acceptability of the drug. RU486 is an alternative abortion method which should be made widely available.

Termination of second trimester pregnancy with sulprostone and mifepristone: A randomized double-blind placebo-controlled trial

A prospective randomized double-blind placebo-controlled trial was conducted in 13 subjects to find out whether mifepristone treatment could facilitate termination of second trimester pregnancy by sulprostone. The women received either 600 mg oral mifepristone or placebo tablets 36 hours before the administration of intramuscular sulprostone 0.5 mg every 6 hours. The median interval between the administration of sulprostone and abortion in the mifepristone group (4.6 hours) was significantly shorter than that in the placebo group (20 hours). The amount of sulprostone required was also significantly less in the mifepristone group. There was no significant difference in the incidence of side effects or analgesic requirement between the two groups. We conclude that oral mifepristone is useful in facilitating termination of second trimester pregnancies by sulprostone.

Microbiological studies in mid-trimester abortion with emcredil versus normal saline

In 40 mid-trimester abortion seekers, in whom abortion was induced by extra-amniotic normal saline or Emcredil, microbiological studies were carried out before induction and at 24 hours. It was observed that there was no difference in the isolation of organisms from vagina and cervix of these subjects between 0 hours and 24 hours. Thus, this study shows that leaving the catheter in the extra-amniotic space until it is expelled spontaneously does not increase the risk of ascending infection. At the same time, leaving the catheter in-situ until it is expelled spontaneously reduces the induction-abortion interval appreciably.

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.

A retrospective study of 932 second trimester terminations using gemeprost (16, 16 dimethyl-trans Δ 2 PGE 1 methyl ester)

A retrospective study of 932 second trimester terminations between 12–27 weeks gestation was carried out to determine the efficacy of gemeprost for second trimester termination. A single course of 5 × 1 mg gemeprost pessaries was administered every three hours. If abortion had not occurred after the first course of pessaries, a further course of 5 × 1 mg pessaries was administered. Intravenous oxytocin was administered after 36 hours if abortion had not occurred. Eighty per cent and ninety five per cent of patients aborted within 24 and 48 hours respectively. Of the remaining 5 per cent of women, 3 per cent aborted with escalating doses of oxytocin. In the remaining 18 (2 per cent) women, the pregnancies were electively terminated with an alternative method. The median induction-abortion interval was 18.0 hours and 15.0 hours in nulliparous and parous women respectively ( P < 0.0001). The number of pessaries required to induce abortion was not influenced by parity. Significantly more parous women bled more than 500 ml. The incidence of pelvic sepsis (0.1 per cent) and cervical tear (0.1 per cent) was low. Twenty six per cent of women had diarrhoea and 23 per cent vomited following administration of prostaglandin. This study confirmed the efficacy of gemeprost for second trimester termination of pregnancy. This method of termination is safe, non-invasive, simple and has a low complication rate.

A pilot study of acceptability of RU486 and ONO 802 in a Chinese population

RU486 and ONO 802 in combination have been shown to be effective in early termination of pregnancy. Anecdotal information suggests that Chinese women have been using herbs to induce abortion, believing that such medication and means of abortion is less harmful to the body than surgery. Hence, a medical means of abortion using RU486 and ONO 802 may be the method of choice for some Chinese women. A pilot study involving 42 Chinese women in Hong Kong was conducted to explore the reasons for acceptance or refusal of RU486 and ONO 802 as abortifacient agents. It was found that more single women chose the medical method for abortion, the main reasons being fear of trauma to the body due to surgery and the feeling of having undergone menstrual regulation rather than having had an abortion with the medical method. Those who refused the treatment were worried about the efficacy and side effects of the new drugs and the long induction-abortion interval. There were 3 failures in the medical group of 23 women. All these 23 women were glad they had chosen the medical abortion method. Twenty-one out of the 23 women said they would choose the same abortion method again. The practice of the use of Chinese herbs was not more common in this group of women as compared to women who did not choose this method of abortion.

Mid-trimester termination of pregnancy with 16,16-dimethyl- trans- Δ2 PGE 1 vaginal pessaries: A comparison with intra- and extra-amniotic prostaglandin E 2 administration

PGE 1 analogue (gemeprost) vaginal pessaries administered three hourly for three doses has been compared with a single extra- or intra-amniotic injection of PGE 2 for mid-trimester termination of pregnancy in 450 women between 13 and 20 weeks gestation. The mean (SD) induction-abortion interval (IAI) in the vaginal pessary group of 19.5 (8.4) h was significantly longer than the respective intervals of 14.4 (9.3) and 16.1 (6.8) h in the patients treated extra- or intra-amniotically (P < 0.001). Seventy-three percent treated with gemeprost aborted within 24 h of initial treatment compared with 84% and 87%, respectively in the extra- and intra-amniotic groups (P < 0.05). Patients treated with gemeprost were more likely to need further prostaglandin treatment and had an increased incidence of gastrointestinal side effects. Despite these differences vaginal gemeprost pessaries provide a safe, effective, easy to administer method for midtrimester termination of pregnancy.

Second Trimester Abortion by Extra-Amniotic PGF2 alpha Infusion: Experience of 178 Cases

There is a continuing need for second trimester induced abortions, most recently due to the increase in the use of antenatal diagnostic procedures, amniocentesis, high resolution ultrasound and cordocentesis. To evaluate the efficacy and safety of extraamniotic infusion of PGF2 alpha for this purpose a retrospective review of 178 procedures was undertaken. There were 4 failures of the technique and the major complication rate was 5.6%. This rate was independent of gestational age. The mean induction to abortion interval was 29.6 (+/- 16.3) hours. The conclusion reached after comparison with other published data is that extraamniotic PGF2 alpha infusion is a slow and painful but safe and effective technique, but that at gestational ages less than 17 weeks, a comparative trial of Dilatation and Evacuation versus extraamniotic PGF2 alpha infusion would be justified.

Second trimester pregnancy termination using extraamniotic ethacridine lactate

To investigate the efficacy of ethacridine lactate by the extra-amniotic route for second trimester pregnancy termination and its associated complications. Retrospective study of women undergoing second trimester termination, over 3 1/2 years, with extra-amniotic ethacridine alone, or extra-amniotic ethacridine supplemented later by extra-amniotic 15-methyl prostaglandin F2 alpha. Teaching hospital in Bombay. 315 consecutive women undergoing late abortions with extra-amniotic ethacridine. Demographic features were similar in the two groups. In group 1, 207 women had 150 ml of 0.1% ethacridine lactate injected slowly into the extra-amniotic space. In group 2, 108 women had the initial injection supplemented 6 h later by an extra-amniotic injection of 250 micrograms (1 ml) of 15-methyl prostaglandin F2 alpha. The occurrence of abortion following the induction procedure. The development of complications such as haemorrhage, infection, or injury to the uterus or cervix. The method was successful in 191 women (92%) in group 1 and in 106 (98%) in group 2. The median induction-abortion intervals were 35 and 19 h, respectively (Mann-Whitney U test, P less than 0.001). The corrected complication rate was less than 10% (30 women), with unplanned uterine evacuation in 6% (20), haemorrhage in 1% (4), and pelvic infection in 4% (14). The use of extra-amniotic ethacridine lactate provides an effective and safe treatment method for second trimester legal abortion. The induction-abortion interval can be appreciably reduced by supplementary prostaglandin.

Late second trimester abortion with 16,16-dimethyl-trans-δ 2-PGE1 methyl ester (gemeprost)

The use of gemeprost (16, 16-dimethyl-trans- Δ 2-PGE1 methyl ester) vaginal pessaries for the termination of pregnancy in the late second trimester has been investigated in an open single-center study. Of 56 nulliparous women between 18 and 22 weeks amenorrhoea, 33 (58.9%) aborted after the administration of 1 mg gemeprost pessaries; 5 women did abort after 3 doses, 10 after 4 doses and 18 after 5 doses. There was no statistical correlation between gestational age and abortion. The mean induction-abortion interval was 15.2 hrs (range 8.5–20.3 hrs). There were no serious complications. The safe induction of therapeutic abortion in 58.9% of women using vaginal gemeprost pessaries alone offers an acceptable alternative to surgical evacuation in the late second trimester but should not be started without the possibility to terminate the procedure by dilatation and evacuation ( D + E).

The physiological and clinical effects of progesterone inhibition with mifepristone (RU 486) in the second trimester

A double-blind placebo-controlled trial was performed in 20 primigravidae to assess the physiological and clinical effects of oral mifepristone on myometrial contractility and sensitivity in the second trimester. Ten women received 600 mg of oral mifepristone and 10 women a placebo 24 h before abortion was induced in both groups, with extra-amniotic PGE2 instillation. Intrauterine pressure recordings demonstrated increased spontaneous uterine activity and increased sensitivity to PGE2 and ergometrine, but no change in oxytocin sensitivity after mifepristone treatment. There were no significant differences in PGE or PGF metabolite concentrations in peripheral maternal plasma over the 24-h study period after treatment between the mifepristone and placebo groups. The mean induction abortion interval in the mifepristone group was 512 (SD 321) min compared with 1128 (SD 606) min in the placebo group (P less than or equal to 0.02). The mechanism whereby mifepristone provokes enhanced uterine contractility and sensitivity to prostaglandins, with a reduction in abortion times, does not appear to be through endogenous production of PGE or PGF.

Mid‐trimester Abortion by Extraamniotic Emcredil Versus Normal Saline

Data is presented for 40 mid-trimester abortions, induced by 0.1% Emcredil (Group 1--20 cases) and normal saline (Group 2--20 cases) by instillation in the extraamniotic space. It was observed that the 2 groups were comparable for age, parity and period of gestation. The mean induction-abortion interval was 18 hours 9 minutes in Group 1 and 19 hours 19 minutes in Group 2. Abortion was complete in 45% and 65% in Group 1 and Group 2, respectively. With a cutoff time of 30 hours, there were 3 failures, 1 in Group 1 and 2 in Group 2. The induction-abortion interval was significantly less in the more advanced pregnancies in the saline group. There was no complication in either of the 2 groups. It is hypothesized that normal saline also acts by damage of the decidual cells with liberation of prostaglandins locally. Also since normal saline is a cheap and easily available commodity with no contraindication for its use and no side-effects, it seems to hold a lot of promise for induction of mid-trimester abortion.

Progesterone antagonist lilopristone: A potent abortifacient in the common marmoset

The effects of a progesterone antagonist ZK 98.734 (lilopristone) on implantation, early pregnancy, and midpregnancy were studied in the common marmoset, Callithrix jacchus jacchus. Treatment (5 mg/da intramuscularly for 3 consecutive days) on day (n = 8) after the midcycle peak in estradiol levels in mated animals induced a premature drop in plasma progesterone levels and shortened the ovarian cycle length. Treatment on day 20 (n = 5) or day 40 (n = 5) induced a drop in progesterone levels and decidual collapse. In three animals treated on day 40, vaginal bleeding was observed within 46 hours of the initiation of treatment. Treatment on day 80 resulted in expulsion of the fetuses with a mean induction abortion interval of 39 hours (range, 20 to 48 hours). The progesterone antagonistic effects of ZK 98.734 could be a result of the decrease in progesterone synthesis by the corpus luteum and/or placenta in addition to the interference with the progesterone binding to its cellular receptors in the target organ. Our study suggests that ZK 98.734 has potential for fertility regulation. Clinical trials for postcoital contraception, induction of menstruation, and early abortifacient effects are warranted.

Intracervical administration of prostaglandin E 2-gel prior to therapeutic abortion: a prospective randomized double-blind study

Forty primigravid women due to undergo first trimster termination of pregnancy were randomly selected for intracervical application of 1 mg prostaglandin E 2 in gel or gel only as placebo. In the PGE 2-gel group, a marked dilatation of the cervical canal was obtained, with post-gel treatment mean Hegar dilatation of 11.18 mm in that group, compared to 4.4 mm in the control group (P 0.001). Moreover, 16 (80%) patients in the PGE 2-gel group had a complete abortion, one (5%) patient had an incomplete abortion and in the remaining three (15%) patients, fetal demise was observed. The mean induction-abortion interval in this group was 7.5 h. In the placebo group, none of the above effects were observed. The only side effect noted was vomiting, which occurred in five (25%) of the patients in the PGE 2-gel group. Termination of pregnancy was found to be easier in the PGE 2-gel group, compared to the placebo group.

ADJUNCTIVE USE OF LAMINARIA TENT WITH INTRAMUSCULAR 15(S)15 METHYL PGF2α FOR INDUCTION OF SECOND TRIMESTER ABORTION.

The adjunctive use of laminaria tent along with intramuscular 15(S)15 methyl PGF2α (Prostin 15M, Upjohn) was studied for induction of second trimester abortion. Three hundred and two patients from eight centres were recruited for the study. Ninety-two were primigravidae and 210 were multigravidae. One to three laminaria tents were inserted overnight and they were removed before the start of treatment with 250 µg Prostin 15M administered intramuscularly every two hours till abortion. Of primigravida 81.5% and of the multigravidae 79.5% aborted within 24 hours of treatment. The induction abortion interval in the primigravida was 11.2 hours and in multigravidae it was 12.0 hours. The overall incomplete abortion rate was 31.0%. The pimigravidae had higher mean number of episodes of vomiting (2.5) and diarrhea (2.9) than the multigravidae (1.7 and 1.5, respectively). No other complications or injuries to genital tract were reported.

INDUCTION OF SECOND TRIMESTER ABORTION BY INTRAAMNIOTIC ADMINISTRATION OF 15(S)15 METHYL PGF2α.

In a multicentre trial 139 women between 15 and 20 weeks of gestation were treated with 2.5 mg intraamniotic administration of 15(S)15 methyl PGF2α (Prostin 15M, Upjohn) for termination of pregnancy. Following treatment 97% of the primigravida and 94.5% of multigravida aborted. The induction abortion interval (Mean ± S.E.M.) in the primigravida was 22.8 ± 1.1 hours, while in the multigravida it was 18.3 ± 1.0 hours. The mean number of episodes of vomiting was 1.4 and 0.9 in primigravidae and multigravidae, respectively. The mean number of episodes of diarrhoea was 0.7 in both groups. Of the primigravidae 10.9% and of the multigravidae 21.7% had incomplete abortions. No injuries to the genital tract were reported.

RANDOMIZED COMPARISON BETWEEN TWO-HOURLY AND THREE-HOURLY INTRAMUSCULAR TREATMENT WITH 15(S)15 METHYL PGF2α FOR TERMINATION OF SECOND TRIMESTER PREGNANCY.

In a multicentre trial, intramuscular 15(S)15 methyl PGF2α (Prostin 15M, Up-john) was tried at 2-hourly and 3-hourly intervals for induction of second trimester abortion. The time schedule was assigned randomly. Eighty-eight patients for 2-hourly schedule and 89 patients for 3-hourly schedule were recruited. Of 2-hourly 83% and of 3-hourly schedule 88.8% of the patients aborted with the treatment. The induction abortion interval was 15.9 hours in 2-hourly and 17.2 hours in 3-hourly schedule. The dose of Prostin 15M was 2.2 mg and 1.7 mg respectively. The incidence of incomplete abortion was 21.9% in 2-hourly and 27.8% in the 3-hourly. The incidence of vomiting was less in the 3-hourly schedule, however, there was no difference in the incidence of diarrhoea.

STUDIES ON 15(S)15 METHYL PGF2α BY INTRAMUSCULAR ROUTE FOR SECOND TRIMESTER ABORTION (THREE HOURLY SCHEDULE).

A multicentre study was undertaken to study the intramuscular 15(S)-5 methyl PGF2α (Prostin 15M, Upjohn) for induction of second trimester abortion. The patients were premedicated with Imodium and Perinorm for control of gastrointestinal side effects. Prostin 15M was given 250 µg every three hours and the progress was assessed before each injection. If there was no progress at the end of 10 injections the case was classified as a failure. Sixty-two patients were recruited for the study, 24 were primigravidae and 38 multigravidae. Twenty-three out of 24 primigravidae and 34 out of 38 multigravidae aborted with the treatment. The mean induction abortion interval in the primigravidae was 23.5 hours while it was 18.0 hours in the multigravidae. The mean number of vomitings was 2.9 and that of diarrhoea 5.0. The overall incidence of incomplete abortion was only 10.5%.

INTRAMUSCULAR 15(S)15 METHYL PGF2α IN THE TREATMENT OF MISSED ABORTION.

Intramuscular 15(S)15 methyl PGF2α (Prostin 15M, Upjohn) was used for induction of labour in cases of missed abortion and intra-uterine fetal death. The patients received premedication to control the gastrointestinal side effects. Prostin 15M was given at a dose of 250 µg every three hours and escalated whenever required. The trial was interrupted in two out of 83 patients. Altogether 75 patients (92.6%) expelled the fetus with the treatment. The mean induction abortion interval was 14.7 hours. The primigravidae had a longer (18.2 hrs) interval than the multigravidae (13.8 hrs). The mean number of episodes of vomiting was 2.9 and of diarrhoea 3.5 per patient and treatment.

15(S)15 METHYL PGF2α BY INTRAMUSCULAR ROUTE AT TWO HOURLY INTERVAL FOLLOWED BY THREE HOURLY FOR INDUCTION OF SECOND TRIMESTER ABORTION.

A multicentre trial of Prostin 15M in second trimester abortion in 322 patients of whom 115 were primigravidae was conducted during the period of six months. Intramuscular injection of Prostin 15M 250 µg was given two hourly till one centimeter dilatation of the cervix, followed by three hourly injections till abortion. The mean dose of Prostin 15M was 2.3 mg for primigravidae and 2.0 mg for the multigravidae. The mean induction abortion interval was 18.5 hours in primigravidae and 17 hours in multigravidae. Two hundred and seventy-six patients (85.7%) aborted with the treatment. There were 26 failures in primigravidae (22.6%) and 20 failures in the multigravidae (9.6%). Side effects of vomiting and diarrhoea were 3.0 and 4.1 episodes, respectively. In 53 cases where prophylactic antidiarrhoeal drug loperamide and antiemetic emidoxyn were given, the incidence of diarrhoea and vomiting was reduced to 1.6 and 1.7, respectively. There were no serious complications. In 50 cases the blood loss, as measured by alkaline hematin method was 25.4 ml (mean).