carboprost and gemeprost

Medical regimens using mifepristone in combination with prostaglandins have been widely available for women undergoing termination of pregnancy (TOP) at 10-16 weeks' gestation in China. We undertook a systematic review to compare different regimens of mifepristone with prostaglandins for TOP at 10-16 weeks' gestation.. We searched multiple electronic databases for English and Chinese language reports (1990-2007) including MEDLINE, the Cochrane Library and the Chinese Biomedical Literature Database. Included were trials comparing mifepristone with prostaglandins (misoprostol, gemeprost or carboprost (PG05)) to each other for women at 10-16 weeks' gestation. Outcomes were successful abortion rates, induction-to-expulsion time, blood loss and side effects. Data were processed with RevMan 5 software.. Nineteen trials comparing mifepristone with prostaglandin (misoprostol and PG05) were found of which 14 contributed to meta-analyses (4206 women). The quality of reports was poor. The effectiveness of vaginal mifepristone/misoprostol was super than mifepristone/PG05 (RR 1.14, 95%CI 1.05-1.22) as was induction-to-expulsion time, blood loss and side effects. When comparing misoprostol/mifepristone 150mg to misoprostol/mifepristone 200mg, no difference in TOP success rates were found (RR 0.98, 95%CI 0.96-1.01). Misoprostol vaginally compared to orally significantly increased the TOP success rate (RR 1.12, 95%CI 1.01-1.24). Gastrointestinal symptoms and fever occurred more often in misoprostol oral group (RR 1.67, 95%CI 1.46-1.91).. Medical regimens of mifepristone/prostaglandins were effective and safe for TOP at 10-16 weeks' gestation. Misoprostol was super than PG05, and misoprostol vaginally was found to have better effectiveness than misoprostol orally. Further research should evaluate the relative effectiveness of medical methods compared to surgery.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Induced; Alprostadil; Carboprost; Female; Humans; Mifepristone; Misoprostol; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Prostaglandins; Randomized Controlled Trials as Topic

Naturally occurring prostaglandins (PGs) are rapidly metabolized in the human circulation. For clinical use a number of PG analogues have therefore been developed which are resistant to rapid inactivation. Among these are carboprost, gemeprost and misoprostol. Following intramuscular injection of carboprost, plasma levels peaked after 20 minutes and declined slowly thereafter. In amniotic fluid the half-life was between 31 and 37 hours. Gemeprost is administered vaginally, and maximum plasma levels were reached after 2-3 hours, with detectable levels for at least 6-8 hours. Pharmacokinetic data on misoprostol are available following oral, vaginal and sublingual administration. Following oral treatment, plasma levels peaked at about 30 minutes, while after vaginal administration of the tablets the levels increased gradually and reached maximum levels after 70-80 minutes, but remained detectable for a significantly longer time. After sublingual administration the peak concentration was the same as for oral treatment but declined significantly more slowly. Endocervical administration of PGE(2) might be regarded as a local therapy, while following vaginal administration increased plasma levels of metabolites can generally be found. The plasma profile varies with the vehicle used.

Topics: Abortifacient Agents, Nonsteroidal; Administration, Intravaginal; Administration, Oral; Administration, Sublingual; Alprostadil; Carboprost; Dinoprostone; Female; Half-Life; Humans; Injections, Intramuscular; Misoprostol; Prostaglandins; Prostaglandins, Synthetic

This article outlines the current modalities of pregnancy termination, as well as their risks and complications, in 3 phases of pregnancy: 1) up to 49 days past the last menstrual period, 2) 8-15 weeks, and 3) 16-24 weeks. Before 8 weeks of pregnancy, suction dilatation and curettage (D and C) is the preferred method. However, a medical approach, possibly self-administered, is viewed as more satisfactory and requires only an improvement in side effects. From 8-15 weeks' gestation, suction D and C and dilatation and evacuation (D and E) are the methods of choice. The use of laminaria tents improves both the facility and safety of these procedures in nulliparous patients and perhaps in multiparous patients. Priming of the cervix with prostaglandin could further decrease the difficulty and risks of these procedures. The use of a hydrogel compound is especially worthy of consideration. There is controversy about the preferred method between 16-20 weeks' gestation. D and E appears to have fewer complications and to be more cost-effective than hypertonic saline injection. Urea-prostaglandin has fewer and less severe complications than saline injection, and seems to be more cost-effective than saline injection in terms of duration of hospitalization. The high frequency of failure and side effects, combined with the possibility of expulsion of a live fetus, make prostaglandin-only injection less desirable. After 20 weeks' gestation, urea-prostaglandin injection is probably the safer method. Given the rapid increase in complications with passing weeks, any delay in providing late abortion services should be avoided. 2nd trimester pregnancy terminations, especially those after 18 weeks' gestation, are associated with increased mortality and morbidity and should be performed at specialized centers where providers are better equipped to manage complications.

Topics: 16,16-Dimethylprostaglandin E2; Abortifacient Agents; Abortion, Induced; Alprostadil; Amnion; Anesthesia; Animals; Arbaprostil; Bacterial Infections; Carboprost; Cervix Uteri; Dilatation and Curettage; Dinoprost; Dinoprostone; Female; Humans; Hypertonic Solutions; Oxytocin; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Progestins; Prostaglandins E; Prostaglandins E, Synthetic; Prostaglandins F; Pulmonary Embolism; Risk; Saline Solution, Hypertonic; Time Factors; Urea; Uterine Hemorrhage; Uterine Perforation

In an eleven-centre study, 627 nulliparous subjects in the 8th to 12th week of gestation admitted for termination of pregnancy were allocated to one of five treatments to induce pre-operative cervical dilatation. The treatments were: 0.5 mg PGE2 methyl sulphonylamide; 1.0 mg PGE1 methyl ester; 30 mg 9-methylene PGE2 free acid, 0.5 mg 15-methyl PGF2 alpha; a single medium-sized laminaria tent. The results indicate that the three PGE analogues are at least equally effective as one medium sized laminaria tent and more effective than 0.5 mg 15-methyl PGF2 alpha in producing adequate pre-operative cervical dilatation prior to vacuum aspiration. It is concluded that both pre-treatment with prostaglandin analogues and laminaria tent are effective methods for preoperative cervical dilatation and both types of treatment are associated with a low incidence of side effects. Prostaglandin analogue treatment can be administered by paramedical personnel but laminaria tent insertion has to be performed by medical staff.

Topics: 16,16-Dimethylprostaglandin E2; Abortifacient Agents; Adolescent; Adult; Alprostadil; Carboprost; Clinical Trials as Topic; Dilatation and Curettage; Dinoprostone; Female; Humans; Laminaria; Prostaglandins; Prostaglandins E, Synthetic; Random Allocation; Seaweed; Vacuum Curettage

Topics: Abortifacient Agents, Nonsteroidal; Alprostadil; Carboprost; Catheterization; Female; Humans; Hysterectomy; Postpartum Hemorrhage; Pregnancy; Risk Factors

The abortifacient effect has been compared of 15 me-PGF2 alpha, ONO 802 and 16 phenoxy-w-17,18,19,20-tetranor PGE2 given intra-muscularly, intravaginally and with or without laminaria dilatation of the cervix. Locally administered, 15 me-PGF2 alpha, proved to be more efficient than ONO 802. Laminaria had a beneficial effect on dilatation. Intramuscular administration involved the necessity of frequent injections and gastrointestinal side effects. A total of 143 patients participated in the study.. Synthetic analogues of prostaglandins (PGs) E and F are now being used widely to induce abortion at any point in pregnancy without surgical intervention. This study compared the abortifacient effect of PGE and PGF given intramuscularly, intravaginally, and with and without laminaria dilatation in 72 1st-trimester abortion patients. Pregnancy was terminated in 40 women through use of a single suppository containing 3 mg of 15-me-PGF2 beta: complete abortion occurred in 18 of the 20 pregnancies at 6-7 weeks gestation but in only 5 of the 20 pregnancies 10-12 weeks gestation. An additional 32 pregnancies at 6-7 weeks gestation were aborted through vaginal suppositories containing 1 mg of 16.16 dimethyltrans-delta 2-PGE1 methyl ether (ONO-802); complete abortion occurred in 24 of these women, within an average of 5-10 hours. Although suppositories containing 15-me-PGF2 beta were more effective than those with ONO-802, the number of side effects experienced was considerably lower with PGE2. Abortion, whether complete or incomplete, was associated in both groups with full cervical dilatation--a factor of significance in the prevention of future is thmicocervical insufficiency. Pregnancy was also terminated in 47 2nd-trimester patients given either intramuscular PGE2 methyl sulfonylamide or intramuscular 15-m3-PGF2 alpha. The abortion time was an average of 14.3 hours with PGE2 and 4.3 hours with PGF2 alpha; patients in both groups experienced severe low back pain of 25-30 seconds' duration. Complete abortion occurred in 3/4 of the PGF2 alpha women and 1/2 of the women receiving PGE2. Complete abortion was twice as likely in parous women than in primigravidae. The use of PGF2 was associated with no side effects, while PGE2 caused vomiting and diarrhea.

Topics: Abortifacient Agents; Abortifacient Agents, Nonsteroidal; Administration, Intravaginal; Alprostadil; Carboprost; Dinoprostone; Female; Humans; Infusions, Intravenous; Laminaria; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Prostaglandins E, Synthetic; Prostaglandins F, Synthetic

The present study included 550 mainly primiparous women in the 8th to 12th week of pregnancy admitted to the hospital for termination of pregnancy. The patients were treated by different prostaglandin analogues or one medium size laminaria tent followed by vacuum aspiration. The treatment period was three hours, which for some analogues was extended to six and twelve hours. The prostaglandins studied were 15-methyl PGF2 alpha methyl ester (0.5 and 1.0 mg), 16,16-dimethyl-trans-delta 2 PGE1 methyl ester (1.0 mg), 9-deoxo-16,16-dimethyl-9-methylene PGE2 (30 mg), all administered by the vaginal route, and 16-phenoxy-omega-17,18, 19,20-tetranor PGE2 methyl sulfonylamide (0.25 and 0.5 mg) given as i.m. injections. At operation the degree of cervical dilatation, the amount of blood loss and other operative complications were registered. The patients were continuously supervised during treatment and during at least three hours after operation. Side effects, complications and vital signs were recorded. The degree of cervical dilatation was related to the duration of prostaglandin treatment. If the duration of prostaglandin treatment was prolonged, the frequency of gastrointestinal side effects, abortion prior to scheduled time for vacuum aspiration and pain needing analgesic treatment also increased. Both the efficacy and the frequency of side effects were dose dependent. The outcome of therapy after three-hour pretreatment was evaluated. All the prostaglandins were more effective than one medium size laminaria tent in dilating the cervical canal. The three E analogues were most effective. The number of patients with bleeding at operation of 50 ml or more was also higher following laminaria than following prostaglandin pretreatment. Most advantageous in this respect were the three E analogues. Frequency of gastrointestinal side effects and degree of pain following 9-methylene PGE2 and 16,16-dimethyl PGE1 methyl ester was the same as following laminaria treatment.

Topics: 16,16-Dimethylprostaglandin E2; Abortion, Induced; Alprostadil; Carboprost; Dinoprostone; Female; Humans; Laminaria; Pregnancy; Prostaglandins E, Synthetic; Seaweed