dinoprost and gemeprost

Preparing the cervix prior to surgical abortion is intended to make the procedure both easier and safer. Options for cervical preparation include osmotic dilators and pharmacologic agents. Many formulations and regimens are available, and recommendations from professional organizations vary for the use of preparatory techniques in women of different ages, parity or gestational age of the pregnancy.. To determine whether cervical preparation is necessary in the first trimester, and if so, which preparatory agent is preferred.. We searched Cochrane, Popline, Embase, Medline and Lilacs databases for randomised controlled trials investigating the use of cervical preparatory techniques prior to first trimester surgical abortion. In addition, we hand-searched key references and contacted authors to locate unpublished studies or studies not identified in the database searches.. Randomised controlled trials investigating any pharmacologic or mechanical method of cervical preparation, with the exception of nitric oxide donors (the subject of another Cochrane review), administered prior to first trimester surgical abortion were included. Outcome measures must have included the amount of cervical dilation achieved, the procedure duration or difficulty, side-effects, patient satisfaction or adverse events to be included in this review.. Trials under consideration were evaluated by considering whether inclusion criteria were met as well as methodologic quality. Fifty-one studies were included, resulting in 24 different cervical preparation comparisons. Results are reported as odds ratios (OR) for dichotomous outcomes and weighted mean differences for continuous data.. When compared to placebo, misoprostol (400-600 microg given vaginally or sublingually), gemeprost, mifepristone (200 or 600 mg), prostaglandin E and F(2alpha) (2.5 mg administered intracervically) demonstrated larger cervical preparation effects. When misoprostol was compared to gemeprost, misoprostol was more effective in preparing the cervix and was associated with fewer gastrointestinal side-effects. For vaginal administration, administration 2 hours prior was less effective than administration 3 hours prior to the abortion. Compared to oral misoprostol administration, the vaginal route was associated with significantly greater initial cervical dilation and lower rates of side-effects; however, sublingual administration 2-3 hours prior to the procedure demonstrated cervical effects superior to vaginal administration.When misoprostol (600 microg oral or 800 microg vaginal) was compared to mifepristone (200 mg administered 24 hours prior to procedure), misoprostol had inferior cervical preparatory effects. Compared to day-prior laminaria tents, 200 or 400 microg vaginal misoprostol showed no differences in the need for further mechanical dilation or length of the procedure; similarly, the osmotic dilators Lamicel and Dilapan showed no differences in cervical ripening when compared to gemeprost, although gemeprost had cervical effects which were superior to laminaria tents. Older prostaglandin regimens (sulprostone, prostaglandin E(2) andF(2alpha)) were associated with high rates of gastrointestinal side-effects and unplanned pregnancy expulsions. Few studies reported women's satisfaction with cervical preparatory techniques.. Modern methods of cervical ripening are generally safe, although efficacy and side-effects between methods vary. Reports of adverse events such as cervical laceration or uterine perforation are uncommon overall in this body of evidence and no published study has investigated whether cervical preparation impacts these rare outcomes. Cervical preparation decreases the length of the abortion procedure; this may become increasingly important with increasing gestational age, as mechanical dilation at later gestational ages takes longer and becomes more difficult. These data do not suggest a gestational age where the benefits of cervical dilation outweigh the side-effects, including pain, that women experience with cervical ripening procedures or the prolongation of the time interval before procedure completion. Mifepristone 200 mg, osmotic dilators and misoprostol, 400microg administered either vaginally or sublingually, are the most effective methods of cervical preparation.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Alprostadil; Cervical Ripening; Dinoprost; Dinoprostone; Female; Humans; Mifepristone; Misoprostol; Pregnancy; Pregnancy Trimester, First

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

The use of gemeprost (16,16 dimethyl-PGE1-methyl ester) pessaries was compared in an open, randomized single-centre trial with the intra-amniotic injection of PGF2 alpha combined with hypertonic saline, intravenous oxytocin and a hygroscopic cervical dilator (Dilapan) for the termination of pregnancy between 14 and 20 weeks. There was no significant difference in the induction-delivery interval for the two groups. With the exception of an increased incidence of diarrhoea in the gemeprost group, there was no significant difference in other side effects, analgesic requirements or retained placentae. Gemeprost pessaries are an effective alternative to the more invasive methods previously used for the induction of second-trimester termination.. Gemeprost vaginal suppositories (16,16-dimethyl-PGE1 methyl ester) were compared with intraamniotic Pgf2alpha in 20% saline after Dilapan tents for termination of 14-16 week pregnancies in 58 women. After randomization there were 44% multigravidae in the Gemeprost group and 58% in the Pgf2alpha-saline-Dilapan group; the Gemeprost group averaged 23.4 years, the Pgf2alpha group 26.2%. Gemeprost 1 mg vaginal pessaries were inserted at 3 hr intervals for a maximum of 5 doses. Pgf2alpha 20 mg in 40 ml 20% NaCl was injected intraamniotically under ultrasonic control immediately after Dilapan was inserted in the cervix. If abortion had not occurred within 24 hours, management by iv oxytocin, iv Pgf2alpha, intraamniotic Pgf2alpha or saline or both was at the physician's discretion, as was post-abortion treatment with oxytocin, ergometric or surgical evacuation of the placenta if not delivered within 2 hours. Successful abortion, defined as induction abortion intervals of 24 hours, occurred in 58% of the Gemeprost group and 90% of the PG-saline group, for mean induction-abortion intervals of 12.6 and 11.7 hours. 6 more Gemeprost patients aborted within 27.8 hours without additional treatment, while the last 2 patients to deliver took 42 and 50 hours, compared to a 32-hour maximum interval for PG-saline patients. Much of the difference in intervals was accounted for by primigravidas, who took 15.84 hours on average with Gemeprost, compared to 13.7 hours with PG-saline. Gastrointestinal side effects were more common in the Gemeprost group: diarrhea in 58% and vomiting in 62%, compared to 7% with diarrhea and 34% with vomiting in the PG-saline group. Retained placenta, hemorrhage 300 ml and pain requiring narcotics were similar in both series. The outcomes in terms of induction-abortion intervals were not significantly different. Gemeprost was considered the agent of choice, since it is not invasive, and avoids the risk of sudden collapse or death, intrauterine infection, saline intoxication or clotting disorders, which occur on rare occasions in Pgf2alpha- or saline-induced midtrimester abortions.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adolescent; Adult; Alprostadil; Dinoprost; Female; Humans; Pregnancy; Pregnancy Trimester, Second; Saline Solution, Hypertonic

The authors, using immunofluorescence, studied the effect of different prostaglandins (F2 alpha, E1, dimethyl PGE1) on cervical connective tissue. They analysed 80 biopsies which were carried out before and after the prostaglandins had been applied locally, both in pregnant and in non-pregnant women. The method showed that there were changes in the collagen fibres but not in fibronectin. On the other hand, there does not seem to be any difference in the collagen effect with the methods used: 1) between pregnant and non-pregnant women, and 2) between the different types of prostaglandin that were studied.

Topics: Adolescent; Adult; Aged; Alprostadil; Biopsy; Cervix Uteri; Dinoprost; Dinoprostone; Female; Fluorescent Antibody Technique; Humans; In Vitro Techniques; Middle Aged; Pregnancy; Prostaglandins; Prostaglandins E, Synthetic

The present study compares two methods of local application of prostaglandins prior to surgical abortion in the first trimester. Fifty patients were treated with a vaginal tablet of Gemeprost (E1 analogue); 50 others by the intra-cervical application of PGF2 alpha gel. Gemeprost was found to be superior to the PGF2 alpha gel. Several hypotheses are formulated to explain this observation. The side effects of the two methods are compared and discussed.

Topics: Abortion, Induced; Administration, Topical; Adult; Alprostadil; Cervix Uteri; Dilatation; Dinoprost; Female; Gels; Humans; Pain; Parity; Pregnancy; Pregnancy Trimester, First; Prospective Studies; Prostaglandins F; Tablets

The effects of prostacyclin (PGI2) on the uterine muscle of pregnant rats were studied in terms of uterine contraction and the variation in cyclic nucleotides. The following results were obtained: The administration of PGI2 stimulated the pregnant uterine muscle (in vitro). The oxytocic potency of PGE1-analog (ONO-802) was greatest, followed in order by that of PGF2 alpha and PGI2. The effect of 5-lypoxygenase inhibitor (AA-861) on uterine contraction was greatest under the administration of LTC4, followed in order by PGI2, oxytocin, PGF2 alpha, LTD4 and ONO-802. The effect of AA-861 was greater under the simultaneous administration of LTD4/LTC4 and ONO-802 than under the simultaneous administration of oxytocin and ONO-802. Terbutaline exerted the inhibitory effect on each of the oxytocies within two minutes in all cases. Its inhibitory effect on the oxytocics was slight in the cases to which oxytocin or ONO-802 was administered. Changes in cyclic nucleotides in the bath medium were determined before and after the administration of each drug. When PGI2 was administered, both c-AMP and c-GMP increased and showed a pattern which was different from that for other oxytocics. This tendency was also observed when PGI2 and other drugs (terbutaline, ONO-802 and AA-861) were administered together.

Topics: Alprostadil; Animals; Dinoprost; Epoprostenol; Female; Myometrium; Nucleotides, Cyclic; Oxytocics; Pregnancy; Pregnancy, Animal; Prostaglandins F; Rats; Rats, Inbred Strains; Uterine Contraction

Topics: Abortifacient Agents; Alprostadil; Dinoprost; Dinoprostone; Female; Humans; Intestines; Pregnancy; Prostaglandins E; Prostaglandins E, Synthetic; Prostaglandins F; Prostaglandins, Synthetic; Urinary Bladder; Uterine Contraction; Uterine Hemorrhage

In most developed countries in which therapeutic abortions are legal, termination of pregnancy is performed at between 8 and 12 weeks of gestation. Because the complication rate after this procedure rises with increasing gestation, there would be many advantages in inducing abortion before the eighth week ('menstrual induction'). With the increasing availability of highly sensitive methods of detecting human chorionic gonadotropin, pregnancy can now be diagnosed as early as 10-14 days after conception. The uterus can be surgically evacuated safely and simply by suction aspiration under local anaesthesia. However, a safe and effective method of inducing abortion by medical means would be a useful and cheaper alternative. Of the potentially useful compounds, only derivatives of prostaglandins E and F administered by vaginal pessary have so far been shown to be effective. Although the rate of haemorrhage and infection is low, 10-30% of women experience moderate side-effects of pelvic pain, diarrhoea and/or vomiting. The possibilities are discussed of reducing the incidence of side-effects by different methods of release or using prostaglandins in combination with other compounds such as antigestogens which might lower the therapeutic threshold.

Topics: Abortion, Induced; Alprostadil; Dinoprost; Dinoprostone; Female; Humans; Pregnancy; Pregnancy Trimester, First; Prostaglandins E; Prostaglandins E, Synthetic; Prostaglandins F; Vacuum Curettage

Topics: Abortion, Induced; Adult; Alprostadil; Anesthesia, Epidural; Dinoprost; Female; Humans; Infusions, Parenteral; Laminaria; Pregnancy; Pregnancy Trimester, Second; Prostaglandins F; Seaweed; Suppositories; Vagina

The effect of four exogenous prostaglandins, PGA1, PG802, PGE2 and PGF2 alpha, upon the lower urinary tract was investigated in female mongrel dogs without neurogenic lesions in vivo. The urethral resistance was studied by means of a urethral pressure profile, and the bladder function by evaluating whether or not the micturition was triggered. The reduction of urethral resistance in terms of the maximum urethral closure pressure was most significant with PGE2 given intraaterially. Micturition was most frequently provoked by the intravenous administration of PG802, a derivative of PGE1. PGE series seemed to be the most potent for the evacuation of urine in female dogs.

Topics: Alprostadil; Animals; Blood Pressure; Dinoprost; Dinoprostone; Dogs; Female; Male; Pressure; Prostaglandins; Prostaglandins A; Prostaglandins E; Prostaglandins E, Synthetic; Prostaglandins F; Urethra; Urination; Urodynamics

Abortifacient effects of 16,16-dimethyl-trans delta 2-PGE1 methyl ester (ONO-802) were studied clinically. The uterine contractile effect of the agent was compared with those of PGF2 alpha and oxytocin (OXY) in the unanesthetized rabbit. 1. Intermittent intravaginal administration of ONO-802 was applied to 32 cases of legal abortion, 15 of missed abortion and 17 of hydatid mole. Eighty eight, 100 and 81 per cent of these patients resulted in abortion, respectively, with fewer side effects than those of natural PGs. 2. In the five groups of non- or pseudo-pregnant rabbits and those in their 7-9, 14-16 and 19-28 days in pregnancy, uterine contractile effects of these agents were assessed by both the contractile patterns and area of contractile curves of initial 5 minutes. The results are as follows: 1) In the non-pregnant rabbits, all of these agents revealed marked uterine contractile effect. 2) ONO-802 induced uterine contraction characterized by its wedge-shaped curves continued considerably longer than that induced by others. 3) ONO-802 revealed much stronger effect on uterine contraction in 7-9 day-of-pregnant rabbits. 4) Fourteen-16-day-of-pregnant rabbits were least influenced by the three agents as regards their uterine contraction in accordance with the highest progesterone levels in their sera among the three groups of pregnant rabbits.

Topics: Abortion, Missed; Abortion, Therapeutic; Alprostadil; Animals; Dinoprost; Female; Humans; Oxytocin; Pregnancy; Prostaglandins E, Synthetic; Prostaglandins F; Rabbits; Uterine Contraction; Uterine Hemorrhage