gemeprost and Abortion--Incomplete

The conventional management of spontaneous abortion is surgical evacuation of the uterus to prevent complications which may arise from retained products of conception (POC). This procedure is not without complications and also demands operating theatre resources. The purpose of this study was to determine the efficacy of a medical approach to the management of spontaneous abortion using the prostaglandin analogue, gemeprost. From an initial 212 women presenting with spontaneous abortion, 4 groups were defined according to what they required in the way of initial management. A group of 20 women were excluded from conservative medical management at presentation because they were bleeding heavily and judged to be unsuitable. Sixty women initially required no further management other than determining that they had a complete abortion using transvaginal sonography (TVS). The 132 women were treated with the prostaglandin analogue, gemeprost. Sixty were judged to need no further management afterwards and were initially discharged. The remaining 72 women underwent evacuation of retained products of conception (ERPC) after the gemeprost treatment as medical evacuation of the uterus appeared to had been incomplete. In each of these 4 groups so defined, there was 1 case where an ERPC was required after the patients have been discharged because of complications attributable to retained POC. We therefore found that no ERPC was necessary in the management of 118 out of 212 (55.6%) women who presented with spontaneous abortion. This has important implications in patient management and economical use of hospital resources.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Incomplete; Abortion, Spontaneous; Administration, Intravaginal; Adult; Alprostadil; Female; Humans; Pessaries; Pregnancy; Prospective Studies; Prostaglandins E, Synthetic; Ultrasonography

Factors affecting method preference for induced abortion in Britain are cost and experience in clinical trials. Demand for abortion exists regardless of access to contraception; 1 in 5 pregnancies in Britain are aborted. Since July 1991, alternatives to vacuum aspiration have become available. RU486, or mifepristone, in combination with gemeprost, a prostaglandin, 48 hours later has shown a 95% successful complete abortion rate. The actual study involve 100 women at 9 weeks' gestation receiving 600 mg of mifepristone followed by 1 mg of gemeprost pessary. The complication rate was low and the pregnancy continuation rate was 0.3% which is similar to vacuum aspiration. Almost 50% of abortion seekers in France prefer medical (drug-induced) abortions. Studies in Aberdeen have shown that about 25% desired either medical or surgical abortion and 50% had no preference. Only about 10% of abortions performed in Britain are medical abortions. The reasons medical abortion is not more widely used, regardless of its availability, may involve the organization of services for abortion: the requirement for prompt referral before 9 weeks, the special licensing required for practice of medical abortion on the premises, and higher cost. Medical abortions cost 43 pounds for the mifepristone and 21 pounds for the gemeprost, but the cost could be reduced by reducing the amount of mifepristone to 200 or 400 mg in combination with 0.5 or 1 mg of gemeprost. World Health Organization studies have found little loss in efficacy and a significant reduction in diarrhea and vomiting, which, with the reduction in cost, ought to make medical abortion more attractive to women and institutions. Studies in France an the United Kingdom have found that a synthetic prostaglandin, misoprostol, could be substituted for gemeprost and reduce the side effects associated with gemeprost. Misoprostol also costs only 1 pound for a 400-600 mg dose. Medical abortion has the advantage of not requiring highly skilled staff or special facilities; the necessary room should have couches or beds. 2 trained nurses under medical supervision could serve 6 women per morning. Three visits are required. Most of the present use is in hospitals in the UK that have conducted clinical trials.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Incomplete; Abortion, Induced; Alprostadil; Day Care, Medical; Drug Costs; Female; Humans; Mifepristone; Patient Acceptance of Health Care; Pregnancy

Therapeutic abortion was induced in 100 women in early pregnancy (less than 56 days' amenorrhoea) with a combination of the antigestagen mifepristone (RU 486) and a synthetic prostaglandin analogue, gemeprost. Mifepristone in oral doses of 400-600 mg was followed 48 h later by a gemeprost vaginal pessary (0.5-1.0 mg). Bleeding was induced in all women 22-70 h after the mifepristone dose and although bleeding continued for 4-43 days (median 12) the total measured blood-loss was only a median of 72.5 ml (range 15-398). Complete abortion occurred in 95 women. Surgical evacuation of the uterus for minimum debris was required in the remaining 5. Only 10 women had diarrhoea or pain that required opioid analgesia. The combination of mifepristone and gemeprost provides a safe and effective alternative to surgical evacuation of the uterus for therapeutic abortion in early pregnancy.. A combination of the antigestagen mifepristone (RU 486) and a synthetic prostaglandin analogue, gemeprost, was used to induce therapeutic abortion in 100 women in early pregnancy. Local family planning services and general practitioners in Edinburgh referred women of less than 56 days' amenorrhea who had requested abortion. Pregnancy was confirmed by measurement of the serum level of human chorionic gonadotropin. Group I (n=20) received 150 mg mifepristone orally each day for 4 days. Groups II (n=30), III (n=30), and IV (n=20) received a single oral dose of mifepristone, 400 mg, 500 mg, or 600 mg, respectively. Samples of peripheral blood were collected at recruitment for measurement of the concentration of hemoglobin, urea, electrolytes, cortisol, and HCG and for liver function tests. Blood also was taken for estradiol and progesterone essay from women in Groups II, III, and IV. Each woman recorded symptoms in a diary from the day prior to the start of treatment. Study participants were reviewed 1, 2, and 4 weeks after treatment and discharged from followup after the onset of the next menstrual period. The effectiveness of the 4 treatment regimens was similar. Only 10 (14%) of the 74 women who received half a gemeprost pessary required the 2nd half. 95 of the women aborted completely; 5 women needed surgical intervention. Data were pooled for analysis because there was no significant difference between the 4 groups in the onset of bleeding and pain, requirement for analgesia, side effects, duration of bleeding, measured blood loss, and the time until the next menstrual period. The 94 women who experienced pain became aware of pelvic discomfort 46.6 hours after the initiation of treatment. No patient needed analgesia during the first 48 hours of treatment. After insertion of the pessary, 44 women received an oral analgesic drug and 9 an intramuscular opioid. 47 women did not need an analgesia. There was no significant difference in the frequency of nausea before and during treatment, but there was a significant increase in the incidence of vomiting and of diarrhea. 30 women vomited after the pessary was inserted compared with 13 the day before treatment; 10 women had diarrhea compared with 3 before treatment. No women had clinical evidence of pelvic infection. Liver function tests and cortisol levels were similar prior to and following treatment. Levels of HCG, and estradiol and progesterone decreased significantly after treatment. Th

Topics: Abortifacient Agents; Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Incomplete; Abortion, Therapeutic; Administration, Oral; Adolescent; Adult; Alprostadil; Chorionic Gonadotropin; Drug Evaluation; Estrenes; Female; Follow-Up Studies; Humans; Mifepristone; Pessaries; Pregnancy; Prostaglandins E, Synthetic