gemeprost and Abortion--Missed

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Intravaginal; Adult; Alprostadil; Cervical Ripening; Dilatation and Curettage; Female; Gels; Humans; Nitric Oxide Donors; Nitroglycerin; Pelvic Pain; Pregnancy; Pregnancy Trimester, First; Prospective Studies; Prostaglandins E, Synthetic; Suppositories; Tocolytic Agents; Uterine Hemorrhage

This prospective, randomized study compared the efficacy of intravaginal misoprostol (Cytotec) and gemeprost (Cervagem) as an abortifacient for intrauterine deaths in second trimester pregnancy. Side-effects, complications and the cost-effectiveness associated with each drug were assessed. 21 out of 25 patients (84%) in the misoprostol group aborted whereas only 17 out of 25 patients (68%) in the gemeprost group aborted within 24 hours after the initiation of therapy. In the misoprostol group, the abortion rate was influenced by the gestational age with 100% abortion rate for those > 17 weeks' gestation compared to 67% for those with a gestational age of 13-16 weeks. Side-effects were rare in either group and no major complications were reported in either group. Misoprostol was definitely more cost-effective compared to gemeprost as the mean cost of inducing an abortion using misoprostol was RM 1.08 whereas that of gemeprost was RM 105. We thus concluded that misoprostol was at least as effective as gemeprost as an abortifacient for intrauterine death in second trimester pregnancy. Moreover, it was less costly, with very few side-effects.. The efficacy of intravaginal misoprostol (Cytotec) and gemeprost (Cervagem) as abortifacients in second-trimester pregnancies was compared in a prospective study of 50 women admitted to Hospital Kuala Lumpur (Malaysia) with an intrauterine death at a gestational age of 13-26 weeks. 25 women were randomly assigned to receive 200 mcg of misoprostol inserted into the posterior fornix of the vagina every 3 hours until abortion occurred; the remaining 25 women received 1 mg of gemeprost every 3 hours until abortion. Within 24 hours of drug administration, 21 women (84%) in the misoprostol group and 17 (68%) in the gemeprost group had aborted. In the misoprostol group, the abortion rate was influenced by gestational age; this rate was 100% in women with pregnancies over 17 weeks' gestation compared with 67% in women in weeks 13-16. No major side effects or complications occurred in either group. The mean cost of abortion induction was RM 1.08 with misoprostol and RM 105 with gemeprost. Misoprostol seems to be the drug of choice for second-trimester pregnancy termination. Not only is intravaginal misoprostol at least as effective as gemeprost, it is less costly, does not require refrigeration for storage, and is associated with few side effects. Additional studies with larger sample sizes are recommended to determine the optimal misoprostol dosage and frequency of administration.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Intravaginal; Alprostadil; Cost-Benefit Analysis; Female; Humans; Infant, Newborn; Misoprostol; Pregnancy; Pregnancy Trimester, Second; Prospective Studies; Treatment Outcome

In 87 patients with a missed abortion prior to 13 weeks, the application of a prostaglandin (PG) E1 derivative (1 mg gemeprost, Cergem) was compared to conventional surgical termination of pregnancy by cervical dilatation and curettage. In 33 patients with PGE1 application, complete expulsion of the abnormal pregnancy occurred after an average of 2.8 +/- 1.5 vaginal suppositories. PGE1 treatment was effective in 76.7%, and surgical management was effective in 90.9% of patients. Sixty percent of the patients in the PGE1 group required analgesia because of uterine pain in comparison to 4.5% in the surgical group. The possibility of medical termination with synthetic PG derivatives should be further investigated.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Abortion, Missed; Adult; Alprostadil; Dilatation and Curettage; Female; Humans; Pregnancy; Pregnancy Trimester, First; Prospective Studies; Treatment Outcome

Forty-eight patients affected with missed abortion, intrauterine fetal death and hydatiform mole were treated with vaginal suppositories containing 1 mg of 16,16-dimethyl-trans-delta 2-PGE1 methyl ester (ONO-802). The patients were divided into two treatment groups. The first, Group A, was given one vaginal suppository every 3 h to a maximum of five suppositories. The product of conception was expelled in 95.8% of patients. In Group B the maximum number of suppositories was reduced to three. The product of conception was expelled in 100% of cases and the average duration of treatment was similar to that for the first group. Although side-effects were mild in both groups, they were reduced in the patients of Group B.

Topics: Abortifacient Agents; Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Intravaginal; Adult; Alprostadil; Dose-Response Relationship, Drug; Drug Evaluation; Female; Fetal Death; Humans; Hydatidiform Mole; Middle Aged; Pregnancy; Prostaglandins E, Synthetic; Suppositories; Time Factors; Uterine Neoplasms

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