gemeprost and Abortion--Spontaneous

Studies of conservative management of early miscarriage have questioned the need for post abortem curettage.. A prospective, randomised study was carried out to clarify the effect of vaginal administration of a prostaglandin E1 analogue (gemeprost) versus surgical management (curettage) of miscarriages at up to twelve weeks of gestation. A questionnaire revealed discomfort as bleeding and pain.. The study comprised 61 patients: group 1 (n: 27) with an endometrial thickness less than 10 mm managed by expectancy, and group 2 with an endometrial thickness greater than 10 mm; group 2 was randomised to group 2A (n: 17), given gemeprost, and group 2B (n: 17), underwent curettage. On entry the mean gestational ages were 51 and 67.5 days for groups 1 and 2, respectively; transvaginal ultrasonography revealed a mean endometrial thickness of 8 mm in group 1 and 19 mm in group 2. One week later this was reduced to 4 mm in group 1 and 5.7 mm in group 2. The duration of vaginal bleeding was similar in all groups, with a mean of 1 week (2-3 days of moderate/heavy bleeding and 6-10 of no bleeding or spotting). The discomfort experienced was similar in all groups (a mean of 36-48 hours of moderate/strong pain and 7-10 days of no or insignificant pain).. Conservative treatment can substitute general anesthesia and curettage in the management of complete spontaneous abortions with fresh vaginal bleeding and an endometrial thickness of up to 10 mm. Vaginal administration of 1 mg gemeprost can substitute general anesthesia and curettage in the management of incomplete spontaneous abortions of up to 12 weeks of gestation and absence of a gestation sac.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Spontaneous; Administration, Intravaginal; Adult; Alprostadil; Dilatation and Curettage; Female; Humans; Middle Aged; Patient Satisfaction; Pregnancy; Pregnancy Trimester, First; Prospective Studies; Prostaglandins E, Synthetic; Surveys and Questionnaires; Uterine Hemorrhage

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

Retained products of conception (RPOC) is a complication that occurs in the second trimester of pregnancy. We enrolled 98 women who had a miscarriage or termination with gemeprost in the second trimester of pregnancy. Eighteen cases (18.4%) were RPOC-positive. The gestational week at miscarriage or termination was earlier in the RPOC-positive group than those in the RPOC-negative group (

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Abortion, Spontaneous; Alprostadil; Female; Humans; Infant; Japan; Placenta; Pregnancy; Pregnancy Trimester, Second; Retrospective Studies; Risk Factors

The only prostaglandin analogue licensed in Italy for induction of labour in spontaneous and therapeutic abortion is gemeprost. The authors report a case of spontaneous uterine rupture of a scarred uterus, for previous caesarean sections, in a woman at 20 weeks of gestation with a diagnosis of spontaneous abortion. She received a pessary of gemeprost every three hours. After the fifth pessary, she complained of severe pain. At the ultrasound examination, uterine cavity appeared empty and the dead fetus was dislocated in the abdomen. Emergency laparotomy was performed and uterine tear was repaired. To induce labour for fetal demise or therapeutic abortion in second trimester in women with scarred uterus, the authors decided to lengthen the time between administrations of pessary from four to five hours depending on patient's symptoms. However the appropriate drug regimen has still to be found and more data are necessary.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Spontaneous; Administration, Intravaginal; Adult; Alprostadil; Female; Fetal Death; Humans; Labor, Induced; Male; Pregnancy; Pregnancy Trimester, Second; Prostaglandins E, Synthetic; Ultrasonography, Prenatal; Uterine Rupture

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Abortion, Spontaneous; Adult; Alprostadil; Female; Fertilization in Vitro; Fetal Death; Humans; Ischemia; Pregnancy; Pregnancy Trimester, Second; Prostaglandins; Torsion Abnormality; Treatment Failure; Uterine Diseases; Uterus