Termination of pregnancy by extraamniotic prostaglandins and the synergistic action of oxytocin.
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Biomedical subjects
Publications and source records attributed to M P Embrey.
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An intravenous infusion of prostaglandin F(2)alpha (12.5-250mug/min) was administered in four volunteers in the mid-late luteal phase and three in the early luteal phase of the menstrual cycle.Frequent measurement of plasma progesterone, oestrogens, and luteinizing hormone (LH) showed that administration of high doses depressed plasma progesterone levels in the late luteal phase and caused concomitant side effects. Levels of progesterone in the early luteal phase were unaffected. In both phases oestrogen and LH levels were little altered. In two subjects, hourly progesterone levels measured throughout the day at a similar time in a subsequent control menstrual cycle showed an appreciable variation in one but steady levels in the second. This variation may contribute to the magnitude of the fall in progesterone noted during the infusion of prostaglandins.
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The use of prostaglandins E(2) and F(2)alpha, administered by extra-amniotic instillation, for the induction of abortion was studied in 94 patients in the first and second trimesters of pregnancy. Abortion was successfully induced in 87% of patients within 36 hours and in 94% within 48 hours. The mean abortion time was 22.4 hours. In 60% of patients abortion was complete.Though the differences were not statistically significant, on average multigravid patients aborted more quickly than primigravidae, while the mean abortion time in PGE(2)-treated patients was less than in those receiving PGF(2)alpha.No serious complications occurred. Some side effects were observed. Occasional vomiting was the commonest symptom but the incidence of side effects was lower than with alternative routes of administration. A leucocytosis was often noted but there were no significant instances of infection.The method has proved a safe and effective means of terminating pregnancies in the second trimester.
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In a preliminary study of 15 patients the clinical effectiveness of prostaglandins (PGE2 and PGF2alpha) as abortifacients when administered by intrauterine instillation compared favourably with previous studies using the intravenous route.Abortion was successfully induced in 14 patients. The average total dose of prostaglandins required was about one-third of the amount needed intravenously, and side effects were minimal.
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The use of intravenous infusions of prostaglandin E (E(1) or E(2)) for the induction of labour was studied in 25 patients at or near term. Labour was successfully induced in 23 patients. The pattern of uterine motility produced resembled that of normal labour. No hypertonus was recorded nor were there any undesirable side-effects.
Intravenous infusions of prostaglandin E (E(1) or E(2)) were used for termination of pregnancy in 11 patients. Induction of abortion was successful in nine instances and in eight the abortion was complete. No undesirable side-effects were recorded.
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