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  • Title: Cervical dilatation with prostaglandin analogues prior to vaginal termination of first trimester pregnancy in nulliparous patients.
    Author: Karim SM, Choo HT, Cheng P.
    Journal: Prostaglandins; 1975 Apr; 9(4):631-8. PubMed ID: 1153813.
    Abstract:
    Dilatation of the cervix with prostaglandin analogues prior to vaginal termination of pregnancy was attempted in 125 nulliparous women in the first trimester of pregnancy. The patients were divided into five groups (25 in each group) and given a single extra-amniotic dose of one of the following prostaglandin analogues 14-16 hours prior to the evacuation of the uterus by vacuum aspiration. (Group A) 15 (S) 15 methyl PGE2 (free acid); (Group B) 15 (S) 15 methyl PGE2 methyl ester; (Group C) 15 (S) 15 methyl PGF2alpha (free acid); (Group D) 15 (S) 15 methyl PGF2alpha methyl ester and(Group E) a mixture of 15 (S) 15 methyl PGE2methyl ester and 15 (S) 15 methyl PGF2alpha methyl ester. Evacuation of the uterus without mechanical dilatation of the cervix was possible in 111 (90%) of the patients. In an additional 10 patients (8%) there was some degree of cervical dilatation and further mechanical dilatation could be performed easily. With the combination of 15 (S) 15 methyl PGE2 methyl ester and 15 (S) 15 methyl PGF2alpha methyl ester the incidence of gastrointestinal side effects and pyrexia were considerably reduced. 125 nulliparous women were divided into 5 groups of 25 each to study the efficacy of various prostaglandin (PG) analogs for cervical dilatation preparato to medical termination of pregnancy. All subjects were in the first trimester of pregnancy, and abortions were to be performed vaginally. All patients received their dosages and analogs as a single extraamniotic infusion 14-16 hours prior to evacuation of uterine contents. The 125 women, 62% of whom were teen-agers, were randomly divided into the following groups: 1) 25 mcg of 15(S)-methyl PGE2 (free acid); 2) 25 mcg of 15(S)-methyl PGE2 methyl ester; 3) 250 mcg of 15(S)-methyl PGF2 alpha (free acid); 4) 250 mcg of 15(S)-methyl PGF2 alpha methyl ester; and 5) a mixture of 125 mcg of 15(S)-methyl PGF2 alpha methyl ester plus 12.5 mcg of 15(S)-methyl PGE2 methyl ester. Overall, cervical dilatation was achieved in 111 patients (90%) for aspiration or curettage of the uterine contents. 10 more required mechanical dilatation as a supplement. More patients treated with 15-methyl PGF2 alpha analogs (groups 3 and 4) expelled the fetus before the scheduled time of evacuation compared with those treated with PGE2 analogs (groups 1 and 2) (42% and 22%, respectively). Only 8% (2 patients) of the mixture group (group 5) aborted. Side effects included vomiting, diarrhea, cold and shivering, and pyrexia. Incidence varied with analog; the mixture group (Group 5) had the lowest incidence of gastrointestinal side effects and pyrexia.
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