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  • Title: Non-invasive methods for termination of second trimester pregnancy.
    Author: Bygdeman M.
    Journal: Baillieres Clin Obstet Gynaecol; 1990 Jun; 4(2):351-9. PubMed ID: 2225604.
    Abstract:
    Medical methods of 2nd trimester abortion are reviewed from recent large studies comparing intramuscular and vaginal application of synthetic prostaglandins (PGs) with natural PGE2 and PGF2alpha, and standard hypertonic saline. The available synthetic PGs for abortion are Sulprostone (Schering) and Carboprost (Upjohn), both PGF analogs for intramuscular injection and Gemeprost (May & Baker, Dagenham, UK) a PGE analog for intravaginal use. Beside these 9-deoxo-16, 16-dimethyl-9-methylene PGE2 and 15(S)-15-methyl-PGF2alpha methyl ester have been evaluated in clinical trials. Best results were obtained in women receiving intramuscular PG analogs by priming the cervix the laminaria tents. All 3 commercially available PGs are more effective than their parent PGs and saline in terms of success rates, 95% or more vs. 85 and 80%. While the abortion interval was 18-20 hours with intraamniotic PGF2alpha, it was about 23 hours with the intramuscular PG analogs, but only 19.3 hours with vaginal Gemeprost. Side effects of vomiting and diarrhea tended to be lower with the PGE analog Gemeprost. Gemeprost was highly acceptable for patients and staff because of the simplicity of administration of the vaginal gel, and also because it caused much less cramping, judging by half as many analgesic injections. The PGE analog in gel form also permits a much lower dose and allows administration by non-physicians, and reduces risk of complications resulting from invasive administration routes. A preliminary study suggests that pretreatment with RU-486 in early 2nd trimester facilitates termination by intraamniotic PGE2.
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