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  • Title: Progesterone inhibition in mid-trimester termination of pregnancy: physiological and clinical effects.
    Author: Selinger M, Mackenzie IZ, Gillmer MD, Phipps SL, Ferguson J.
    Journal: Br J Obstet Gynaecol; 1987 Dec; 94(12):1218-22. PubMed ID: 3322376.
    Abstract:
    A double-blind, placebo controlled clinical trial was conducted to assess the clinical and physiological effects of 'epostane', a progesterone synthesis inhibitor, in mid-trimester prostaglandin termination of pregnancy. Mean peripheral progesterone levels had fallen by 74% after 72 h in the patients treated wtih epostane. The mean induction-abortion interval in the treatment group was 490 (SD 271) min, compared with 1432 (SD 640) min in the control group. Intrauterine pressure recording demonstrated increased sensitivity to prostaglandin E2 after epostane treatment but no change in oxytocin sensitivity. The clinical implications of facilitated induction of abortion are discussed. A double-blind, placebo-controlled clinical trial of epostane, a progesterone synthesis inhibitor, as an adjunct to early mid-trimester abortion by extraamniotic PGE2 was conducted. 5 primigravidae 13-18 weeks pregnant received 100 mg epostane 3 times daily for 3 days, and 5 women received identical placebos. Then they were given exponentially increased doses of oxytocin from 2 to 64 mu/min. In 1 hour 1.5 mg PGE2 in 6% Tylose gel was injected extraamniotically, followed by oxytocin at 100 mu/min 6 hours later. The average interval between PGE2 and abortion was 490 min in the epostane group, compared to 1432 min in controls. The treated women required 1 injection of narcotic analgesic, compared to 2 or 3 in controls. Uterine activity, recorded transcervically, was significantly greater during the baseline recording (p0.05) and the PGE2 infusion (p0.001) phases in the treated group, but not during oxytocin infusion. Progesterone had fallen 74% after epostane treatment. This priming technique has potential benefits for women in less pain, lower PGE2 doses, shorter abortion interval and hospital stay. Possibly by maximizing dose and timing, a day-case mid-trimester abortion or even a medical induction of mid-trimester abortion may be possible in the future.
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