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  • Title: [A new therapeutic approach for terminating intact and disturbed pregnancies: three years of experience with the prostaglandin E2-derivative sulprostone (SHB 286) (author's transl)].
    Author: Schmidt-Gollwitzer K, Schüssler B, Elger W, Schmidt-Gollwitzer M.
    Journal: Geburtshilfe Frauenheilkd; 1979 Aug; 39(8):667-75. PubMed ID: 478268.
    Abstract:
    Sulprostone, a new synthetic prostaglandin E2-derivate has been tested for artificial abortion in 628 women with intact or disturbed pregnancies in all stages of gestation. Compared with other prostaglandins used for this purpose systemic side-effects were low and success-rate was high. Systemic routes of application (constant intravenous drop infusion, intramuscular injection) were evaluted to be more successful and conventient than the local ones (extra- and intraamniotic). Suppositories showed no clinical success. Based on our expereince recommendations for the treatment with sulprostone are given: Intramuscular injections for inducing early abortion or menstrual regulation (less than 6th week of pregnancy) without necessity of curettage and for cervical rpiening (less than 12th week of pregnancy) prior to curettage, constant intravenous drop infusion for induction of abortion in second and third trimester pregnancy. Sulprostone was administered to 628 women, 14-47 years of age, to induce abortion in cases of intact and disturbed pregnancies in the 5th - 37th weeks. The preparation was administered in 30 cases as a suppository, in 86 cases intra- or extraamnially, in 302 cases intravenously (i.v.) and in 210 cases intramuscularly (I.m.). The suppositorial administration cannot be used in induce abortion. A complete abortion was induced in 10 of 56 women in the first trimester and in 15 of 20 women in the second trimester with an extraamnial instillation of sulprostone, and in 90% by intraamnial infusion. The best results from i.v. administration of sulprostone were obtained by administering a total dosage of 1000 mcg of the drug over a 10 hour period. Incomplete or complete abortion was induced in 84.7% of the women in the first trimester who received sulprostone i.v. with an average induction-abortion interval (i.a.i.) of 12.2 hours. Complete abortion was obtained in 90% of the women in the 2nd trimester who received sulprostone i.v., with an average i.a.i. of 13.2 hours for intact and 9.3 hours for disturbed pregnancies. 30 patients less than 6 weeks pregnant received two 500 mcg i.m. injections of sulprostone to induce bleeding. 167 women in the early second trimester were given sulprostone i.m., 1-3 doses of 500 mcg at 4-8 hr. intervals. An abortion resulted in 50% of the patients after 1 injection. The rate of incomplete abortions increased with increased dosage. An average i.a.i. of 11.4 hours was recorded. In both i.v. and i.m. applications, increased dosage did not cause increased effectiveness, but increased side effects. 23.5% of the patients experienced nausea, 15.1% vomiting, and less than 1% diarrhea. I.m. administration is preferred up to the 12th week of pregnancy, while i.v. administration is preferred for disturbed pregnancies after the 12th week.
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