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  • Title: Termination of second trimester pregnancy with a long-acting vaginal pessary containing 15-methyl-PGF2 alpha methyl ester.
    Journal: Int J Gynaecol Obstet; 1983 Apr; 21(2):159-65. PubMed ID: 6136437.
    Abstract:
    This report summarizes the results of 3 studies comprising 1147 2nd trimester patients admitted to 11 different centers for pregnancy termination. In the 1st, mainly early 2nd trimester patients received 1 longacting vaginal pessary containing 3.0 mg 15-methyl-prostaglandin F2alpha (PGF2alpha) methyl ester, in the 2nd study the pessary was randomly compared with intraamniotic administration of 2.5 mg 15-methyl-PGF2alpha in late 2nd trimester patients (after the 15th week of gestation), and in the 3rd study the same type of patients received the longacting pessary complemented, if necessary, at 24 hours, with intramuscular injections of 15-methyl-PGF2alpha (0.2-0.4 mg every 3rd hour) for up to 12 hours. The efficacy of the longacting pessary was related to the duration of pregnancy. In patients 15 weeks or less pregnant, the frequency of abortion was 8.12% within 30 hours; in pregnancies greater than that, success was 73.3% (P0.05). Both vaginal administration of the longacting pessary containing 15-methyl-PGF2alpha and intraamniotic administration of 15-methyl-PGF2alpha were equally effective during the 1st 24 hours following start of therapy. However, within the next 6 hours, the intraamniotic administration was found to be significantly superior, especially in patients with a more advanced pregnancy. To achieve an efficacy comparable to the intrauterine treatment, it was necessary to add intramuscular injections of 15-methyl-PGF2alpha. This combined treatment resulted, however, in an increased frequency of cervical laceration. The results of the present study indicate that a treatment with a longacting pessary is useful in 2nd trimester pregnancy up to the 15th week of gestation, when puncture of the amniotic sac is difficult. After that, intraamniotic administration of 15-methyl-PGF2alpha appears to be a more effective method with less side effects despite the invasive route of administration. The longacting pessary in conjunction with intramuscular supplement is equally effective if appropriately given.
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