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  • Title: Intramuscular administration of 16 phenoxy omega 17,18,19,20 tetranor PGE2 methyl sulfonylamide for pre-operative cervical dilatation in first trimester nulliparae.
    Author: Karim SM, Ilancheran A, Wun W, Ho TH, Ratnam SS.
    Journal: Prostaglandins Med; 1978 Jul; 1(1):71-5. PubMed ID: 715049.
    Abstract:
    A single intramuscular dose of 500 microgram 16 phenoxy omega 17,18,19,20 tetranor PGE2 methyl sulfonylamide was used for cervical dilatation prior to vacuum aspiration in 80 first trimester nulliparae. Three hours after prostaglandin administration the cervix had dilated to 8 mm or more in 60 patients (75%). The uterus was evacuated in these patients without mechanical dilatation of the cervix. In the remaining 20 patients the cervix had dilated 4 to 7 mm. Further mechanical dilatation to 8 mm was carried out easily in most of these patients. Side effects included pain requiring analgesic (3 patients), vomiting (4 patients) and transient pyrexia (greater than 1 degrees C, 2 patients). There were no complications or damage to the uterus or the cervix during evacuation of the uterus. Because preoperative cervical dilatation is advantageous, especially in nulliparous subjects, dilatation before vacuum aspiration was achieved by a single intramuscular dose of 500 mcg of 16 phenoxy delta 17,18,19,20 tetranor prostaglandin (PG) E2 methyl sulfonylamide. 80 first trimester nulliparas, aged 15-34, were pretreated 3 hours before uterine evacuation with the PG analog. None of the 80 aborted during the interval between PG injection and uterine evacuation, but 25 (31%) had some uterine bleeding. In 24 of these 25, bleeding was slight ( 10 ml), and it was moderate in the other (25-50 ml). 3 hours after PG administration, the degree of cervical dilatation ranged from 4-14 mm. 60 patients (75%) achieved adequate dilatation (8 mm or more), allowing for complete uterine evacuation without mechanical dilatation. 17 patients whose cervices had dilated 6-7 mm had slight further dilatation which was easily performed. The cervix failed to dilate beyond 4 mm in 3 subjects, and mechanical dilatation proved difficult. Uterine pain was reported by all subjects. Complications (through 4-weeks follow-up) were not evident. Side effects were those common to PG, i.e., vomiting, transient pyrexia 1 degree centigrade, and pain requiring analgesia. The time interval between PG injection and adequate cervical dilatation was short enough to avoid overnight hospitalization and seems an efficacious outpatient procedure.
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