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  • Title: [Treatment in miscarriage and abortion. Widened use of drugs has many advantages].
    Author: Bygdeman M.
    Journal: Lakartidningen; 1994 Apr 06; 91(14):1396-7. PubMed ID: 8189866.
    Abstract:
    In the fall of 1992, an abortifacient, mifepristone (Mifegyne), was introduced in Sweden. Mifepristone is an antiprogesterone that binds with progesterone receptors without releasing the biological effect of progesterone. The result is a local progesterone burst that causes damage in the blood vessels in the capillaries of the decidua, bleeding, necrosis of the decidua, the detachment of the pregnancy, increased sensitivity of the myometrium to prostaglandin, uterine contractions, and expulsion of the conceptus. Treatment with a combination of mifepristone and a prostaglandin analog, usually gemeprost (Cervagem), is a very effective method of abortion and an alternative to vacuum aspiration during the first weeks of pregnancy. At the present, time this is the only well-known indication for antiprogesterone. However, the range of use of antiprogesterone will most likely rise in the coming years. In a 1992 study, 60 patients with pregnancy up to the 13th week were treated with 600 mg of mifepristone and 36-48 hours later with 600 mcg of misoprostol (Cytotec) for missed abortion and anembryonic pregnancy. 57 aborted, and the rest underwent vacuum aspiration. The average time of abortion was 4 hours, and the period of bleeding averaged 10 days. Uterine pain required analgesics in 20 cases. In a 1993 analysis, 44 women were given prostaglandin for abortion: either in the form of an intramuscular injection of 0.5 mg of sulprostone or in two tablets of misoprostol (400 mcg). The treatment failed in two cases, but 50% of women could return to work immediately, while the rest waited an average of 3 days. Often after the 12th and always after 14th week of pregnancy, a 2-step method is used that consists of prostaglandin analogs such as gemeprost given vaginally. However, it takes up to 24-28 hours to abort. Cervical ripening with intracervical PGE2 or laminaria can shorten the time to 10-15 hours equivalent to one day of hospitalization instead of 2-3 days.
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