An open study comparing two regimens of gemeprost for the termination of pregnancy in the second trimester

Abstract

Two regimens of the prostaglandin E1 analogue, gemeprost, were compared in an open trial for termination of pregnancy between 12 and 18 weeks. Fifty women received 5 x 1 mg of gemeprost every 3 h and in another 50 cases, 4 x 1 mg of gemeprost was administered every 6 h. Although the median abortion interval was slightly shorter in the 3-hourly group (15.9 h vs. 16.9 h; p = 0.5), the cumulative abortion rates at 24 h were similar (88% vs. 82%; p less than 0.5). In women who aborted within the first 24 h, significantly fewer pessaries (p less than 0.01) were required to induce abortion in the 6-h treatment group (median 3, range 1-4) than the 3-h group (median 5, 2-5). Parous women in both treatment groups required fewer pessaries to induce abortion than did nulliparous women (not significant; p = 0.5). Significantly (p less than 0.01) fewer pessaries were required to induce abortion in the 6-h gemeprost group. The were no significant differences between the groups regarding incidences of diarrhea, vomiting, or the request for analgesia. These results suggest that in many women the number of pessaries used to induce mid-trimester abortion could be reduced by lengthening the interval between insertion of pessaries within the first 24 h, without loss of clinical efficacy.

PIP: Obstetrician/gynecologists compared the efficacy, side effects, and complications of the 3-hour regimen of 1 mg gemeprost for inducing abortion with those of the 6-hour regimen of 1 mg gemeprost in 100 women of at least 16 years of age and of 12-18 weeks gestational age at the Simpson Memorial Maternity Pavilion in Edinburgh, Scotland. The 3-hour regimen decreased the induction-abortion interval by 1 hour (15.9 vs. 16.9), but this reduction was insignificant. All 50 women who received gemeprost vaginal pessaries every 3 hours aborted within 48 hours, while 10% who received them every 6 hours did not abort. The cumulative abortion rate at 24 hours was essentially the same for both groups (88% vs. 82%). Women who expelled the conceptus within 24 hours, and on the 6-hour regimen, required considerably fewer pessaries than those on the 3-hour regimen (median 3 vs. 5; p .01). Multiparous women needed fewer pessaries than did primiparous women, but the difference was not significant. Further, women in the 6-hour gemeprost group required significantly fewer pessaries than those in the 3-hour group (p .01). Women in the 3-hour group were just as likely as those in the 6-hour group to experience diarrhea (0.7 vs. 0.98), vomiting (0.7 vs. 0.6), or ask for pain killers (0.9 vs. 1.1). Women in the 3-hour group were twice as likely to retain the placenta than those in the 6-hour group (40% vs. 20%; p .05). Considerably more women in the 6-hour group needed intravenous oxytocin to induce abortion (16% vs. 4%; p .05). These results suggested that physicians should administer gemeprost pessaries every 6 hours within the first 24 hours as a clinically efficacious and cost-efficacious and cost-effective means to induce abortion.