Abortion with sulprostone, a prostaglandin E2 derivative

Abstract

Sulprostone, a prostaglandin E2 derivative, was used in a multicenter trial to terminate 478 pregnancies of 8-21 weeks' gestation. The compound was clinically well accepted without premedication in extraovular, intravenous and intramuscular routes of administration. At 24 hours after treatment, 67%-88% of the patients had aborted, with a low average incidence of side effects. Sulprostone is preferred clinically to primary prostaglandins. Intravenous infusion was found to be the safest route, but intramuscular injection proved to be the most practical.

PIP: A study of 478 first or second trimester abortion patients was made to determine the proper dose of sulprostone (a prostaglandin E2 derivative) for extraovular, intravenous, and intramuscular administration, to establish the drug's efficacy, and to record side effects of this abortifacient agent. The optimal extraovular dose was found to be 50-100 mcg, delivered as a single dose. Doses higher than 100 mcg increased side effects dramatically, and doses under 15 mcg were completely ineffective. For intravenous infusion, the optimal dose was from 1000-1500 mcg of sulprostone. For intramuscular administration, the optimal total intramuscular dose was about 1500 mcg, with an initial dose of 500 and an additional injection of 1000 mcg 4 hours later. The maximum average efficacy with the different routes of sulprostone administration varied from an abortion score of 67 for intravenous, of 70 for extraovular, and of 84 for intramuscular at 24 hours. (Abortion score was as follows: 20=failure to abort, 40=cervix opened for dilatation and curettage, 60=fetus delivered, and 100=complete abortion.) Side effects were dose dependent for all routes of administration, and were generally acceptable. The incidence of vomiting was .4-2.2 times per patient in the various study groups when a clinically effective dose of sulprostone was administered.