Prostaglandins and abortion. III. Comparison of single intra-amniotic injections of 15-methyl prostaglandin F2alpha and prostaglandin F2alpha for termination of second-trimester pregnancy: an international multicenter study. World Health Organization Tast Force on the Use of Prostaglandins forthe Regulation of Fertility

Abstract

A multicenter, multinational study involving 1,521 patients has compared prostaglandin F2alpha (PGF2alpha) (40 or 50 mg.) and 15-methyl PGF2alpha (2.5 mg.) given intra-amniotically for induction of second-trimester abortion. The highest success rates for PGF2alpha at 24 and 48 hours were 67.8 and 86.6 per cent, respectively. The percentages for 15-methyl PGF2alpha for the equivalent times were 74.1 and 95.6 per cent, respectively. There were 75 cases classified as failures in 602 patients treated with PGF2alpha and only 34 cases were classified as failures among 919 patients treated with 15-methyl PGF2alpha. A further 35 patients required additional treatment to complete the abortion. The over-all incidence of diarrhea and vomiting was low, less than 3.4 episodes per patient. There were 20 cases of cervical laceration (2.9 per cent); only one extended into the lower segment of the uterus. It is concluded that intra-amniotic administration of either 50 mg. of PGF2alpha or 2.5 mg. 15-methyl PGF2alpha provides an effective and safe method for termination of second-trimester pregnancies.

PIP: Multinational midtrimester abortion trials were conducted with 2.5 mg 15-methyl-prostaglandin f2 alpha (PGF2a) given intraamniotically in 311 women, 2.5 mg 15-methyl-PGF2a compared with 40 mg PGF2a in 251 women, and 2.5 mg 15-methyl-PGF2a compared with 50 mg PGF2a in 684 women. Success rates within 48 hours were 95.2, 95.6, and 92.8% in the 3 15-methyl-PGF2a groups, 81.7% in women given 40 mg PGF2a, and 86.6% in women given 50 mg. There were 109 failures, the majority in PGF2a groups. 35 women were given supplementary treatment. Incidence of complete abortion ranged from 49 to 55% in the 5 groups, usually higher at longer gestation. Frequency of heavy bleeding was higher in PGF2a groups. Both vomiting and diarrhea occurred more frequently in the 15-methyl-PGF2a groups. Cervical rupture of up to 2 cm occurred overall in 4.4% of primigravidae and 1% of multigravidae, and 1 serious cervical rupture occurred.