Oral administration of RU 486 and 9-methylene PGE2 for termination of early pregnancy

Swahn, Marja‐Liisa; Gottlieb, Claes; Green, K.; Bygdeman, M.

doi:10.1016/0010-7824(90)90056-2

Cited by 23 publications

(7 citation statements)

References 17 publications

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“…Karman exeresis, and administration of prostaglandins and antiprogestin. These methods have been found effective and safe, with a success rate over 95% and very few complications (1)(2)(3)(4)(5) .…”

mentioning

confidence: 99%

Women's evaluation of three early abortion methods

Holmgren¹

1992

Acta Obstet Gynecol Scand

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Today several very early abortion methods are available; effective and safe, medical as well as surgical. The aim of the present study is to estimate women's attitudes towards three early abortion methods, to see if one or several of these methods are preferable--or best avoided--for psychological reasons, and to assess if women of a certain social or psychological background would benefit from a specific abortion method. Three groups of women were interviewed two weeks after a first trimester abortion; 1/43 women having an 'ordinary abortion' with preoperative ripening of the cervix followed by a vacuum aspiration under heavy sedation, 2/40 women having a modified Karman exeresis with a paracervical block, 3/45 women having a medical abortion with RU 486 and prostaglandin. There was a noticeable difference in the effect the three abortion methods had on the women taking part in the study. Women with a medical abortion reported more bleeding and somewhat more pain and moral considerations than the other women, but also a relief to be spared a surgical procedure. Most of the women said they preferred the abortion method they had just experienced. A short waiting time appeared to be more important than whether a surgical or a medical method was used. Which abortion method is the best in each case is dependent on a variety of personal reasons, and can only be decided by each woman, in consultation with her doctor.

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mentioning

confidence: 99%

Women's evaluation of three early abortion methods

Holmgren¹

1992

Acta Obstet Gynecol Scand

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“…2 and 3). However, oral doses of 1.0-1.5 mg PGE 2 and intravenous injections of oxytocin were without effect under the same experimental conditions (4,5,6).…”

Section: Effects Of Prostaglandins and Antiprogestins On Uterine Contmentioning

confidence: 83%

“…Preliminary results from an ongoing study indicate that mifepristone (50 mg/ day for 4 days) combined with oral administration of the analog 9-methylene PGE 2 (5 or 10 mg) increased the frequency of complete abortion to 85%. The degree of absorption of the PG analog is found to vary considerably between patients, so the success rate may be increased further if the com position of the vehicle used could be improved to promote absorption (6). Interestingly, addition of ergonovine (0.2 mg 6 times per day) (17) or oxytocin (Ulmann A, personal communication) did not increase the frequency of complete abortion in comparison with mifepristone alone.…”

Section: Combination Of Mifepristone and Prostaglandinsmentioning

confidence: 99%

Prostaglandins and Antiprogestins

Bygdeman

Swahn

1989

Acta Obstet Gynecol Scand

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There is considerable interest in the development of a non‐surgical method to terminate early pregnancy. During the three weeks immediately following the first missed menstrual period, several prostaglandin (PG) analogs such as sulprostone, gemeprost and 9‐methylene PGE2 have been used to terminate the pregnancy. Prostaglandins, however, at the doses required to induce disruption of the conceptus cause gastrointestinal side effects and uterine pain which are more severe than those subsequent to vacuum aspiration. Treatment with the antiprogestin, mifepristone counteracts the effects of progesterone in pregnancy and thus prevents maintenance of the pregnancy. Mifepristone administered alone causes termination of the pregnancy in most, but not all, cases. In addition to removing the influence of progesterone, mifepristrone also induces regular uterine contractions and significantly increased the sensitivity of the uterus to PG analogs. Mifepristone (50 mg/day) followed by an intramuscular injection of a low dose, (0.25 mg), of sulprostone (approximately 1/6 of the dose of prostaglandin necessary to induce abortion if used alone) was highly effective in terminating early pregnancy, causing complete abortion in 94% of cases. Gastrointestinal side effects were rare and uterine pain significantly less common than if PG analogs were used alone. Subsequently the combination of mifepristone and vaginal administration of gemeprost (0.5–1.0 mg) has been shown to be equally effective (1). Ideally, the PG analog would be administered orally rather than by injection or vaginal administration. Preliminary data indicate that 9‐methylene PGE2 but not PGE2 may be suitable for this purpose in combination with mifepristone. In a naturally occurring spontaneous abortions a decreased influence of progesterone and increased local production of PGF2α are thought to result in uterine contractions and hence termination of pregnancy. Thus sequential therapy with antiprogestin and a PG analog may mimic the physiological events of a spontaneous abortion.

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“…When given alone, mifepristone has successfully induced abortion in 50-85% of women with amenorrhea up to 49 days (2,9,10), thus resulting in an unacceptable high frequency of post-treatment surgical interventions. Consequently, mifepristone has in most clinical trials and current practice been combined with a prostaglandin analog administered either vaginally as Gemeprost (8,(11)(12)(13); d1-15-methyl PGF2alpha (14); 9-methylene PGE2 (15) or misoprostol (16) or orally as 9-methylene PGE2 (17) or misoprostol (18)(19), or by intra-muscular injection as Sulprostone (7). Sulprostone has now been withdrawn because of three cases of myocardial infarction possibly related to the use of this drug (20).…”

Section: Discussionmentioning

confidence: 99%