Termination of Pregnancy by a Slow Release Device Containing 16, 16‐Dimethyl‐Trans‐Δ² PGE Methyl Ester

Abstract

Repeated administration is generally necessary t o terminate pregnancy with the last generation of E analogues now in increasing use. In the present study degree of absorption, effect on uterine contractility, and clinical efficacy of a new slow release vaginal device containing between 0.75 t o 2.0 mg 16,16-dimethyltrans-A2 PGEl methyl ester is described. The study included 26 late second trimester patients (15th t o 24th week) and 22 early second trimester patients (12th to 14th week) admitted to the hospital for termination of pregnancy. The former group of patients was treated with one medium size laminaria tent followed 12 hours later by either 1.5, 1.75, or 2.0 mg of the analogue. The early second trimester patients received 0.75, 1.0, or 1.25mg of the analogue and 1 2 hours later vacuum aspiration was performed. Irrespective of the administered dose a maximum plasma level around 400 pg/ml was reached after four hours. The duration of elevated plasma levels was, however, longer with the device containing 1.5 or 2.0 mg in comparison with that containing 0.75 mg. The development of uterine contractility was in accordance with the plasma levels. In the late second trimester patients the three dose levels were equally effective. Twenty-one out of 26 patients aborted within 18 hours following the start of prostaglandin treatment. The effect on cervical dilatation in the early second trimester patients was dose dependent. The highest dose, 1.25 mg, had the drawback of a higher frequency of abortions prior to scheduled time for vacuum aspiration and gastrointestinal side effects. To this group of patients a 1.0 mg device seemed most suitable. The only side effects observed were vomiting and diarrhea, which occurred in approximately one third of the patients. The degree of gastrointestinal side effects was much lower than that generally reported for classical prostaglandins but also for F analogues.termination of pregnancy, slow release device, 1 6 , 16-dimethyl-trans-Az -PGE, m e t h y l ester, levels, uterine contractility plasma