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Intramuscular administration of 15-methyl prostaglandin F and laminaria insertion for termination of mid-trimester pregnancy

  • S. D. Sharma
  • V. M. Steinmiller
  • R. W. Hale
Chapter
Part of the Advances in Reproductive Health Care book series (ARHE, volume 4)

Abstract

Termination of mid-trimester pregnancy remains a significant clinical problem. In order to avoid operative procedures such as hysterotomy, a number of techniques for the induction of uterine activity resulting in spontaneous expulsion of products of conception are being investigated. Since the 1970s the naturally occurring Prostaglandins E2 and F have been used to terminate pregnancy (Karim and Filshie, 1970; Bygdeman and Wiqvist, 1971; Embrey, 1971). Naturally occurring Prostaglandins E2 and F are rapidly metabolized and inactivated in the body. They must be given by continuous intravenous infusion or by repeated administration via other routes such as intrauterine, vaginal or intramuscular methods. The introduction of the methyl group in the 15 position of the Prostaglandins E2 and F protects them against enzymatic degradation by Prostaglandin 15-dehydrogenase, thus prolonging their duration of action and their potency (Bundy et al., 1971; Yankee and Bundy, 1972). The clinical application of these analogs to terminate pregnancy was first reported by Karim and Sharma (1972). The analog 15(S)-15-methyl-prostaglandin F (15-me-PGF), unlike the naturally occurring PGF can be given intramuscularly without causing local inflammation or severe pain at the site. It also has a practical advantage in patients with ruptured membranes in mid-trimester pregnancy. 15-me-PGF has an overall potency of approximately ten to twenty times that of PGF2α. A large number of clinical trials have been carried out since 1972 to evaluate the usefulness of intramuscular 15-me-PGF for termination of mid-trimester pregnancy (WHO Multicenter Study, 1977). While the efficacy of 15-me-PGF is not in doubt, the incidence of gastrointestinal side-effects, such as nausea, vomiting, and diarrhea, are too high and in unacceptable ranges. In order to reduce the severity of gastrointestinal side-effects, antidiarrheals and antiemetics are recommended routinely as premedication and during the procedure. The side-effects can also be minimized by shortening the injection-abortion interval by the use of laminaria tents 12–18 h prior to the administration of 1 S-me-PGF (Sharma et al., 1975; Stubblefield et al., 1976). The use of laminaria has also reduced the number of serious cervical lacerations (Duenhoelter et al., 1976; Stubblefield et al., 1975).

Keywords

Placenta Accreta Uterine Activity Trimester Pregnancy Fertility Regulation Uterine Curettage 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© MTP Press Limited 1984

Authors and Affiliations

  • S. D. Sharma
  • V. M. Steinmiller
  • R. W. Hale

There are no affiliations available

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