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 ::  Abstract
 ::  Introduction
 ::  Material and Method
 ::  Results
 ::  Discussion
 ::  Acknowledgement
 ::  References
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ARTICLE
Year : 1977  |  Volume : 23  |  Issue : 2  |  Page : 91-94

Serial intramuscular injections of 15 methyl P.G.F. for second trimester abortions


Department of Obstetrics & Gynaecology, K.E.M.Hospital, Parel, Bombay-400 012, India

Correspondence Address:
R M Gharse
Department of Obstetrics & Gynaecology, K.E.M.Hospital, Parel, Bombay-400 012
India
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Source of Support: None, Conflict of Interest: None


PMID: 614421

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 :: Abstract 

Second trimester abortions were induced in forty-four cases by giving serial int.rwmuscular injections of 15 Methyl PGF 2α in intial dose of 200 micrograms followed by 300 micrograms every 3 hours till the foetus was expelled or till a maximum time limit of 30 hours whichever was earlier. Tablets containing diphenoxylate -atropine combination were given to minimise side effects. Forty­three cases (97.8%.) were successful; 39 (88.6%) aborted within the specified time limit of 30 hours. The mean abortion time was 18.8 hours. The main disadvantages were a high percentage of incom­plete abortions (48.8%) and a high incidence of side effects, viz. vomiting and diarrhoea.



How to cite this article:
Gharse R M, Krishna UR, Ganguli A C, Purandare V N. Serial intramuscular injections of 15 methyl P.G.F. for second trimester abortions. J Postgrad Med 1977;23:91-4

How to cite this URL:
Gharse R M, Krishna UR, Ganguli A C, Purandare V N. Serial intramuscular injections of 15 methyl P.G.F. for second trimester abortions. J Postgrad Med [serial online] 1977 [cited 2020 Feb 20];23:91-4. Available from: http://www.jpgmonline.com/text.asp?1977/23/2/91/42801



 :: Introduction Top


Prostaglandins have been used by various routes and in various doses for the termination of pregnancy. The in­travenous route, though useful for the in­duction of labour, is found unsuitable for inducing second trimester abortions be­cause the larger dose required is associat­ed with an intolerably high incidence of side effects like vomiting and diarrhoea. The local routes, viz. the intra-amniotic and extra-aminotic are very effective, but require technical skill and experience. The intramuscular route is an im­portant breakthrough, as the administra­tion of the drug does not need much technical skill. The primary Prosta­-glandins when administered intramus­cularly produce a local reaction at the site of the injection. The 15 Methyl analogues are found to be free from this disadvantage. Also the thres­hold dose of the 15 Methyl derivatives is 1/10th of that of the parent compound and the duration of action is more pro­longed.


 :: Material and Method Top


This paper presents the results of a clinical trial of 44 cases of second trimes­ter abortions, induced with serial intra­muscular injections of 15 Methyl PGF 2α.

The first dose was 200 micrograms, followed by 300 micrograms every 3 hours till 30 hours or till the foetus was expelled whichever was earlier. Half an hour before the first 3 doses, 2 tablets containing diphenoxylate atropine com­bination were given as a routine, and then repeated if necessary. Antiemetics were also administered as and when necessary.


 :: Results Top


[Table 1] shows the distribution of these cases according to age, marital status and gravidity.

[Table 2] depicts the distribution of cases according to gestation period. The mean gestational period was 16.1 weeks. The observation time as per WHO pro­tocol was 30 hours. The induction-onset interval was the period from the first in­jection to the onset of pains. The induc­tion-abortion interval was the period from the first injection to the time of ex­pulsion of the foetus. Thirty-nine out of 44 cases had thus aborted successfully within 30 hours. Four more cases had reached the stage of inevitable abortion at the end of 30 hours, and they aborted later without any supplementary therapy. One case did not respond adequately to the drug and she aborted after a pitocin drip. The mean abortion time was 18.8 hours for all cases; in primi-gravidae the mean induction-abortion interval was 21.9 hours, in second gravidae it was 16.7 hours and in multigravid patients it was 15.9 hours [Table 3].

The average total dose required for inducing abortion was 1.86 mg. (the average number of injections being 6.5). The maximum total dose was limited to 3.2 mgms (11 injections) in 5 cases. The quickest abortion was within 2 hours, after the first injection of 200 µg.

The 6 hourly cumulative abortion rate is represented in [Figure 1] in graphical form. The salient features in this graph are a steep rise till a period of 24 hours and later a smaller gradient. At the end of 30 hours, 88.6% patients had aborted.

Thirty patients had vomiting and 31 suffered from diarrhoea. Nine patients had no side effects at all. A considerable number of patients had severe side effects inspite of diphenoxylate-atropine combination and antiemetics. The mean number of vomits was 3.66 per patient and the mean number of loose motions was 5.27. One patient had 15 vomits and 24 loose motions, developed dehydration and was resuscited with intravenous fluids. The multigravidas aborted with­ in a shorter time, required a smaller dose and had fewer side effects [Table 4].

Immediate complications: In 21 cases (48.8%), the abortion was incomplete and required surgical evacuation. This was the major drawback as with most other methods. One patient had exces­sive post-abortal bleeding due to an atonic uterus and required intravenous fluids with oxytocics.

Delayed complications: All of our patients were called for a regular follow-­up for a period of 4-8 weeks after the abortion. 39 cases were re-examined. ­Five patients were lost to follow-up. Twenty-nine cases had stopped bleeding within 5 days after the abortion, 9 cases bled upto 10 days. One patient had to be readmitted for curettage because of per­sistent bleeding and a few adherent placental bits were removed. There was no evidence of post-abortal infection in any case.


 :: Discussion Top


In countries like India with inadequate obstetric facilities the intramuscular route of administration has tremendous advant­ages. Although the efficacy and success from the point of view of abortion is high, the incidence of vomiting and diar­rhoea is disturbing. Devi [2] from Chandi­garh and Hingorani [3] from Delhi however have reported a much lower incidence of side effects in their series. This may possibly be due to the fact that most of their cases were multiparous and of lower gestational periods-12 to 14 weeks -and hence required fewer doses.

A distinct advantage with the intra­muscular method is that as the uterine cavity is not entered, the risk of introduction of sepsis is minimal. This route can also be used in early second trimester cases where intra-amniotic ap­proach is difficult. Yet, a major draw­back is the high incidence of incomplete abortions. Brenner et al [1] and Lauersen [4] reported an incidence of 29% and 14.3% of incomplete abortions respectively in their series. Brenner et al [1] suggest con­tinuing the use of the Prostaglandin in­jections after the expulsion of the foetus as a possible means of decreasing the number of incomplete abortions.

In conclusion, the merits of high effec­tiveness, the ease of administration, suitability for early and late second tri­mester patients, minimal risk of sepsis of intramuscular route must be weighed against the disadvantages mainly the higher incidence of side effects and possi­bility of incomplete abortion. Efforts to minimise the cost of the drug and the search for an analogue with minimum side effects are most essential for a wider application of this drug.


 :: Acknowledgement Top


We thank Dr. C. K. Deshpande, Dean, K.E.M. Hospital, for permitting us to publish the hospital data.

This investigation received financial support from the World Health Organiza­tion.

 
 :: References Top

1.Brenner W. E., Dingfelder, J. R., Staurovsky, L. G., Kumarswamy, T. and Grimes, D. A.; Intramuscular adminis­tration of 15(S)-15 methyl prostaglandin E 2 -methyl, ester for induction of abortion. Amer. J. Obstet. & Gynec., 120: 833-836, 1974.  Back to cited text no. 1    
2.Devi, P. K.: Personal communication at W.H.O. P.G. Task Force meeting, Bom­bay 1975.  Back to cited text no. 2    
3.Hingorani, V.: Personal communication at W.H.O. P.G. Task Force meeting, Bom­bay, 1975.  Back to cited text no. 3    
4.Lauersen. N. H. and Wilson, K. H.: Midtrimester abortion induced by serial intramuscular injection of 15(S)-15 methyl-prostaglandin F.,a. Amer. J. Obstet. & Gynec.. 121: 2 . 73-2.77, 1975.  Back to cited text no. 4    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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