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|Year : 1977 | Volume
| Issue : 2 | Page : 91-94
Serial intramuscular injections of 15 methyl P.G.F. 2α for second trimester abortions
RM Gharse, Usha R Krishna, AC Ganguli, VN Purandare
Department of Obstetrics & Gynaecology, K.E.M.Hospital, Parel, Bombay-400 012, India
R M Gharse
Department of Obstetrics & Gynaecology, K.E.M.Hospital, Parel, Bombay-400 012
Source of Support: None, Conflict of Interest: None
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. 2α 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. 2α for second trimester abortions. J Postgrad Med [serial online] 1977 [cited 2020 Jun 6];23:91-4. Available from: http://www.jpgmonline.com/text.asp?1977/23/2/91/42801
| :: Introduction|| |
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|| |
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|| |
[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|| |
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  from Chandigarh and Hingorani  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  and Lauersen  reported an incidence of 29% and 14.3% of incomplete abortions respectively in their series. Brenner et al  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|| |
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|| |
|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. |
|2.||Devi, P. K.: Personal communication at W.H.O. P.G. Task Force meeting, Bombay 1975. |
|3.||Hingorani, V.: Personal communication at W.H.O. P.G. Task Force meeting, Bombay, 1975. |
|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. |
[Table 1], [Table 2], [Table 3], [Table 4]