Which factors influence the number of gemeprost pessaries used in inducing second-trimester abortions?

The course of second-trimester abortions with the intention to use gemeprost as the only abortifacient is described.

The report is based on 278 consecutive second-trimester abortions, excluding missed abortions, during a 12-year period in a tertiary referral center. The women were treated with 1 mg gemeprost pessaries every fourth hour with a maximum of five applications during 24 h. If abortion had not occurred, a new treatment of gemeprost was prescribed after an interval of 12 h.

The median number of gemeprost pessaries used was 4 (range 1-16) and the mean number (+/-SD) 4.09 (+/-1.90). Abortion occurred within 24 h in 78% of the women and within 48 h in 96%. The efficiency of gemeprost was highly dependent on previous vaginal deliveries (p<0.001), with a mean number of applications of 4.63 (+/-2.04), 3.93 (+/-1.74), and 3.13 (+/-1.26) in those with none, one, and two or more previous vaginal deliveries, respectively. Previous spontaneous abortions were associated with a lower number of applications. Including previous vaginal deliveries and spontaneous abortions in a two-way analysis of variance (anova), only the number of spontaneous abortions was marginally significant (p=0.05). After excluding four patients with three or more spontaneous abortions from the analysis, the number of previous vaginal deliveries was significant (p=0.010) whereas that of spontaneous abortions became nonsignificant. Postprocedure complications were reported in 13% of the women.

The course of the abortions was dependent on previous vaginal deliveries and spontaneous abortions.