The use of prostaglandins for termination of abnormal pregnancy

Termination of abnormal pregnancy has long been a major gynecological problem. Both surgical and non-surgical procedures are associated with a significant risk for both minor and major complications. Treatment with natural prostaglandins and especially prostaglandin analogues administered by non-invasive routes seems to be an attractive alternative to methods in current use. In the present study 68 consecutive patients with a missed abortion or hydatiform mole were treated with vaginal suppositories containing either 15-methyl-PGF2 alpha methyl ester or 9-deoxo-16,16-dimethyl-9-methylene PGE2. When the uterine size at treatment was 13 weeks or less, vacuum aspiration was performed 12 hours after start of prostaglandin therapy (group I: 41 patients). When the uterus was larger, curettage was performed only after abortion (group II: 27 patients). In group I approximately 45% of the patients aborted within 12 hours from the start of prostaglandin treatment. In the remaining patients the cervical canal was sufficiently dilated and the uterus contracted to allow an easy evacuation. In group II all patients aborted within 26 hours from start of therapy. No serious complications were observed. Both prostaglandin analogues seemed equally effective in terminating an abnormal pregnancy. The E analogue has the advantage of causing significantly fewer gastro-intestinal side effects than the F analogue, though temperature elevation is more common with the former. It may be concluded that vaginal administration of prostaglandin analogues is a simple and effective therapy for termination of abnormal pregnancy and seems to offer considerable advantages over methods in current use.