The effects of longacting paracervical block anesthesia on the abortifacient efficacy of intra-amniotic PGF2alpha and hypertonic saline.

A comparative study was conducted to evaluate the effects of repeated, longacting paracervical blocks on the abortifacient efficacy of intraamniotic prostaglandin F2alpha (PGF2alpha)-40 mg initially and an additional 20 mg after 24 hours--and hypertonic saline augmented with intravenous oxytocin, for patients at 16 to 20 weeks' gestation. Patients were randomly assigned to the 2 abortion procedures, and one half (50) of the patients induced with each procedure received serial, longacting paracervical blocks. For those patients aborted with saline, the rates of complications, side effects, incomplete abortion, and cumulative abortion were similar for patients whether they did or did not receive paracervical blocks. Among the PGF2alpha-treated patients who were administered paracervical blocks, there was a significant reduction in the rates of gastrointestinal side effects and incomplete abortion and a significant differences in the cumulative abortion rates. Within 32 hours of the initial PGF2alpha, instillation, 98% of the patients who received paracervical blocks aborted compared to 70% of those who did not receive paracervical blocks. Although the cumulative abortion rates of PGF2alpha-treated patients with paracervical blocks and saline-treated patients were similar, the rate of incomplete abortion for the PGF2alpha-treated patients was significantly lower. Additional studies will be necessary to evaluate the safety and advantages of using paracervical block anesthesia as an adjunct to midtrimester abortion procedures.

PIP: 200 women pregnant for 16-20 weeks were aborted either 1) by 40 mg prostaglandin F2a (PGF2a) with an additional 20 mg at 24 hours if necessary, or 2) by saline plus oxytocin; 1/2 of the patients in each group were given a paracervical block (PCB) of lidocaine with epinephrine. Side effects were lower (p .1) in the PGF2a patients receiving the PCB than in those who did not. Also, abortion under PGF2a plus PCB was complete (without retained placenta) more often than under PGF2a alone. Regardless of PCB use, the instillation-to-labor interval was lower in the PGF2a group than in the saline group, (p .1). PCB was not found to improve the efficacy of the saline abortions in any respect. It is suggested that the PCB may act by enhancing cervical compliance.

Early termination of pregnancy: a comparative study of intrauterine prostaglandin F2alpha and vacuum aspiration.

The relative safety and effectiveness of vacuum aspiration and the intrauterine administration of 5 mg PGF2alpha for terminating pregnancies within two weeks of a missed menstrual period were evaluated in a study where subjects were randomly assigned to procedures; 100 patients were aborted with vacuum aspiration and 100 patients were aborted with PGF2alpha. All PGF2alpha-treated patients were premedicated with meperidine, diazepam and atropine. Complications were infrequent with either of the procedures. Vomiting occurred more frequently during the PGF procedure (30.0%) than during the vaccum aspiration procedure (9.0%). The intrauterine instillation of PGF2alpha successfully terminated all pregnancies. One patient continued to be pregnant after the vacuum aspiration procedure. Based on the results of this study both study procedures appeared to be safe and effective for terminating early first trimester pregnancies.

Repeated extra-amniotic administration of prostaglandin F2alpha for midtrimester abortion.

Midtrimester abortion was induced in 94 of 100 patients at 16 to 24 weeks' gestation by the extra-amniotic administration of 1170 microng of prostaglandin F2alpha (PGF2alpha) every 10 minutes. The number of prostaglandin doses varied from 16 to 24 depending on the patient's response to the prostaglandin. The median abortion time was 10.0 hours, and 82.0% of the patients aborted within 24 hours. Overall, 68.0% of the patients failed to expel the placenta within one hour of abortion of the fetus. Vomiting and diarrhea occurred among 42.0 and 17.0% of the patients, respectively. Compared with the intra-amniotic administration of a single 50 mg dose of PGF2alpha, the extra-amniotic procedure was associated with similar side effect rates, a higher rate of incomplete abortion, and a significantly shorter abortion time.

Midtrimester abortion: a comparison of intraamniotic prostaglandin F2alpha and hypertonic saline.

The safety and effectiveness of two intraamniotic prostaglandin F2alpha (PGF2alpha) dose schedules (a single 50 mg dose and a repeated 25 mg dose) and intraamniotic hypertonic saline were evaluated in a study where each abortion procedure was randomly assigned to 50 patients. All patients were at 16 to 20 weeks' gestation. Rates of gastrointestinal and other side effects were generally higher for the 50 mg PGF2alpha dose schedule than for the other two procedures. The repeated 25 mg PGF2alpha dose schedule resulted in higher 24-hour (68.0%) and 48-hour (98.0%) cumulative abortion rates than the 50 mg PGF2alpha dose schedule (54.0%, 92.0%) or saline (34.7%, 91.8%). Rates of spontaneous placental expulsion were highest for the repeated 25 mg PGF2alpha dose (74.0%) and lowest for the 50 mg PGF2alpha dose schedule (40.0%).

The early post-partum insertion of the nylon ring.

PIP: 200 women were fitted within 24 to 48 hours after delivery with Ragab's nylon ring. Only 50 women were followed for 6 months postpartum. The incidence of follow-up was 30% in primaparae and 24% in multiparae. There were 21 women who continued to wear the IUD at 6 months, 2 who had had it removed, and 27 who had expelled the device. (The expulsion rate was 54%). The average insertion to expulsion period was 10 days. The high expulsion rate was felt to be due to the earlier insertion date postpartum than is usual. There were no clinical complications. The early postpartum insertion was recommended for this particurly low socioeconomic group.^ieng