Use of intra-amniotic, intramuscular or intravaginal prostaglandins for mid-trimester termination of pregnancy.

277 terminations of 2nd trimester pregnancies performed at the University Department of Obstetrics and Gynecology of Bari, Italy, during 1985-1990 with intraamniotic administration of hypertonic saline and 35 mg of PGF2alpha (Dinoprost) was the method used initially; more than 90% of cases (84 out of 91) were carried out before 1987. From the end f 1986, intramuscular Sulprostone was used at the dose of 500 mg every 3 hours, for a maximum of 3 injections in 87 cases. Vaginal administration of 1 mg Gemeprost suppository every 3 hours was introduced in 1988 and almost completely replaced the previous techniques (99 cases were reviewed). The mean age of patients was 26.3 years (range 15-47), and gestational age varied from 15 to 24 weeks. 169 (61%) were nulliparous, 97 (35%) had 1 to 3 children, and 11 patients had more than three. 139 (50.2%) were married. Regarding previous terminations of pregnancy, 235 patients (84.8%) had had none, 23 had had one, and 19 more than one. 128 (46.2%) patients came from low socioeconomic class, 105 (37.9%) were middle class, and 44 were high class. The statistical analysis ANOVA showed abortion induction interval of 24.02, 24,28, and 14.24 hours, respectively for the intraamniotic, the sulprostone, and the Gemeprost methods. The days of hospitalization were 9.57, 8.50, and 11.18, respectively. Psychological evaluation indicated that Gemeprost was preferred by the patients, while the intraamniotic method was perceived negatively. Side-effects were significantly milder, thus Gemeprost is considered the first choice for induction of mid-trimester abortion after evaluation of possible contraindications to prostaglandins. In those cases where severe stenosis of the cervical canal arises, laminaria pretreatment followed by either Gemeprost or Sulprostone is highly effective.