Menstrual induction--termination of early pregnancy with a new prostaglandin analogue SHB 286.

 The efficacy and side effects of a new synthetic analogue, 16 phenoxy 17, 18, 19, 20 tetranor prostaglandin E2 methyl sulphonylamide (SH 286) for menstrual induction was studied at the Kandang Kerbau Hospital in Singapore. Subjects were 150 patients with a delay in menstruation of 7-14 days. In 128 patients the pregnancy test before prostaglandin administration was positive and in 22 patients it was negative. Most of the 22 patients with a delay in menstruation had other symptoms suggestive of pregnancy. The prostaglandin analogue (50 mcg in 1 cc of saline) was instilled into the uterine cavity via a 6 mm catheter introduced through the cervix. The catheter was flushed with 1.5 cc of saline and immediately withdrawn. The patients were observed for the next 6 hours and allowed to go home. At the follow-up visit 10-14 days later, the pregnancy test was repeated. The criteria for successful treatment was vaginal bleeding after prostaglandin administration followed by a negative pregnancy test at the follow-up visit. The treatment was successful in 144 patients (96%). Of the remaining 6 patients, 4 had uterine bleeding for 2-13 days but pregnancy test remained positive. The prostaglandin failed to induce bleeding in 2 patients. The uterus was evacuated in these 6 patients by vacuum aspiration. The interval between prostaglandin administration and onset of bleeding ranged between 30 minutes and 6 hours. The average length of uterine bleeding was 7.3 days with a range of 2-13 days. All patients experienced mild uterine pain a few minutes after prostaglandin administration, but only 11 patients required analgesics. Side effects included 1 or 2 episodes of vomiting in 9 patients and headache in 6 patients. There were no changes in blood pressure, pulse, or respiration. 1 patient was treated for pelvic infection 10 days after prostaglandin administration, and curettage was performed in 2 patients for intermittent bleeding 2 weeks after successful treatment with prostaglandin. 16 phenoxy 17, 18, 19, 20 tetranor prostaglandin E2 methyl sulphonylamide was found to be effective in inducing menstruation when this was delayed by up to 2 weeks.
