Clinical Applications of Mifepristone (RU486) and Other Antiprogestins Assessing the Science and Recommending a Research Agenda (1993) / Chapter Skim
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B6. Uses of Antiprogestins After 63 Days of Amenorrhea
B6. Uses of Antiprogestins After 63 Days of Amenorrhea
Pages 174-182
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From page 174... ...
0 Its distribution must be strictly controlled. O Each patient must sign a form indicating that she is aware that the method does not ensure a 100 percent success rate, hence, the need for a mandatory control visit 8-10 days after RU 486 intake.
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Previous studies with RU 486, including studies of first-term pregnancy termination, indicate that RU 486 treatment sensitizes the myometrium to the action of prostaglandins, allowing a decrease in the amount of prostaglandin necessary to induce expulsion. This observation led to several clinical trials in which the effect of RU 486 treatment prior to PG administration was evaluated as a means to allow a decrease in PG doses and to accelerate expulsion in second-term pregnancy termination.
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176 EM o a, 7 ~o .~ be V)
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The optimal dose of RU 486 was studied in the aforementioned Canadian study, in which different groups received either a placebo or 50, 100, 200, 400, or 600 mg of RU 486, as a single administration 24 or 48 hours prior to cervical calibration. For all doses of RU 486 studied, there was a significant increase of cervical diameter, which was linearly related to dosage up to 400 ma.
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Given the short time between drug intake and cervical calibration, it is likely that the maximal effect was not observed. In this study, the ease of comDlementarv mechanical dilation we; lin~rl~r 6.4 (1.2b)
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, which compared RU 486 to gemeprost (1 mg pessary 3-4 hours prior to calibration) , both RU 486 and gemeprost induced an identical increase in cervical diameter and a similar reduction in the resistance to mechanical dilatation.
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of oxytocina Number of cesarean sections Neonatal tolerance N (A of infants) · With Apgar score below 7 · At 1 minute · At 5 minutes · With umbilical vein pH below 7.20 NOTE: IU = intrauterine; NS = not significant; SD = standard deviation.
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From page 181... ...
Since these other obstetrical indications are limited to inpatient use, the approved antiprogestins can be distributed and prescribed following the same procedures as those followed for medical pregnancy termination, which limits the risk of improper use. REFERENCES Burgess, K.M., Jenkin, G., Ralph, M.M., et al.
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From page 182... ...
for cervical preparation in first trimester pregnancy termination by vacuum aspiration. British Journal of Obstetrics and Gynaecology 97:260-266, 1990.
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