Early pregnancy termination: a comparison between vacuum aspiration and medical abortion using prostaglandin (16,16 dimethyl‐trans‐Δ2‐PGE1 methyl ester) or the antiprogestogen RU 486

Dear Sir, We were very interested in the article by Dr Cameron and Professor Baird [Br J Obstet Gynaecol(1988) 95, 271-2761, We have been using Cervagem (gemcprost) pessaries to induce a medical abortion in women with missed abortion or a recognized fetal abnormality such as spina bifida or Down's syndrome diagnosed by either ultrasound scan, amniocentesis or chorionic villus sampling. The majority of pregnancies were mid-trimester. Between 1986 and 1987, we treated 53 patients with Cervagem pessaries (gemeprost 1 mg) either for missed abortion in 21 or proven fetal abnormality in 32. All the patients were admitted to a single ward adapted to their needs, providing private selfcontained accommodation, with emotional and physical support during the in-patient period, and community support at home if required. All patients were given one Ccrvagem pessary vaginally every 3 h until abortion took place, and there was no limit placed on the number of pessaries to be used. In the missed-abortion group, the mean gestational age at diagnosis was 19 weeks (range 12-27 weeks) based on the last menstrual period. These patients required an average of three pessaries (range 1-5) before the fetus aborted. Of the 21 abortions 11 (52%) were complete and did not require evacuation of retained products, or blood transfusion; 10 (48%) required evacuation of retained products or manual removal of placenta under general anaesthesia, two of these patients required blood transfusion for excessive blood loss. In the fetal abnormality group, where fetal death had not occurred, the same procedure was followed. In this group mean gestation was tS weeks (range 12-23 weeks), the average number of pessaries used was 4.4 (range 1-8). Of the 32 patients 18 ( 5 6 % ) aborted completely and required no transfusion or evacuation, in 14 (44%) the abortion was incomplete and required evacuation of uterus or manual removal of placenta, four of these patients required blood transfusion. All the patients had adequate pain relief either with oral analgesics or intramuscular opiate. There were no major side-effects in any of the patients sufficient to cause the proccdure to be abandoned Previous reports on uses of Cervagem in midtrimester abortions have involved normal pregnancies (Nair et al. 1986; Sakamoto et al. 1982) and have reached favourable conclusions. Our experience in the use of Cervagem in pregnancies associated with fetal abnormality or early fetal death at a variety of gestational ages shows no major side-effects and avoids any operative procedures in just SO% of the patients studied. We would therefore recommend the further assessment of this method of termination of abnormal and normal pregnancies at all gestations. P. K. Iqbal Senior SHO R. E. Hopkins Consultant T. C. Stevenson Consultant F. N. Mayers Consultant M. W. Gartside Consultant Bolton General Hospital Minerva Road, Farn worth Bolton BL4 OGR