Continuation of pregnancy after mid-trimester gemeprost administration



We read with interest the case report by Lakasing and Spencer1 (Vol 106, December 1999). We recently managed a 37-year old multiparous lady, a heavy smoker with a poor social history, who after counselling, was booked for termination of pregnancy in terms of The Abortion Act (1967). An ultrasound scan confirmed an intrauterine pregnancy of 15 weeks' gestation. She received 5 vaginal gemeprost (1 mg) pessaries at three-hourly intervals. The course had to be repeated after 24 hours. Apart from crampy abdominal pain, she remained asymptomatic. A repeat scan, confirmed a viable pregnancy. At this stage she changed her mind in spite of being counselled at length and decided to continue with the pregnancy. She presented at 27 weeks of gestation with preterm, prelabour rupture of membrane. An ultrasound scan revealed oligohydramnious and growth along the third percentile. She was admitted, screened for infection and was given glucocorticoids. She went into labour at 30 weeks of pregnancy and had a spontaneous vaginal delivery. The baby weighed 1.23 kg, had a normal Apgar score and is doing well.

There is currently strong epidemiological evidence suggesting a teratogenic effect of misoprostol2. There is however, a paucity of information relating to pregnancy outcome after the use of gemeprost.

In a review3 of continuing pregnancy after failed early medical termination of pregnancy, there were 10 cases where gemeprost and mifepristone had been used as an abortifacient. Among these, there were seven cases of congenital malformation, five of these being limb defects.

Prostaglandins cause intense vasoconstruction and uterine contractions, which can theoretically lead to limb defects due to vascular disruption. There is even less information relating to the risk associated with failure of gemeprost use in the second trimester. This is mainly due to the fact that gemeprost, especially in association with mifepristone is highly effective as a medical method of termination of pregnancy during the second trimester.

Our experience and those of the authors was similar and fortunately had favourable outcomes. We strongly agree with the need to collect clinical data, which in the long run would help clinicians in decision making and counselling their patients appropriately.