Prostaglandin E2 (PGE2) Is Known To Cause Nausea And Vomiting In Early Pregnancy When Used For Treatment To Obtain Legal Abortion In Early Pregnancy

Prostaglandin E2 (PGE2) Is Known To Cause Nausea And Vomiting In Early  Pregnancy When Used For Treatment To Obtain Legal Abortion In Early  Pregnancy

Nausea and vomiting were the most troublesome side effects when PGE2 was first used to procure
a termination of pregnancy in the early 1970’s.  These side effects of nausea and vomiting
associated with giving Prostaglandin E2 and F2! (PG’s) have been clearly and persistently
described when given by intravenous infusion (1) (2) by single intra-amniotic injection (3) by
intrauterine infusion (4 and 5).  The oral route of PG administration is quite unsuitable because of
the severity of side effects (6).  
Gillett (7) has shown raised plasma levels of prostaglandins were associated with an increased
incidence of nausea and vomiting, these side effects regressed rapidly when the infusion was
reduced (2) or stopped (8).
Wiqvist (2) found continuous intravenous infusion of PGF2! caused nausea and vomiting, these
symptoms disappeared on reducing the infusion rate, and the dose which produced side effects
varied considerably from one woman to another. Some patients can tolerate a high dose before
symptoms of nausea and vomiting appear while other patients develop these symptoms on a
considerably lower dosage. Wiqvist et al also state that it is a well-known clinical experience that
suitable dose levels of intravenous prostaglandins vary within a wide range and have to be adjusted
to suit an individual patient (9) they showed that prostaglandins were metabolised at different rates
by individual patients. It has been shown by Karim et al (10) and Beazley et al (11) that side effects
of nausea and vomiting occur more readily when PGE2 or PGF2 are given in the first  or second
trimester of pregnancy. In the third trimester a much lower dose of prostaglandin is required to
induce labour so that fewer side effects are associated with the dosage given at this stage of
pregnancy. A more modern paper, Millar et al (12) describing the use of Prostaglandin E2 pessaries
10milligrams given pre-operatively before termination of pregnancy states, the use of these
pessaries was found to be associated with an unacceptably high incidence of nausea and vomiting.  
The incidence of nausea and vomiting is only too apparent to those providing an anaesthetic
service to patients who have received prostaglandins.

REFERENCES

1. KARIM S M M, FILSHIE G M.

 Use of Prostaglandin E2 for therapeutic abortion.

 British Medical Journal. 1970;3:198-200.

 

2. WIQVIST M, BYGDEMAN M.

 Induction of therapeutic abortion with intravenous Prostaglandin F2..

 Lancet. 1970;1:889.

 

3. CRAFT I.

 Intra-amniotic Prostaglandin E2 and F2. for induction of abortion:

 A dose - response study.

 J Obstet. Gynaecol British Commonwealth. 1973;80 (1):46-47.

4. MIDWINTER A, BOWEN M, SHEPHERD A.

 Continuous intrauterine infusion of Prostaglandin E2 for termination of pregnancy.

 Journal Obstet. Gynaecol British Commonwealth. 1972;79:807-809.

 

5. MILLER A W F, CALDER A A, MACNAUGHTON M C.

 Termination of pregnancy by continuous intrauterine infusion of prostaglandins.

 Lancet. 1972;11:5-7.

 

6. EMBERY M P.

The use of prostaglandins for therapeutic termination of pregnancy: the extra-amniotic route.  The use of Prostaglandins E and F2a in obstetrics and gynaecology.
P 69-79.

 Upjohn Prostaglandins Symposium Specialists, Florida, 33161, USA.

 September 1972.

 

7. GILLETT P G, KINCH R A H, WOLFE L S, PACE-ASCIAK C.

 Therapeutic abortion with use of Prostaglandin F2a.

A study of accuracy, tolerance and plasma levels in intravenous administration.

 Am J. Obstet Gynecol. 1972;112(3):333-337.

 

8. JENELEWICZ R, CANTOR B, DYRENFIRTH I

Prostaglandins 1972 (1) 443

 

9. WIQVIST M, BEGUIN P, BYGDEMAN M, TOPPOZADA M

In Prostaglandin Clinical Application to Human Reproduction

Edit Southern p293 Futura Publishing Company, New York 1972

 

10. KARIM S M M, HILLIER K, TRUSSELL P

 Journal Obstet Gynecol British Commenwealth 1970; 77:200-21

 

11. BEAZLEY J M, DENHURST C T, GILLESPIE A

 Nausea and vomiting after prostaglandins in day case termination of pregnancy

Anaesthesia 1987; 42:613-618


12. MILLAR J M, HALL P J,
Nausea and vomiting after prostaglandins in day case termination of pregnancy
Anaesthesia 1987; 42:613-618

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