Use of sulprostone for induction of preoperative cervical dilation or uterine evacuation: a comparison among the effects of different treatment schedules.

Sulprostone was administered to 144 pregnant women to induce either preoperative cervical dilation or uterine evacuation. A comparison was performed to select the drug treatment schedule showing the greatest effects with the lowest incidence of side effects. As for preoperative cervical dilation, the local (intracervical/intramural) injection of 50 + 50 micrograms and the intramuscular treatment with 500 micrograms of sulprostone showed the most favorable effects on the cervix after 12 and 6 hours, respectively. The cervix dilated 8 mm or more in 82.6% of subjects treated locally and in 85.7% of those treated intramuscularly. No patient experienced a serious side effect, but two displayed vomiting after receiving 500 micrograms of the drug. Uterine evacuation was induced by both repeated intramuscular injections (500 micrograms every 4 hours) and continuous intravenous infusion (2.8 micrograms/minute for 6 hours) of sulprostone in more than 90% of the patients with intact pregnancy, missed abortion, or fetal death. The efficacy of the drug was not influenced by gestational age or parity. Gastrointestinal symptoms were the only recorded side effects, with negligible incidence and intensity for both routes of sulprostone administration.