Abortion Without Surgery?

Common sense suggests that the safest way to induce an abortion is to use the hormone oxytocin, which nature produces when it is time for a fetus to leave the womb. But nature does not always abide by man's logic. Oxytocin in large doses can induce an abortion, but not until the 20th week of pregnancy. And most unwanted pregnancies should be ended no later than the 16th week. Until now this has required surgical intervention--scraping out the contents of the womb, which involves some risk of bleeding and infectious complications even in a well-run hospital.

Now, as a result of uncommon-sense reasoning, doctors are inducing early abortions with prostaglandin F2 alpha, a hormone-like substance derived from semen. The prostaglandins are a class of chemicals, 16 of which have now been isolated, that were originally believed to be secreted in the prostate gland. The first were found in human semen, which is still the richest source known. Now prostaglandins are known to occur in many other human tissues and in menstrual fluid. They are also found in the semen of sheep, and it was from the seminal vesicles of rams that medical researchers obtained their early supplies. Synthetic PGs are now becoming more available.

The first detailed report of success with PG abortions comes from King's College Hospital in London. There, Obstetrician Gilbert M. Filshie worked with Dr. S.M.M. Karim, a biochemist, to select a prostaglandin that would induce an abortion early in pregnancy, yet produce a minimum of side effects, such as altering the blood pressure. They devised a solution containing 50 micro-grams of PG F2 alpha per milliliter, and infused it into the veins of 15 women who were from nine to 22 weeks pregnant. The amount was tiny: only one milliliter (one-fifth of a teaspoonful) per minute. The infusion was continued until uterine contractions brought about a complete abortion. All but one of the women aborted within four to 27 hours, eight of them in twelve hours or less. Six had diarrhea or vomiting or both. None suffered severe bleeding. In a last-minute addendum to their report in the Lancet, Karim and Filshie say they have since used another prostaglandin, E2, and have aborted twelve women with no occurrence of diarrhea.

Their experience is too limited, the researchers concede, for them to recommend routine use of prostaglandins for abortion, and they urge a more extensive trial. (Dr. Marc Bygdeman is already using F2 at Stockholm's Karolinska Institute.) But, they suggest, the technique could eliminate most of the risks in surgical abortion, notably infection and damage to the uterus. Perhaps equally important, when the technique of PG abortion is simplified and improved, it is likely to be more acceptable than surgery--both emotionally and aesthetically--to many women.

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