Reproductive Health During the COVID-19 Pandemic.

Globally reproductive health services such as contraception and abortion are impacted and are not accessible to a considerable population. The International Planned Parenthood Federation reported anticipated shortage of contraception as the lockdown measures led to reduction in the manufacturing of contraceptives. A recent analysis by the Guttmacher Institute estimated the potential effects of the pandemic. It was found that a 10% decline of sexual and reproductive health services due to COVID-19, would mean an additional 15.4 million unintended pregnancies, over 3.3 million unsafe abortions and 28,000 maternal deaths. The UN Secretary General has issued a call to continue the delivery of sexual and reproductive health services even without prescription. The focus is now to provide vaccines, and therefore, a number of research organizations and pharmaceutical industries are working on their production. One of the reasons for vaccine refusal is the concern that it may affect female and male reproductive functions. However, it is important to correct this misunderstanding as vaccination does not affect fertility. In most cases, vaccination during pregnancy and lactation can be considered safe and effective.

RANDOMIZED COMPARISON BETWEEN TWO-HOURLY AND THREE-HOURLY INTRAMUSCULAR TREATMENT WITH 15(S)15 METHYL PGF2α FOR TERMINATION OF SECOND TRIMESTER PREGNANCY.

In a multicentre trial, intramuscular 15(S)15 methyl PGF2α (Prostin 15M, Up-john) was tried at 2-hourly and 3-hourly intervals for induction of second trimester abortion. The time schedule was assigned randomly. Eighty-eight patients for 2-hourly schedule and 89 patients for 3-hourly schedule were recruited. Of 2-hourly 83% and of 3-hourly schedule 88.8% of the patients aborted with the treatment. The induction abortion interval was 15.9 hours in 2-hourly and 17.2 hours in 3-hourly schedule. The dose of Prostin 15M was 2.2 mg and 1.7 mg respectively. The incidence of incomplete abortion was 21.9% in 2-hourly and 27.8% in the 3-hourly. The incidence of vomiting was less in the 3-hourly schedule, however, there was no difference in the incidence of diarrhoea.

STUDIES ON 15(S)15 METHYL PGF2α BY INTRAMUSCULAR ROUTE FOR SECOND TRIMESTER ABORTION (TWO HOURLY SCHEDULE).

A multicentre study was undertaken to study intramuscular 15(S)15 methyl PGF2α (Prostin 15M, Upjohn) for induction of second trimester abortion. The patients were premedicated with Imodium and Perinorm to control the gastrointestinal side effects. The dose of Prostin 15M was 250 µg every two hours and the progress of the abortion was assessed before each injection. If there was no progress at the end of 10 injections the case was classified as a failure. Ninety-seven patients were recruited for the study, 39 were primigravidae and 58 multigravidae. Twenty-four out of 39 primigravidae and 52 out of 58 multigravidae aborted with the treatment. The mean induction abortion interval was 17.8 hours in the primigravidae and 14.5 hours in the multigravidae patients. The mean number of episodes of vomiting was 2.9 and diarrhoea 4.2 per patient per trial. The primigravidae had slightly higher incidence of gastrointestinal side effects. The overall incidence of incomplete abortion was 17.1%.

INTRAMUSCULAR 15(S)15 METHYL PGF2α IN THE TREATMENT OF MISSED ABORTION.

Intramuscular 15(S)15 methyl PGF2α (Prostin 15M, Upjohn) was used for induction of labour in cases of missed abortion and intra-uterine fetal death. The patients received premedication to control the gastrointestinal side effects. Prostin 15M was given at a dose of 250 µg every three hours and escalated whenever required. The trial was interrupted in two out of 83 patients. Altogether 75 patients (92.6%) expelled the fetus with the treatment. The mean induction abortion interval was 14.7 hours. The primigravidae had a longer (18.2 hrs) interval than the multigravidae (13.8 hrs). The mean number of episodes of vomiting was 2.9 and of diarrhoea 3.5 per patient and treatment.