KARL JOHN KARNAKY, M.D.
AJOG, Volume 58, Issue 3, Pages 622–623, September 1949
Dr. 0. Watkins Smith’s paper on “ Diethylstilbestrol in the Prevention and Treatment of Complications of Pregnancy’’ (AM. J. OBST. & GYNEC. 56: 821, 1948) was read with a great deal of interest, especially the part about the dosage of stilbestrol. I have been trying for about ten years to find the correct dose of stilbestrol in threatened and habitual abortion and premature labor.
Most interesting to me were the following statements:
(1) “15 cases [threatened abortion] on too high dosage, 4 of whom aborted.”
(2) ‘I Of the 28 women who were given what we would consider an overdosage, only 17, or 61 per cent, carried. ”
(3) “We have considered the dosage too high if 10 mg. or more are given daily for more than 10 consecutive days before the sixth week, 25 mg. or more daily before the tenth week, 50 mg. or more before the fifteenth week and 100 mg. or more before the twentieth week. ”
It has been found that the dose of stilbestrol varies in each individual. The amount of stilbestrol required is that amount that stops cramps, spotting, bleeding, and/or pain and keeps them from returning. The original dose may be from 25 to 1,000 mg. The dose required to keep these signs and symptoms from recurring is usually ys grain (10 mg.) to 11h grains (100 mg.) daily. Most patients require 25 to 50 mg. (3/s to 8/a grains) every morning. We have been unable to make up a table of doses in these conditions, and we have tried to for years.
As soon as the patient begins to abort, regardless of the week of pregnancy, 10 to 25 mg. micronized stilbestrol tablets are given immediately and 4 25-mg. tablets are given every 15 minutes until all signs and symptoms have stopped. Then 2 25.mg. tablets three times a day and at bedtime for one week, ‘one 25-mg. tablet three times a day and at bedtime for one week. Then 50 mg. every morning on rising. In 24 to 48 hours the patient comes to the office and 10 C.C. (25 mg. per c.c.) of micronized stilbestrol are given intramuscuIarly twice a week for four to six doses. This aids in saving more threatened abortion cases. TWO hundred fifty milligrams of stilhestrol intramuscularly as soon as possible after a patient begins to abort are a very valuable adjunct in the treatment of threatened abortion. The dose is not increased as term is approached. Regardless of the dose we have been unable to cause any patient to abort or produce any sign or symptom of abortion with doses that are many times (even a thousand times) more than those advocated by Dr. Smith, given in her table of dosage. The daily dosage of 5 to 1,000 mg. at any stage of pregnancy did not produce any harm to the pregnancy, mother, baby, placenta, nor was any harm shown by repeated weekly complete laboratory studies. We have given pregnant patients very large amounts of stilbestrol during pregnancy up to 120,730 mg. without producing any signs or symptoms of an abortion.
It has been my observation that the larger the daily dose, the surer the patient will be to carry the baby to term and deliver a normal baby. Also it requires a much larger daily dose of stilbestrol as the number of abortions which had occurred rises. In one patient who had lost thirteen babies, it required 77,040 mg. during the entire pregnancy to hold the fourteenth baby. In an habitual aborter who had lost six babies, it required approximately 30,000 mg. to carry the baby to term.
In premature labor it has been found that it requires 200 or more mg. daily of micronized stilbestrol to keep patients from aborting if they begin to have labor pains. TO prevent possible premature labor from occurring again, 50 mg. daily are given up to the eighth month.
In conclusion, the larger the daily dose of stilbestrol, the surer the patient will be to carry the pregnancy to term and have a normal baby. It is impossible to abort a woman with stilbestrol regardless of the daily initial dose of 500 mg. or total dose of 120,730 mg. during the entire pregnancy. No set table of dosage of stilbestrol has been found by me because the dose varies in each individual. The amount that does the job is the required dose.
- Diethylstilbestrol Dosage in Threatened and Habitual Abortion and Premature Labor , Correspondence ajog, 1949.
- Pregnancy myths feature image nymag.