Pregnancy termination in patients with pregnancy-induced hypertension or eclampsia at less than 22 weeks' gestation

Abstract

3 patients with fetal death, 2 of whom had pregnancy-induced hypertension and a third with eclampsia had pregnancy termination before 22 weeks' gestation with vaginal prostaglandin E2 (PGE2) suppositories, without complication. PGE2 has a hypotensive action, decreasing blood pressure by arteriolar dilation and blocking the angiotensin-induced rise in blood pressure in the pregnant rhesus monkey and should be useful abortifacient in patients with hypertension including preeclampsia and eclampsia. One patient received magnesium sulfate and the other 2 received hydralazine and methyldopa during PGE2 administration which could alter mean arterial pressure (MAP). MAPs remained stable and dropped slightly after PGE2 administration in the 2nd and 3rd patients. These outcomes suggest that PGE2 suppositories can be used to terminate 2nd trimester pregnancy in cases of hypertension and eclampsia when routine medical management is ineffective or when fetal death occurs although caution is advised since severe hypotension can occur with PGE2 administration.