Intra-amniotic Prostaglandin F2α Research Articles

Interrupción del embarazo. Estudio comparativo entre diferentes pautas de inducción médica

Objective To compare the effectiveness of distinct medical induction regimens used for second trimester abortions. Materials and methods We performed a retrospective review of 145 pregnancies between 13 and 22 weeks that underwent an induced abortion using four different methods: 1) intraamniotic prostaglandin F2α and endocervical E2; 2) endocervical prostaglandin E2; 3) intravaginal and oral prostaglandin E1; and 4) intravaginal prostaglandin E1. All these methods were followed by oxytocin infusion. Results The mean induction to abortion interval was 20.2 ± 7.6 h; 17.5 ± 8.2 h; 16.8 ± 8.7 h, and 12.6 ± 4.2 h, respectively. The differences were statistically significant when the mean interval was analyzed globally (p = 0.02, ANOVA) and in nonprimigravidas (p = 0.02, ANOVA). The rate of successful abortions within 12 hours was 5.5%, 31%, 32.5% and 50%, respectively (p = 0.002 χ 2 test). Surgical abortion and serious side effects (one case of disseminated intravascular coagulation) occurred only with prostaglandin E2. Conclusions Vaginal administration of prostaglandin E1 resulted in a shorter mean induction to abortion interval and a higher rate of successful abortions within 12 hours.

A Randomized Trial Comparing Oral Misoprostol with Intra-Amniotic Prostaglandin F2α for Second Trimester Terminations

Objective: To compare the efficacy of oral misoprostol with that of intra-amniotic prostaglandin F2α (PGF2α) for second trimester pregnancy termination.Methods: One hundred seventeen women with pregnancies of between 16 and 22 weeks’ gestation were randomly assigned after insertion of laminaria to receive either oral misoprostol 400µg every 4 hours (to a maximum of four doses) or intra-amniotic PGF2α 40 mg. The rate of complete abortion within 24 hours was the primary outcome for power analysis. Secondary outcome measures were the rate of dilatation and curettage (D&C) for retained placenta and the rates of fever and gastrointestinal complications.Results: Patient characteristics were similar in both groups. The rate of complete abortion within 24 hours was similar in the misoprostol (63%) and PGF2α (66%) groups. The rate of retained placenta requiring D&C was significantly greater in the PGF2α group (22.4% vs. 3.4%, P = 0.002). There were no differences in other maternal morbidities. Parous patients treated with oral misoprostol had a significantly greater rate of complete abortion than nulliparous patients (84% vs. 57%, P = 0.04).Conclusions: Oral misoprostol is as effective as intra-amniotic PGF2α for second trimester pregnancy termination when laminaria is inserted before treatment. Parous patients have a higher success rate than nulliparous patients with use of oral misoprostol. Oral misoprostol is associated with a very low rate of placental retention.

Termination of pregnancy complicated by anencephaly with intra-amniotic prostaglandin F2α

It is anticipated that there will be more frequent need to terminate anencephalic pregnancies of greater than 20 weeks' duration before term. Since present methods are unsatisfactory, the use of incremental intra-amniotic injections of prostaglandin F2α with continuous monitoring of intrauterine pressure was evaluated in three cases. The method appears to be satisfactory.

Laminaria use in midtrimester abortions induced by intra-amniotic prostaglandin F2α with urea and intravenous oxytocin

A laminaria tent was used as an adjunct during midtrimester abortion to attempt to shorten the injection-abortion interval without adversely affecting the frequency of infection, hemorrhage, failed abortion, or cervical laceration. Eighty patients, between 14 and 20 weeks' gestation and desiring pregnancy termination, were randomized into three groups. Abortion was initiated by an intra-amniotic infusion of 20 mg of prostaglandin F2alpha and 80 gm of hyperosmolar urea in Ringer's lactate (135 ml total volume), followed by oxytocin infused intravenously at 333 mU/min. Group I (N = 28) received no additional therapy; Group II (N = 23) had laminaria placed at the time of the abortifacient injection and removed 4 hours later; Group III (N = 29) had laminaria placed 4 hours prior to inejction and removed at the time of injection. The injection-abortion intervals in these three groups were 17.76, 20.80, and 12.96 hours, respectively. This study illustrates that a laminaria tent palced 4 hours prior to injection is significantly more effective than a laminaria tent placed at the time of injection, and produces a shorter mean injection-abortion interval than that in patients receiving no laminaria. Furthermore, laminaria augmentation results in no demonstrable increase in the frequency of serious complications.

The Effect of Intra-Amniotic Prostaglandin F2α on Anterior Pituitary Hormone Release During Midtrimester Abortion

The effect of intra-amniotic administration of prostaglandin F2alpha (PGF2alpha) on pituitary hormone release was studied in women undergoing midtrimester abortion. Serum prolactin (PRL), growth hormone (GH), thyrotropin (TSH), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were measured prior to and at 15-minute intervals for 2 hours following intra-amniotic administration of 40 gm of urea alone, 20 mg of PGF2alpha and 40 gm of urea, or an equal volume of normal saline. Serum PRL levels were significantly higher at sampling times from 15 through 120 minutes when both PGF2alpha and urea were administered than after saline or urea alone. The elevation in serum GH following PGF2alpha and urea was not significantly greater than for urea alone. The GH response in the women receiving normal saline was significantly less than for the two groups of women receiving the abortifacients. These results indicate that the GH response was related to the stress effects of the abortifacients. There was no difference in the TSH, LH, and FSH responses for the three groups. These results suggest that PGF2alpha selectively causes pituitary release of PRL in women during midtrimester pregnancy.

Catecholamines during therapeutic abortion induced with intra-amniotic prostaglandin F2α

Serial plasma, amniotic fluid, and urine samples were analyzed for epinephrine (E) and norepinephrine (NE) in eight subjects during midtrimester abortion induced by intra-amniotic prostaglandin F2α (PGF2α). After PGF2α administration, plasma E increased and there was no change in plasma NE levels. Amniotic fluid levels of E and NE decreased initially. During the course of abortion the mean level of E in the amniotic fluid increased after fetal distress and decreased after fetal death, indicating that the midtrimester fetus may respond to stress by the urinary excretion of E. The maternal urinary excretion rates of both E and NE increased following PGF2α. The observation that mean plasma levels and urinary excretion rate changes correlated better with the course of abortion and uterine contractility rather than with the time of PGF2α administration was consistent with the hypothesis that the catecholamine response may be due to the stress of labor rather than to the PGF2α per se.

Prolactin and human placental lactogen changes in maternal serum and amniotic fluid in midtrimester induced abortions

Prolactin (hPRL) and human placental lactogen (hPL) concentrations in maternal serum and amniotic fluid were serially determined in 19 patients undergoing midtrimester elective abortion. Two subgroups were studied: Group 1 (10 patients) received 40 mg. of intra-amniotic prostaglandin F2α (PGF2α); in Group 2 (nine patients), 200 ml. of 20 per cent sodium chloride was instilled in the amniotic cavity. Maternal serum samples were serially obtained for 24 hours after induction of abortion by either abortifacient. Serial anmiotic fluid samples were obtained in Group 1 for the first seven hours after induction of abortion. The time from induction of abortion to fetal death (IDT) as well as the induction-abortion time (IAT) were recorded in all cases. Maternal serum hPL values declined significantly within one and one half hour from the induction of abortion. At six hours, a decline of more than 50 per cent of the original hPL value occurred in both groups. Prolactin in maternal serum did not show significant changes until six hours after induction. In Group 1, a significant drop of 40.5 per cent occurred at this time. In Group 2, a similiar declining trend was apparent, but this did not reach statistical significance until 12 hours after induction. In the amniotic fluid, no significant change in the hPRL values was noticed throughout the observation time. Amniotic fluid hPL did show a rising trend, ranging to between 41.1 and 79.4 per cent above the base-line value. However, this change was not statistically significant. The decrease in maternal serum hPRL following the more rapid fall in hPL in both study groups indicates a close dependency of hPRL levels on the intact functions of the fetoplacental unit. Changes in the amniotic content of these lactogenic hormones appear to be independent of the respective changes of these hormones in maternal serum.

Abortion deaths associated with the use of prostaglandin F2α

Six abortion-related deaths associated with the use of prostaglandin F2α were reported through the Center for Disease Control's surveillance of abortion deaths between 1972 and 1975. Prostaglandin may have had only indirect association with these deaths. The patients' ages ranged from 16 to 38 years, their length of gestation ranged from 15 to 24 menstrual weeks, four were white, and three were nulliparous. Four patients had pre-existing conditions that increased their risks and contributed to their death. The estimated death-to-case rate for prostaglandin F2α was 10.5 per 100,000 abortions. Although lower than the rate for intra-amniotic saline instillation, this death-to-case rate is only an approximation. The relative safety of intra-amniotic prostaglandin F2α as a second-trimester abortifacient, compared to saline, remains to be established.

Use of combination prostaglandin F2α and hypertonic saline for midtrimester abortion

Midtrimester abortion was induced by intraamniotic prostaglandin F2α in combination with hypertonic saline in 102 patients and by hypertonic saline alone in 102 others. Abortion time and duration of hospital stay were shorter with the prostaglandin-saline combination.

The effect of meperidine analgesia on midtrimester abortions induced with intra-amniotic prostaglandin F2α

To determine whether increased amounts of meperidine significantly affect the induction of abortion with intra-amniotic prostaglandin F2α, 42 midtrimester subjects were treated with an identical dose schedule of PGF2α and one of two dose schedules of meperidine. Although the group that received more meperidine reported severe pain less frequently, their mean and median induction-to-abortion times, cumulative abortion rate, uterine contractility, and complications were not significantly different from those of the group that received less meperidine.

Prostaglandin E2 on the electroencephalogram

Present study was prompted by the report from another center on the occasional occurrence of convulsions and abnormal electroencephalogram (E.E.G.) patterns in women aborted with intraamniotic prostaglandin F2α (PGF2α). Fifty four subjects were investigated by means of an E.E.G. taken before and after initiation of PGE2 administration. They included pregnant and non-pregnant patients, nearly half (23) of whom were known epileptics. One seizure was observed during PG administration in a man with daily psychomotor attacks who had not taken his anticonvulsants on the day the test was performed. PGE2 caused no alteration of the E.E.G. in subjects with a normal control tracing; in those with an abnormal E.E.G., a deterioration was seen in one and an improvement in three. It is concluded that PGE2 is not epileptogenic at doses required for termination of pregnancy.

Prostaglandin E2 on the electroencephalogram

Present study was prompted by the report from another center on the occasional occurrence of convulsions and abnormal electroencephalogram (E.E.G.) patterns in women aborted with intraamniotic prostaglandin F2α (PGF2α). Fifty four subjects were investigated by means of an E.E.G. taken before and after initiation of PGE2 administration. They included pregnant and non-pregnant patients, nearly half (23) of whom were known epileptics. One seizure was observed during PG administration in a man with daily psychomotor attacks who had not taken his anticonvulsants on the day the test was performed. PGE2 caused no alteration of the E.E.G. in subjects with a normal control tracing; in those with an abnormal E.E.G., a deterioration was seen in one and an improvement in three. It is concluded that PGE2 is not epileptogenic at doses required for termination of pregnancy.

The synergistic activity of intra-amniotic prostaglandin F2α and urea in the midtrimester elective abortion

Most midtrimester abortions are still being performed with hypertonic saline and hysterotomy, but the morbidity and mortality rates are too high. The efficacy of a single intra-amniotic injection of prostaglandin F2α and hyperosmolar urea without oxytocin augmentation was demonstrated and results were compared with those obtained by current methods.

Intra-amniotic prostaglandin for induction of abortion: an improved regime using prostaglandin E2.

SummaryEighty‐two patients were studied using four different dose schedules of intraamniotic prostaglandin F2α and E2. The most successful results were obtained in 32 patients receiving two injections of 10 mg. of prostaglandin E2 at a six‐hour interval; 31 aborted within 24 hours with a mean time of 12.6 hours; an acceptable level of side effects was observed. The addition of an infusion of oxytocin did not significantly affect the result. These results represent an improvement over previously published data using intra‐amniotic prostaglandin E2 alone.

Mid-trimester abortion induced by intra-amniotic prostaglandin F2α: Fetal tissue viability

I N T R A A M N IO T I c prostaglandin F,, (PGFzn) has been used successfully as a secondtrimester abortifacient.‘-9 In contrast to hypertonic saline, prostaglandin is not directly lethal to the fetus.1 The occasional delivery of a fetus with a heartbeat suggests that fetal death usually occurs close to the time of abortion, probably secondary to anoxia during labor. Therefore, it seemed likely that the fetal tissues so obtained might be suitable for organ transplants, for growing and attenuating viruses for vaccines, and for basic research. This report on second-trimester PGF,, abortions demonstrates that fetal tissues are viable and that representative enzymes are not altered significantly by the abortion technique. Transabdominal amniocentesis was performed in 15 women with the use of a 22 gauge disposable 3r/2 inch spinal needle. Forty milligrams (8 ml.) PGF,,” was instilled after a free flow of amniotic fluid was obtained without prior removal of fluid. Each patient was given 10 mg. of prochlorperazinei intramuscularly at the time of the PGF,, instillation. Blood samples for serum chemistry and hematologic studies were drawn before the PGF,, injection and 24 and 48 hours later. Samples of skin, lung, and thymus from 11 fetuses were minced, digested in 0.1 per cent pronase,$ and placed in 25 sq. cm. T-flasks3

Pretreatment with laminaria tents before mid-trimester abortion with intra-amniotic prostaglandin F2α

Pretreatment with laminaria tents before mid-trimester abortion with intra-amniotic prostaglandin F2α

Experience with intra-amniotic prostaglandin F2α for abortion

Intra-amniotic prostaglandin F2α was utilized for induction of midtrimester abortion in 133 women. A 94.7 per cent incidence of abortion was achieved. Seventy per cent of patients vomited and 13.6 per cent became febrile, but the incidence of other side effects was low. Sepsis, systemic reaction to prostaglandin, and cervical laceration were serious complications. Prostaglandin F2α effectively induces uterine activity. However, its safety, convenience, and acceptability have not been established.

Intra-amniotic prostaglandin F2α to induce midtrimester abortion

Ninety-five of 100 women treated with intra-amniotic prostaglandin F2α were successfully aborted. Various dosage schedules were followed. The effects of parity, age, dose of prostaglandin, and gestational age on the interval of time from first injection to abortion are evaluated. The type and incidence of side effects also are discussed. A comparison was made between these results and those achieved in other centers. The use of this compound is compared with hypertonic saline.

Midtrimester abortion produced by intra-amniotic prostaglandin F2α augmented with intravenous oxytoxin

Prostaglandin F2α was administered by a single intra-amniotic injection of either 10 or 15 mg. in combination with continuous intravenous infusion of oxytocin to produce second-trimester abortion. Eight of the 10 patients aborted in less than 20 hours. The only toxicity encountered was a brief episode of vomiting in one patient.

Intra-amniotic administration of prostaglandin F2α for abortion

Prostaglandin F2α was administered intra-amniotically to 20 women for mid-trimester abortion. Seventeen patients aborted completely, one incompletely, and two patients failed to abort after 32 hours. The average medication-abortion time was 22 hours and 8 minutes. The only significant side effect was vomiting. Intravenous oxytocin was evaluated as an ancillary means of inducing more rapid abortion. Intra-amniotic prostaglandin F2α was shown to be an effective oxytocic agent, but side effects may limit its clinical usage.