Intra-amniotic Urea Research Articles

Intraamniotic 15(s)-15-methyl prostaglandin F 2α and termination of middle and late second-trimester pregnancy for genetic indications: A contemporary approach

Our purpose was to determine whether intraamniotic 15(s)-15-methyl prostaglandin F2 alpha could serve effectively and safely as a surrogate for natural prostaglandin F2 alpha when used to effect middle and late second-trimester pregnancy termination for genetic indications. Further, we sought to compare efficacy and side effects with those found when intravaginal prostaglandin E2 is used. A total of 62 patients received intraamniotic 15(s)-15-methyl prostaglandin F2 alpha and urea, and intracervical laminaria. Case patients at < or = 20 weeks' gestation (n = 32) were compared with case patients at > 20 weeks (n = 30) and with a matched group (n = 64; 1:2 ratio) of control patients in whom cervical laminaria and intraamniotic urea were used with prostaglandin E2 vaginal suppositories. The mean induction-to-abortion interval among the case patients (gestational age 16 to 27 weeks) was 13 hours 11 minutes; 60 of 62 (97%) were delivered within 24 hours. There was a statistically significant negative correlation between the induction-to-abortion interval and gestational age (p = 0.04). When patients at < or = 20 weeks and those at > 20 weeks were compared, few differences were noted. The mean induction-to-abortion interval for case patients at < or = 20 weeks was 13 hours 54 minutes versus 19 hours 34 minutes for control patients (p = 0.001). One of 32 (3%) case patients remained undelivered beyond 24 hours compared with 17 of 64 (27%) control patients (p < 0.01). Immediate and delayed complications were uncommon in either group. Our study demonstrates that 15(s)-15-methyl prostaglandin F2 alpha can serve safely as a surrogate for prostaglandin F2 alpha when used in combination with urea and laminaria for termination of pregnancy. This technique appears safe for use through 27 weeks' gestation; further investigation is encouraged.

6 - Mid-Gestational Abortion for Medical or Genetic Indications

Women who have major medical complications, such as cardiovascular conditions leading to cardiac, renal, or cerebral impairment, which interfere with their lifestyle or who have fetuses with major malformations or chromosomal abnormalities are eligible for pregnancy terminations before the fetus has reached a viable stage. Any method for uterine evacuation may be offered at any time if the woman's life is threatened or if the fetal chromosomal abnormality (e.g. triploidy) or malformation is considered to be definitely incompatible with life. Such malformations would include bilateral renal agenesis, anencephaly, lethal forms of chondrodysplasia, holoprosencephaly, and severe pulmonary hypoplasia. Prostaglandin vaginal suppository therapy is the primary method for cervical dilation and induction of uterine contractions at most perinatal centres. This therapy is particularly useful when a fetal abnormality is suspected, since the fetus is usually delivered intact for gross and histological evaluation. Postmortem findings are helpful to the parents and other family members for future childbearing and family history. Disadvantages of such therapy include side-effects from the medication, prolonged labour discomfort, and delivery of a viable rather than stillborn infant. A surgical dilation and evacuation of the uterus may be undertaken between 12 and 20 weeks' gestation for women with prior uterine surgery, contraindication to prostaglandin use, no future childbearing being desired, and a fetus having a known lethal chromosomal abnormality (e.g. trisomy 13 or 18). This form of therapy is rapid, less painful, and fetal blood and tissue may be gathered for analysis although complete morphological examination of the fetus is not possible. Instillation of hypertonic saline or urea is no longer widely used for pregnancy termination, although intra-amniotic urea may be used adjunctively. Prolonged instillation-to-evacuation times and potential metabolic concerns are limitations. This therapy may be particularly useful when a stillborn infant is desired or when prior prostaglandin therapy has been unsuccessful. Abdominal operations such as hysterectomy or hysterotomy are also unnecessary unless there is an accompanying gynaecological complication or unless other pregnancy termination methods have been unsuccessful or unavailable. Women experiencing mid-gestation pregnancy terminations undergo a grief process which involves disbelief, sadness, guilt, anger and acceptance before and after the pregnancy termination. This is common and understandable. Parental counselling is recommended both before the procedure and several weeks thereafter.

Intra-amniotic urea and prostaglandin F2α for midtrimester abortion: Clinical and laboratory evaluation

The clinical management of the elective midtrimester abortion continues to be unsatisfactory as judged by either national mortality or morbidity rates. This report documents the results of a randomized series of 16 midtrimester abortions induced by either intra-amniotic hyperosmolar urea and 5 mg. of prostaglandin F2α (PGF2α) or intra-amniotic hyperosmolar urea alone. Pertinent clinical characteristics and biochemical determinations were compared between these two groups. A series of 150 patients were then treated with urea and 5 mg. of PGF2α. The clinical results of this series of patients are presented and compared with a previous group who had urea and 10 mg. of PGF2α. These studies demonstrate that 5 mg. of PGF2α with 80 Gm. of urea achieves injection-abortion intervals that are less than 24 hours.

Induction of midtrimester abortion with intra-amniotic urea and intravenous oxytocin

Midtrimester abortions were induced in 295 patients with a combination of intraamniotic urea and intravenous oxytocin. The mean injection-abortion interval was 26.4 hours. Abortion occurred spontaneously within 50 hours of amnioinfusion in 257 patients. The macerating effects of the hypertonic urea on fetal tissues allowed easy termination of the remaining 38 pregnancies by suction curettage at 50 hours after injection. Decreased urinary output occurred during the oxytocin infusions, but water intoxication was prevented by close monitoring of urinary output and serum electrolytes, and by the use of a concentrated solution of oxytocin in normal saline, allowing the administration of small volumes.

Intra-amniotic urea and prostaglandin F2α for midtrimester abortion: A modified regimen

A study comparing intra-amniotic urea plus intravenous oxytocin and intra-amniotic urea with 10 mg. prostaglandin F2α was completed. In addition, the results obtained with a further 150 patients receiving urea and prostaglandin are reported. Mean injection-abortion intervals ranged from 15.75 hours for urea-prostaglandin to 18.93 hours for urea-oxytocin. The advantages of urea-prostaglandin and suggested improvements are discussed. Over all, the method appears efficacious though incomplete abortions and cervical laceration are persistent problems.

Consumption coagulopathy after intra-amniotic urea.

Consumption coagulopathy after intra-amniotic urea.

In vitro measurements of sound velocity in human fetal brain tissue.

Sound velocity measurements were performed on 23 fresh fetal brain samples obtained at gestations between 17 and 41 weeks duration. Determinations were made at 0, 8, 16, 24, 30 and 37°C. In 14 samples the water content was also calculated. An increase in sound velocity through fetal brain tissue with advancing gestational age, together with an increase in sound velocity associated with increasing temperature of the sample from 0 to 37°C, was found. Sound velocity was higher through fetal brain tissue from pregnancies terminated using intra-amniotic urea when compared with spontaneous abortions of the same gestational age. A significant positive correlation was found between sound velocity and the percentage content of solids in the brain.

Intra-amniotic urea as a midtrimester abortifacient: Clinical results and serum and urinary changes

Seventy-four patients, from I6 to 20 weeks pregnant, received intra-amniotic urea (80 Gm.) and intravenous oxytocin for the purpose of inducing abortion. Seventy-one of the 74 patients were successfully aborted by the primary method with a mean injection-to-abortion interval of 18.33 hours. There were no serious side effects, and the mean hospital stay was 32 hours. Following urea injection, the mean serum urea nitrogen rose to 33 mg. per cent at 4 hours. Maximum changes in serum electrolytes occurred at 8 to I2 hours after injection and included a decrease in the mean concentrations of sodium, chloride, and carbon dioxide and an increase in serum potassium. An increase in the urinary excretion of urea began within 4 hours, but significant diuresis did not occur in the presence of intravenous oxytocin administration. There was a significant increase in the leukocyte concentration while hematocrit values remained unchanged. Beginning approximately 8 hours following urea injection, the mean plasma fibrinogen concentration decreased by approximately 15 per cent and the mean platelet count showed a drop of approximately 18 per cent. Fibrinogen-fibrin degradation products were significantly increased in 36 per cent of the patients studied.

Letter: Adverse reactions to intra-amniotic urea and prostaglandin.

Letter: Adverse reactions to intra-amniotic urea and prostaglandin.

Letter: Adverse reactions to intra-amniotic urea and prostaglandin.

Letter: Adverse reactions to intra-amniotic urea and prostaglandin.

INDUCTION OF ABORTION BY COMBINED INTRA-AMNIOTIC UREA AND PROSTAGLANDIN E2 OR PROSTAGLANDIN E2 ALONE

Abstract Combined intra-amniotic urea and Summary prostaglandin E 2 induced abortion more effectively than prostaglandin E 2 alone. The mean injection/abortion interval (101/2 hours) was significantly shorter and the process was more often complete. This combined technique has advantages over alternative methods since it requires only a single initiating procedure and reduces nursing involvement.

Intra-amniotic urea and prostaglandin E 2 for abortion. A clinical study to determine the efficacy of using a variable prostaglandin dosage

Intra-amniotic urea 80 g combined with either prostaglandin E 2 5 mg or 10 mg was injected in two groups of patients to induce mid-trimester abortion. Abortion invariably resulted within 24 hours with both schedules used. The mean injection-abortion interval was not significantly shorter in those receiving the higher dose of prostaglandins. There were fewer gastrointestinal side effects in those receiving the lower dosage. This combined technique has some advantages over other methods used for a single initiating procedure only is required and nursing involvement is minimal.

INDUCTION OF ABORTION BY COMBINED INTRA-AMNIOTIC UREA AND PROSTAGLANDIN E 2 OR PROSTAGLANDIN E 2 ALONE

Combined intra-amniotic urea and Summary prostaglandin E 2 induced abortion more effectively than prostaglandin E 2 alone. The mean injection/abortion interval (101/2 hours) was significantly shorter and the process was more often complete. This combined technique has advantages over alternative methods since it requires only a single initiating procedure and reduces nursing involvement.

INDUCTION OF MID-TRIMESTER THERAPEUTIC ABORTION BY INTRA-AMNIOTIC UREA AND INTRAVENOUS OXYTOCIN

Combined intra-amniotic urea and simultaneous intravenous oxytocin infusion was used to induce mid-trimester therapeutic abortions. This technique, which was successful in each of a series of 30 patients (there were no serious side-effects), has advantages over those more commonly used at present.

Induction of Therapeutic Abortion by Intra-amniotic Injection of Urea

A new method of mid-trimester termination of pregnancy is described in which intra-amniotic urea was used. The mean interval between intra-amniotic injection and abortion was 59 hours and the mean length of hospital stay six days; the feto-maternal haemorrhage incidence was one out of 10 cases, which compares favourably with other methods. No complications have yet been encountered.