Prostaglandin E2 Vaginal Suppositories Research Articles

Second-trimester abortion by intramuscular 15-methyl-prostaglandin F 2α or intravaginal prostaglandin E 2 suppositories: A randomized trial

To compare intramuscular (IM) prostaglandin 15 methyl-F2 alpha (15M-PGF2 alpha) with prostaglandin E2 (PGE2) vaginal suppositories for second-trimester abortion in terms of efficacy and side effects. Fifty-one women were randomized to receive either 15M-PGF2 alpha IM injections or PGE2 intravaginal suppositories for second-trimester abortion. Efficacy and side effects of the two agents were analyzed by two-tailed t tests, chi 2 analysis with Fisher exact test, and survival analysis. The mean times to rupture of membranes, delivery of fetus, and delivery of placenta were significantly less for women receiving PGE2 vaginal suppositories. The cumulative abortion rate after 24 hours for the PGE2 group was 96%, compared with 69% for the 15M-PGF2 alpha group. Although there were few differences in side effects, the 15M-PGF2 alpha group had significantly fewer headaches, fevers, and chills. Intravaginal PGE2 is superior to IM 15M-PGF2 alpha for second-trimester abortion.

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.

A case report of prostaglandin E 2 termination of pregnancy complicated by Cushing's syndrome

A case of Cushing's syndrome caused by an adrenal adenoma seen at 10 weeks' gestation is described. The pregnancy was terminated at 18 weeks' gestation, representing the first reported case of therapeutic termination of pregnancy in Cushing's syndrome with prostaglandin E2 vaginal suppositories.

Mid-Second-Trimester Labor Induction: Concentrated Oxytocin Compared With Prostaglandin E2 Vaginal Suppositories

A concentrated oxytocin infusion and prostaglandin E2 (PGE2) vaginal suppositories were compared in a retrospective analysis for indicated abortion in the mid-second trimester (17-24 weeks' gestation). Eighty-one women underwent second-trimester pregnancy termination, 59 by PGE2 suppositories and 22 by concentrated oxytocin infusion. Success was achieved by PGE2 in 93% (55 of 59) and oxytocin in 91% (20 of 22). The mean duration of labor was 13.1 hours with PGE2 and 8.2 hours with oxytocin. The mean dose of PGE2 was 65.2 mg; of oxytocin, 200 units. Women who received PGE2 experienced nausea (46%), vomiting (37%), fever (64%), and diarrhea (20%) despite appropriate premedication. Few side effects occurred in the women who were treated with oxytocin. We conclude that concentrated oxytocin infusion seems to be a reasonable alternative to PGE2 vaginal suppositories for induction of labor in the mid-second trimester.

277 Mid-second trimester labor induction: Concentrated oxytocin as compared to prostaglandin E2 vaginal suppositories

277 Mid-second trimester labor induction: Concentrated oxytocin as compared to prostaglandin E2 vaginal suppositories

Management of the third stage of labor in pregnancies terminated by prostaglandin E 2

In the management of second-trimester medical terminations of pregnancy, it is a commonly accepted practice to allow 2 hours for the third stage of labor. This practice is based on data from terminations with saline solution as the abortifacient. Herein we report our experience with the use of prostaglandin E2 vaginal suppositories for midtrimester terminations, with particular regard to placental delivery rates and associated complications. Ninety-six patients underwent prostaglandin E2 vaginal suppository terminations. Fifty-eight percent of patients had spontaneous placental delivery within 2 hours of the passage of the fetus; approximately two thirds of these were expelled within 30 minutes. Previous work involving elective saline solution-induced terminations suggested the 2-hour time limit for the third stage of labor. This was based on an unacceptable complication rate of greater than 4% beyond 2 hours. The present study of the use of prostaglandin E2 suppositories for a variety of indications demonstrated a similar complication rate of 4% at 30 minutes. These findings suggest expectant management beyond this time limit may produce unacceptably high complication rates.

Uterine Rupture Associated with the Use of Vaginal Prostaglandin E2 Suppositories

The authors present an obstetrical case of silent uterine rupture due to prostaglandin E2 vaginal suppositories. Although this complication has been reported in the obstetrical literature, lack of attention to it in the anaesthesia literature, causes us to call this problem to the attention of anaesthetists.

A simpler approach to labor induction using lipid-based prostaglandin E2 vaginal suppository

The outcome of labor induced by use of a glyceride-based vaginal suppository of prostaglandin E2 (PGE2) inserted 3 hours before amniotomy, when the cervix is favorable, has been assessed. Using 5 mg PGE2 for primigravidas and 2.5 mg for multigravidas, 63% of the former and 81% of the latter established labor and were delivered of their infants without oxytocin augmentation, allowing ambulation during early labor. No maternal complications were detected as a result of the PGE2 treatment. Compared with patients undergoing conventional induction by amniotomy and immediate oxytocin titration there was no difference in the duration of labor, with a few patients establishing labor and giving birth quickly with both induction methods. Fetal distress was less common following PGE2 treatment than following conventional induction, with three patients in each group requiring delivery by cesarean section. Cephalopelvis disproportion in the second stage of labor requiring cesarean section to deliver occurred more frequently in the prostaglandin-treated group, possibly as a result of reduced upper segment contractility in the first stage of labor with subsequent poor fetal head molding. Epidural analgesia and postpartum hemorrhge were both reduced following PGE2-induced labor.

Prostaglandin E2 vaginal suppository as a midtrimester abortifacient

The efficacy of prostaglandin E2 (PGE2) vaginal suppositories as an abortifacient was evaluated in 40 women between 16 and 20 weeks' gestation. All pregnancies were successfully terminated with a mean time of 12.7 hours (S.D. 5.7). Eight patients (20 per cent) were treated with oxytocin augmentation after spontaneous rupture of the membranes during PGE2 vaginal suppository therapy. Gastrointestinal side effects and drug fever were frequent but self-limiting. The success of this approach eliminates amniocentesis for drug instillation as well as the supplementary use of intravenous oxytocin in high concentrations and/or intracervical laminaria.