Single Dose Extra-Amniotic Prostaglandin Gel for Midtrimester Termination of Pregnancy

Summary: The efficacy of a single dose of prostaglandin F2α gel instilled into the extra-amniotic space to induce termination of pregnancy in the second trimester has been assessed and compared with intra-amniotic prostaglandin F2α and with an extra-amniotic infusion of prostaglandin F2α combined with intravenous oxytocin. There was no significant difference between the methods in time taken to abortion, incidence of retained placenta, need for blood transfusion, or rate of sepsis. Single dose extra-amniotic prostaglandin gel is recommended as a safe, effective, and convenient method of midtrimester termination of pregnancy.     

Pre-induction with Mifepristone for Second Trimester Termination of Pregnancy

Objective

To study the efficacy and safety of combining mifepristone before misoprostol use in second trimester to considerably reduce the induction–abortion interval with the lowest possible dose and adverse reaction.

Material and methods

A prospective study was conducted which included 60 patients visiting the antenatal OPD for elective abortions between 13 and 20 weeks of gestation as per the MTP act. They were randomly divided into two groups of 30 each—the study group received mifepristone 200 mg orally before misoprostol, whereas the control group was induced with misoprostol alone. The results were analyzed.

Observation

Statistical analysis of the study was done using χ² test. The induction–abortion interval was significantly shorter in the study group, thereby decreasing the side-effects of the drug as well as duration of hospital stay.

Conclusion

This study, like many others, offers a reliable, safe, and cost-effective option by combining mifepristone before misoprostol to decrease the induction–abortion interval.     

Vaginal Misoprostol vs. Concentrated Oxytocin Plus Low-Dose Prostaglandin E2 for Second Trimester Pregnancy Termination

Objective: To examine the efficacy of vaginal misoprostol for mid-trimester pregnancy termination.

Results: Interim analysis of the first 30 (15-misoprostol, 15-concentrated oxytocin) women demonstrated that the 2 groups were similar with regard to indication for delivery, gestational age, and demographic characteristics. Misoprostol was associated with a lower success rate (67 vs. 87%, P =. 2), a longer induction-delivery interval (22 h vs. 18 h, P =. 09), a higher rate of retained placenta requiring curettage (27 vs. 13%, P =. 65), and a higher live birth rate (50 vs. 0%, P =. 006).

Conclusions: Compared to a regimen of concentrated oxytocin plus low-dose prostaglandin E₂, misoprostol administered as vaginal tablets in a dose of 200 μg q 12 h is not satisfactory for mid-trimester pregnancy termination in an unselected population.

Methods: This randomized trial compared misoprostol, 200 μg per vaginum q 12 h to a protocol of concentrated oxytocin plus low-dose vaginal prostaglandin E₂ suppositories (10 mg q 6 h). Success was defined as an induction-to-delivery interval ≤24 h.     

Vaginal Prostaglandin F2α Gel Before First Trimester Termination of Pregnancy

Summary: Tylose gel containing either 10 mg prostaglandin F_2α or sterile water was inserted into the posterior vaginal fornix of 130 patients either 12 hours or 4 hours before suction curettage. No benefit in terms of cervical softening or blood loss was noted in patients who received the prostaglandin gel.     

Misoprostol Vs Mifepristone and Misoprostol in Second Trimester Termination of Pregnancy

Objective

The present study was conducted with the aim to assess and comparatively evaluate the safety and efficacy of misoprostol alone and mifepristone with misoprostol for second trimester termination of pregnancy.

Methods and Materials

The study was conducted on 200 selected cases, divided in two groups of 100 cases each. In the study group mifepristone was given 200 mg 12 h before intravaginal insertion of 600 μg of misoprostol followed by 400 μg every 3 h up to a maximum of 5 doses or until the abortion occurs, whichever occurs early. In the control group only misoprostol was inserted in the same dose regime. The results were analyzed.

Results

The success rate in both regimens was 100%. Mean induction abortion interval from the insertion of the first misoprostol tablet was significantly shorter in the mifepristone pretreated group 6.72 ± 2.26 h as compared to 12.93 ± 3.4 h in the misoprostol alone group (P < 0.001). The mean blood loss was slightly higher in the control group. The mean dose of the misoprostol required was significantly less in the study group 1,186 ± 291.64 μg as against 1,736 ± 320.20 μg (P < 0.001). The side effects observed in both the groups were similar mainly nausea vomiting, fever, abdominal cramps.

Conclusion

Pretreatment with mifepristone 12 h before intravaginal misoprostol significantly improves the induction abortion interval.     

Sublingual Misoprostol for Cervical Priming in Surgical First Trimester Pregnancy Termination

Objectives

To determine the efficacy of 400 mcg sublingual misoprost as an adjunct to suction evacuation in first trimester pregnancy termination.

Method(s)

During the study period of January2006–June 2007, two hundred twenty-one pregnant women wanting first trimester pregnancy termination were randomised into two groups. In the study group of one hundred twenty-one women, sublingual misoprostol was used 3 h prior to suction evacuation. In the control group of hundred women, direct suction evacuation was used. In cervical dilatation achieved by misoprostol, time required for suction evacuation, blood loss, pain perceived by patient and complications that occurred in the two groups were compared by STATA 9 stastistical software.

Result(s)

In the study group, mean cervical dilatation was up to 5.61 with Hegar dilator and in control group, it was 5.03. (P = 0.004). Average time required for suction evacuation was 7.28 min in study group and 8.73 min in control group (P < 0.0001). Blood loss was less in study group as compared to those in the controls. In study group, only 10.74% women perceived pain compared to twenty percent women in control group.

Conclusion(s)

Use of sublingual misoprost prior to first trimester pregnancy termination by suction evacuation ripens the cervix so there is less need for cervical dilatation, pain perceived by patient is less, the time required for suction evacuation is less and there is reduction in blood loss. Sublingual misoprostol is effective and safe for cervical ripening and dilatation before suction evacuation.     

Pregnancy Loss Rates Following Second Trimester Genetic Amniocentesis

Data from 3,953 consecutive second trimester genetic amniocenteses were analysed to determine pregnancy loss rates up to 6 weeks after the procedure. Information was prospectively collected on a cohort of 3,685 women in 3,896 singleton and 50 twin pregnancies, from 2 operating sites in Perth, Western Australia, using 9 operators over the 6-year period, 1989 to 1995. Complete information regarding pregnancy outcome was obtained for 3,643 of the 3,685 women (98.9%). There were 27 identified singletons and 1 set of twins lost within 6 weeks following amniocentesis. The overall pregnancy loss rate in this cohort was 29 of 3,911 (0.74%). The pregnancy loss rate associated with genetic amniocentesis is not excessive in comparison to the calculated background pregnancy loss rate of 1%, and it is suggested that each prenatal diagnostic team should determine their own complication rates for the purpose of counselling prior to amniocentesis.     

米索前列醇引产在早期重度妊高征中的应用

目的观察米索前列醇用于早期发生的重度妊高征终止妊娠的安全性和可行性.方法选择伴有各种严重并发症且发病较早,需要终止妊娠的重度妊高征8例(孕周26～32+5),同期正常足月需引产者13例为对照组.米索前列醇50μg阴道给药,依据宫缩情况3～4h重复给药.监测血压、心率、体温、诱发宫缩时间、用药至临产时间及产程.结果两组用药前后血压、心率、体温变化均无统计学差异(P＞0.05),两组均荻引产成功,妊高征组用药总量及给药次数明显高于对照组(P＜0.001),但临床经过平稳,无副反应.结论米索前列醇用于早期重度妊高征的终止妊娠,尤其是对不期待活产的病例,具有一定的安全性和可行性.     

对米非司酮合并前列腺素终止早孕监护措施的探讨

我们对129例早孕患者应用米非司酮合并前列腺素终止妊娠并采用尿hCG 半定量测定,B 型超声检查及绒毛、蜕膜组织病理检查作为监护方法。结果表明在药流d15,出血在15d 内完全流产者中有70%尿hCG 滴度呈正常水平(<312mIU/ml)。而药流d15尿hCG 滴度≥1250mIU/ml 者,可能为不完全流产或完全流产但出血时间延长。B 型超声检查对诊断子宫出血时间长短有一定价值。绒毛蜕膜组织坏死程度则并非确定出血时间长短的唯一因素。     

The Effect of Prostaglandin E1on the Pressor Response to Angiotensin II in Second Trimester Human Pregnancy and in the Non-Pregnant Subject

The effect of a simultaneous infusion of prostaglandin E₁ (PGE₁) on the pressor response to angiotensin II (AII) has been studied in 8 pregnant and six non-pregnant subjects to date. PGE₁ 15 ng kg^?1 min^?1 had no effect on basal blood pressures in the pregnant patients, but increased heart rate by 9.1 ± 1.6 bpm (P<0.001). Six of these eight wanen had scanewhat diminished pressor responses to AII (4, 8 and 16 ng kg^?1 min^?1) during PGE₁ infusion; this difference reached statistical significance at the lowest dose of AII (P<0.05). PGE₁ 10 ng kg^?1 min^?1 slightly increased basal diastolic pressure in the non-pregnant subjects (P<0.05) and increased heart rate by a similar amount (8.4 ± 1.8 bpm, P<0.01). Again, the overall pressor response to AII was sanewhat diminished in the majority of these subjects. The pregnant patients exhibiting the greatest initial pressor response to AII were those in whom the greatest decrease in response was seen; this correlation achieved statistical significance at 8 and 16 ng kg^?1 min^?1 AII (P<0.01, P(0.002 respectively). A similar trend was apparent in the non-pregnant subjects.     

米非司酮配伍前列腺素抗早孕的临床试验

上海市15个单位合作完成米非司酮配伍前列腺素抗早孕，按常规筛选对象共1884例。米非司酮分次给药共150mg，第3天随机给于PG05栓1mg置后穹窿或米索前列醇0．6mg顿服。结果完全流产率95．1％。效果与不同产地的米非司酮和不同前列腺素无差异；与以往人流或自然流产史、体重、胚囊直径、孕妇血色素、有无恶心呕吐等有关。药流副反应轻。完全流产后平均出血时间14．91±7．66d。药流后的对象满意度达85％以上。说明本法抗早孕安全有效、反应轻，建议通过培训、掌握常规，在有抢救条件的基层医疗单位推广应用。     

Vaginally Administered 16,16-Dimethyl-PGEl-Methyl Ester (Gemeprost) to Induce Termination of Pregnancy after the First Trimester

The results of the first 40 patients, whose pregnancies were terminated using Gemeprost vaginal suppositories are presented. The indication for termination of pregnancy was either fetal abnormality, or fetal death in utero. The mean gestational age was 20.9 +/- 4.4 weeks. 82.5% of patients were delivered within 24 hours, following a mean number of 3.9 +/- 1.3 pessaries. Side-effects were uncommon, and the procedure was well tolerated, with 30% of patients requiring no analgesia, and 60% receiving narcotic analgesia only. The results obtained compare favourably with the overseas experience with this method. Augmentation with oxytocic agents is of questionable value, and routine evacuation of the uterine cavity, under general anaesthesia seems unnecessary. Administration is simple and well tolerated by patients, and this method of pregnancy interruption appears safe, efficient and superior to extra-amniotic infusion of PGF2 alpha.     

妊娠中期合并神经系统疾病21例临床分析

目的:探讨妊娠中期合并神经系统疾病的临床特点、诊断、治疗方法和妊娠结局.方法:回顾性分析首都医科大学宣武医院近十年收治的妊娠中期合并神经系统疾病21例患者的临床及随访资料.结果:妊娠合并脑损害18例:其中癫痫4例,颅内静脉窦血栓3例,脑血管动静脉畸形2例,脑血管动脉瘤2例,脑梗死2例,病毒性脑炎2例,急性炎性脱髓鞘性脑脊髓炎3例;妊娠合并脊髓损害:脊髓动静脉畸形2例;妊娠合并神经肌肉接头损害:重症肌无力1例.临床症状主要表现为头痛、恶心、呕吐、抽搐、严重者出现癫痫持续状态,下肢麻木、四肢无力等.入院后患者行脑电图(EEG)、电子计算机断层扫描(CT)、磁共振成像(MRI)、磁共振脑静脉血管成像(MRV)、脑血管造影(DSA)和腰椎穿刺等检查明确诊断后,针对不同种类的神经系统疾病进行相应的抢救处理,孕妇存活19例;放弃治疗出院1例,失访;母婴死亡1例.存活的19例患者中,终止妊娠17例,其中12例行依沙吖啶羊膜腔穿刺引产,4例药物流产,1例剖宫取胎术;2例维持妊娠至足月剖宫产,新生儿均存活,随访良好.2例遗留功能缺损.结论:妊娠中期合并的各种类型神经系统疾病病情凶险,应争取尽早诊断,选择合理治疗方法确保孕妇安全.待病情平稳,综合评价引产的必要性后及时终止妊娠,并选择对孕妇安全的引产方式.     

Minimally Invasive Surgical Management of a Second Trimester Pregnancy in a Rudimentary Uterine Horn

BackgroundPregnancy in a rudimentary uterine horn is a rare form of ectopic pregnancy with a high risk of rupture. Management usually involves excision of the rudimentary horn. If diagnosed after the first trimester, it has been managed in the past by laparotomy.CaseA primigravid woman was found on routine ultrasound to have a rudimentary horn pregnancy. The diagnosis was confirmed on MRI, and a thin uterine wall was demonstrated. Management comprised fetal injection of potassium chloride followed by complete laparoscopic excision of the rudimentary horn at 16 weeks’ gestation.ConclusionLaparoscopic management of a mid-trimester rudimentary horn pregnancy is feasible, but expert radiological characterization is required for optimal surgical planning.     

Intravaginal Misoprostol for Termination of Midtrimester Pregnancy

EDITORIAL COMMENT: We accepted this paper for publication because readers will be interested to see this alternative method for termination of second-trimester pregnancy to that reported in the preceding paper by Prasad and colleagues. We agree with the authors that trials comparing intravaginal misoprostol with other prostaglandins are required. Such a study of a prospective, randomized trial comparing the efficiency and safety of misoprostol with that of prostaglandin E* in 55 women between 12–22 weeks' gestation, has recently been reported (Jain JK, MishellDR. A comparison of intravaginal misoprostol with prostaglandin E₂for termination of second-trimester pregnancy. New Engl J Med 1994; 331:290–293). This study concluded that misoprostol was at least as effective as PGE₂ and was less costly, easier to administer, and associated with fewer adverse effects.
Summary: Misoprostol seems to be a drug with many potential uses apart from the treatment of gastric and duodenal ulcers. The oral tablet appears to be effective for termination of midtrimester pregnancy when administered intravaginally. Further research should be carried out to determine its full range of action in order that the drug can be utilized to its maximum potential.