Low‐dose sulprostone for pregnancy termination in cases of fetal abnormality

Abstract

Thirty-two pregnancies (11 primi- and 21 multi-gravid) with an abnormal fetus were terminated between 16 and 35 weeks (mean 22 weeks; median 20 weeks) and a continuous intravenous infusion of 1 microgram of the prostaglandin analogue sulprostone. All pregnancies were terminated vaginally, 31 of them with this regimen in a median induction-expulsion interval of 23 h (range 8-52 h). Complete expulsion of the placenta occurred in 72 per cent of cases. Median blood loss was 100 ml (range 20-2000 ml). There were only a few side-effects. We conclude that this induction regimen is both appropriate and safe for pregnancy termination in cases of fetal anomaly.

Second and Third Medical Termination of Pregnancy with Misoprostol without Mifepristone

“…The 12.7 h mean induction-expulsion interval is shorter than that reported in studies with 1st generation prostaglandin given intravaginally (table 3) [2][3][4][5][6][7][8][9]. Indeed, only Visentin has reported similar delays, but the series reported in that study deals only with fetal intra-uterine deaths [4].…”

“…For a long time, expulsion of fetuses older than 3 months was difficult to perform and serious maternal complications could result due to such proce- dures [1]. First-generation prostaglandins and mifepristone (RU 486) have allowed realization of TOP with greater efficacy and shorter delays [2][3][4][5][6][7][8][9]. Misoprostol, an artificial E1 prostaglandin, has been used more recently, usually after the administration of mifepristone [10][11][12][13][14][15][16].…”

To Compare the Methods of Pregnancy Termination for Fetal Abnormality in the First and Second Trimesters

“…Kanhai and Keirse studied the use of low dose sulprostone in termination of pregnancy for fetal abnormality between 16 and 35 weeks in 32 pregnancies [13]. In 31 pregnancies, intravenous infusion of 0.5 mg sulprostone per minute was given for 60 minutes followed by 1 mcg per minute until the fetus was expelled.…”

“…The study by Kanhai and Kierse [13] illustrated the possible transference of methods of termination of pregnancy for other indications, for example fetal death, to fetal abnormalities. It appears that the methods used for termination of pregnancy in the first and second trimesters are also transferrable [14, 15, 17, 25–27].…”

Termination of pathological pregnancy in second and early third trimesters with extraamniotic instillation of 16-phenoxy-ω-tetranor prostaglandin E2methylsulfonylamide

“…Continuous infusion of PGF2, into the extraamniotic space has also been reported and has been concluded to be slow and painful [8]. Sulprostone has been used in the termination of second trimester pregnancies by intraamniotic [2], intramuscular [l-6] or intravenous routes [3,7]. Pretreatment cervical priming with overnight sulprostone gel 100 pg [5], with a 500-rg intramuscular injection [5] or with Laminaria tents [2,4,15], has been used in some studies.…”