Rupture of the cervix in a sulprostone induced abortion in the second trimester

Corrado, Francesco; R, D'Anna; Cannata, Maria Letizia

doi:10.1007/s004040000092

Cited by 9 publications

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Uterine rupture following prostaglandins use in second trimester medical abortion: Fact or fiction? A systematic review

Malvasi,

Tinelli,

Mulone

et al. 2024

Intl J Gynecology & Obste

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BackgroundProstaglandins (PGs) have emerged as key drugs in second trimester medical abortion (STMA) and are currently a cornerstone in obstetric practice. Nevertheless, the application of PGs, integral to labor and abortion procedures, is not risk‐free, and has been associated with several complications, particularly maternal fever and uterine rupture (UR).ObjectivesThe main outcome of the present systematic review was to assess the safety of PGs use in STMA, particularly in scarred uterus (SC).Search StrategyThe review adhered to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guideline. We performed a comprehensive systematic review by searching multiple databases, including MEDLINE, EMBASE, Global Health, The Cochrane Library, Health Technology Assessment Database, and the research registers of Web of Science during the years 1990–2022.Selection CriteriaOnly articles regarding cases of UR occurred after the use of PGs for STMA were included in the article. We excluded papers regarding UR during first trimester abortion induction of labor or pregnancy or unrelated to PGs use for STMA. Risk of bias was assessed employing a modified version of the “Newcastle‐Ottawa Scale” (NOS).Data Collection and AnalysisA total of 178 studies were initially identified as potentially meeting the criteria for inclusion in the review. After full text evaluation, 110 other articles were excluded and 67 studies that suited the inclusion criteria were included. A total of 19 of the included studies were judged to have a high risk of bias. Given the heterogeneous nature of the findings, we opted for a narrative synthesis of the results.Main Results and ConclusionsPGs appear to be an effective pharmacologic tool for STMA; however, their use is not entirely risk‐free. STMA requires well‐equipped obstetric centers with skilled clinicians and surgeons prepared for emergencies. Ultrasonographic scans should be routinely performed during STMA management, since a UR can also be silent during the induction of labor. Intrapartum transabdominal, transperineal, and transvaginal ultrasound may have the diagnostic potential to early recognize this obstetric emergency, to facilitate rapid medical and surgical treatment, improving the outcome.

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Uterine rupture following prostaglandins use in second trimester medical abortion: Fact or fiction? A systematic review

Malvasi,

Tinelli,

Mulone

et al. 2024

Intl J Gynecology & Obste

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Racemic sulprostone

2004

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SHORT COMMUNICATIONSSulprostone (I) is a metabolically more stable analog of prostaglandin E 2 , which is widely used in biomedical research [1,2] and is known in gynecologic practice as an efficient agent (in combination with RU-486 or without it) for abortion [3][4][5]. The chemical synthesis of sulprostone and structurally related compounds, N-methylsulfonyl-16-phenoxyprostaglandincarboxamides, was described in [6]. Corey et al. [7] obtained sulprostone from optically active aldehyde; it was isolated as a colorless powder with mp 78.5-79.5°C (from ethyl acetate-diethyl ether); however, no α D value was given. According to patent [8], the melting point of sulprostone is 76°C, but its optical rotation is also missing. Commercial sulprostone produced by Cayman has mp 84-86°C (purity ≥98%); insofar as its α D value is absent, it is not clear whether this product is racemic or optically active. To elucidate this problem and compare biological properties of the products we have synthesized racemic sulprostone according to a modified procedure [9].Using standard methods, stereoisomerically pure bis-trimethylsilyl ether II [9] was converted (through dihydroxy lactone III) into bis-ethoxyethyl ether IV which was reduced with i-Bu 2 AlH to the corresponding hydroxy lactone, and the latter was subjected to Wittig olefination with ylide generated from triphenylphosphonium salt V. The final steps in the synthesis of I were oxidation of the hydroxy group in VI with Collins' reagent and removal of protecting groups by acid hydrolysis.Sulprostone (I) thus obtained was purified first by column chromatography on silica gel and was then II, R = Me 3 Si; III, R = H; IV, VI, R = CH 3 CH 2 OCH(CH 3 ); a: 3% HCl-THF, yield 95%; b: ethyl vinyl ether, CH 2 Cl 2 , PPTS, yield 93%; c: i-Bu 2 AlH, CH 2 Cl 2 , -78°C, yield 95%; d: [Ph 3 P + (CH 2 ) 4 CONHSO 2 CH 3 ]Br -(V), t-BuOK, THF, 0°C, 1 h, yield 80%; e: CrO 3 · 2 Py, yield 85%. e, a O HO OH

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Sulprostone

2006

Meyler's Side Effects of Drugs: The International Encyclopedia of Adverse Drug Reactions and Interactions

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Rupture of the cervix in a sulprostone induced abortion in the second trimester

Cited by 9 publications

References 4 publications

Uterine rupture following prostaglandins use in second trimester medical abortion: Fact or fiction? A systematic review

Uterine rupture following prostaglandins use in second trimester medical abortion: Fact or fiction? A systematic review

Racemic sulprostone

Sulprostone

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