Termination of pathological pregnancy in second and early third trimesters with extraamniotic instillation of 16-phenoxy-omega-tetranor prostaglandin E2 methylsulfonylamide.
OBJECTIVE
To evaluate the efficacy, safety and influence on subsequent fertility of sulprostone, a prostaglandin E2 analog, in terminating pathological pregnancies via the extraamniotic route.


METHODS
Forty pregnant women with intrauterine fetal death or major congenital anomalies were enrolled. Sulprostone was instilled into the extraamniotic space through a silicon Foley catheter. The instillation rate was 0.5-1 microgram/min. Instillation was discontinued when the catheter was expelled or when rupture of the membranes occurred. The duration of instillation and the time interval to completion of abortion was recorded. Information about subsequent fertility was collected by telephone or at outpatient clinic visits.


RESULTS
The mean duration of instillation was 7.0 h and the mean dose of sulprostone was 314.8 micrograms. The mean induction-to-abortion interval (IAI) was 17.0 h. In two of the 40 patients, the cervix was not adequately ripened after 48 h and these pregnancies were ultimately terminated by alternative methods. The success rate of termination in 48 h was 92.5% (37/40). No severe side effects were encountered.


CONCLUSIONS
To the best of our knowledge, this is the first report in the English literature of administration of sulprostone by extraamniotic instillation for termination of pathological pregnancies. The method is effective and safe and has an insignificant influence on subsequent fertility.
Department of Obstetrics and Gynecology, Taichung Veterans' General Hospital, Taiwan, China.
S F
SF
Hwang
M M
MM
Chou
E S
ES
Ho
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000030:Abortion, Missed / Q000628:therapy; D000032:Abortion, Therapeutic / Q000379:methods*; D000328:Adult; D000650:Amnion; D015232:Dinoprostone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D005260:Female; D005298:Fertility / Q000187:drug effects; D005313:Fetal Death / Q000628:therapy; D005333:Fetus / Q000002:abnormalities; D006801:Humans; D007322:Instillation, Drug; D011247:Pregnancy; D011446:Prospective Studies; D013997:Time Factors
D000020:Abortifacient Agents, Nonsteroidal; C016767:sulprostone; D015232:Dinoprostone