Intraamniotic 15(s)-15-methyl prostaglandin F2 alpha and termination of middle and late second-trimester pregnancy for genetic indications: a contemporary approach.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Ferguson
J E
JE
Department of Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville 22908.
Burkett
B J
BJ
Pinkerton
J V
JV
Thiagarajah
S
S
Flather
M M
MM
Martel
M M
MM
Hogge
W A
WA
D000032:Abortion, Therapeutic / Q000009:adverse effects / Q000379:methods*; D000282:Administration, Intravaginal; D000293:Adolescent; D000328:Adult; D000650:Amnion; D002260:Carboprost / Q000008:administration & dosage*; D016022:Case-Control Studies; D002869:Chromosome Aberrations; D025063:Chromosome Disorders; D015232:Dinoprostone / Q000008:administration & dosage; D005260:Female; D005865:Gestational Age; D006801:Humans; D007267:Injections; D007795:Laminaria; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D014508:Urea / Q000008:administration & dosage
D002260:Carboprost; D014508:Urea; D015232:Dinoprostone