title: Inflammation or infection at the time of second trimester induced abortion.
abstract: BACKGROUND
  Induced abortion via dilation and evacuation (D&E) typically involves cervical preparation. Some clinicians also induce fetal death in the second trimester. We designed this study to determine if the combination of intra-amniotic digoxin and osmotic dilators induced intrauterine inflammatory changes.
  
  
  METHODS
  Twenty-two women requesting abortion at 19-23 weeks gestation had amniotic fluid sent for measurement of interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α), white blood cell (WBC) count and anaerobic and aerobic cultures on day 1, before dilators and digoxin amnioinjection. Sampling was repeated on Day 2, prior to D&E.
  
  
  RESULTS
  All subjects had significantly elevated IL-6, IL-8 and TNF-α in the amniotic fluid on Day 2. The median difference for IL-6 was 19,893.4 pg/mL (p<.0001), 7040.7 pg/mL (p<.0001) for IL-8 and 181.0 pg/mL (p<.0001) for TNF-α. There was no significant difference in WBC count. There were no clinically significant positive cultures and no clinical infections.
  
  
  CONCLUSIONS
  The administration of intra-amniotic digoxin and the placement of osmotic dilators prior to D&E create an intrauterine inflammatory response.
authors.affiliation: Department of Obstetrics and Gynecology, Tufts Medical Center, Box 22, Boston, MA 02111, USA. droncari@tuffsmedicalcenter.org
authors.forename: Danielle
authors.initials: D
authors.lastname: Roncari
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Politch
authors.forename: Sarita
authors.initials: S
authors.lastname: Sonalkar
authors.forename: Molly
authors.initials: M
authors.lastname: Finneseth
authors.forename: Lynn
authors.initials: L
authors.lastname: Borgatta
mesh_terms: D000028:Abortion, Induced / Q000009:adverse effects*; D000328:Adult; D000649:Amniocentesis; D000653:Amniotic Fluid / Q000378:metabolism / Q000382:microbiology; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000382:microbiology; D002821:Chorioamnionitis / Q000209:etiology / Q000378:metabolism* / Q000382:microbiology*; D004077:Digoxin / Q000008:administration & dosage / Q000009:adverse effects*; D004107:Dilatation and Curettage / Q000009:adverse effects*; D004318:Doxycycline / Q000627:therapeutic use; D005260:Female; D005313:Fetal Death / Q000139:chemically induced; D006801:Humans; D007375:Interleukin-1 / Q000378:metabolism; D016209:Interleukin-8 / Q000378:metabolism; D007958:Leukocyte Count; D010865:Pilot Projects; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D018709:Statistics, Nonparametric; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D000889:Anti-Arrhythmia Agents; D000900:Anti-Bacterial Agents; D007375:Interleukin-1; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha; D004077:Digoxin; D004318:Doxycycline