dinoprost and Genetic-Diseases--Inborn

The purpose of this investigation was to evaluate the accuracy of common sonographic techniques in assessing the amniotic fluid volume in pregnancies of less than 24 weeks' gestation. Patients at less than 24 weeks' gestation undergoing an amniocentesis for the placement of prostaglandin F2 alpha for termination (because of genetic or fetal anomalies, or both) were assessed for amniotic fluid volume. All fetuses were alive at the time of prostaglandin instillation. The amniotic fluid index and two-diameter pocket were used to determine the amniotic fluid volume. Prior to the prostaglandin instillation, the amniotic fluid volume was determined with para-aminohippurate using a diazo dye reaction with spectrophotometric analysis. The amniotic fluid volume was determined in 21 pregnancies between 15 and 24 weeks' gestation, yielding volumes ranging from 189 to 1840 ml. Using published standards for amniotic fluid volume in singleton pregnancies, oligohydramnios was present in three gestations, the volume was found to be normal in 15, and hydramnios complicated three pregnancies. The two-diameter pocket identified the amniotic fluid volumes correctly more often (18 of 21 [85.7%]) than the amniotic fluid index (10 of 21 [47.6%]) (P = 0.02). Normal amniotic fluid volume was identified in nine of 15 (60%) pregnancies by the amniotic fluid index and in 14 of 15 (93.3%) by the two-diameter pocket (P = not significant). Abnormal amniotic fluid volumes, oligohydramnios, and hydramnios were recognized more often by the two-diameter pocket (66.7%) than by the amniotic fluid index (1 of 6 [16.7%], P = not significant).

Topics: Abortion, Induced; Adolescent; Adult; Amniocentesis; Amniotic Fluid; Coloring Agents; Congenital Abnormalities; Dinoprost; Female; Genetic Diseases, Inborn; Gestational Age; Humans; Oligohydramnios; p-Aminohippuric Acid; Polyhydramnios; Pregnancy; Pregnancy Trimester, Second; Prospective Studies; Spectrophotometry; Ultrasonography, Prenatal

71 abortions after prenatal diagnosis of genetic defects have been performed between 1974 and 1983. Mean duration of pregnancy was 21 weeks, mean hospital stay 10 days. In 28 per cent an intraamnial prostaglandin induction was done, which was successful in 85 per cent. Extraamnial prostaglandin application was combined with oxytocin in 51 per cent, which was followed by abortion in 51 per cent within 26 hours. Primary hysterectomy was performed in 4 per cent and rupture of the membranes combined with oxytocin infusion in 6 per cent. Complication rate overall was 20 per cent. In 6 per cent the following complications have been observed: 1 perforation with lesion of intestine, 1 cervical rupture with hemorrhage, 1 colpaporrhexis, 1 shock. Pelveoperitonitis and rupture of the symphysis pubis in one case each (3 per cent). Other complications, like fever, hemorrhages and thrombophlebitis have been observed in 11 per cent. Midtrimester abortion after prenatal diagnosis of genetic defects should be done only in experienced clinics. Special importance in prophylaxis of complications of abortion has chorion biopsy to predate prenatal diagnosis in the 6th till 12th gestational week.

Topics: Abortion, Induced; Adult; Dinoprost; Female; Follow-Up Studies; Genetic Diseases, Inborn; Gestational Age; Humans; Hysterectomy; Intraoperative Complications; Oxytocin; Postoperative Complications; Pregnancy; Prenatal Diagnosis; Prostaglandins F