dinoprost and Lymphangioma

An original route for prostaglandin F2 alpha administration for midtrimester pregnancy termination is presented. The diagnosis of nuchal cystic hygroma in a hydropic fetus with severe oligohydramnios was made by real-time ultrasonography. Forty milliliters of fluid was aspirated for laboratory studies and prostaglandin F2 alpha was injected into the nuchal cysts to induce abortion. The pregnancy was successfully terminated 8 hours later.. Although the use of prostaglandins (PGs) in 2nd-trimester abortions is well established, less clear is the optimal route of administration. The literature includes reports of intra- and extraamniotic, intracervical, intravaginal, intravenous, intramuscular, and oral administration. This article describes a case in which PG F-2-alpha was injected into the nuchal cysts of a fetus with cystic hygroma, edema anasarca, and oligohydramnios. Nuchal cystic hygroma, a congenital malformation of the lymphatic system involving a jugular lymphatic obstruction sequence, was diagnosed in the 27-year-old patient by real- time ultrasonography performed at 21 weeks' gestation. Since there was no pouch of amniotic fluid, intraamniotic PG instillation was not an option. However, the severe cystic hygroma and hydrops offered an alternative site for PG instillation. During the abortion procedure, 40 ml of fluid contained in the cysts was aspirated for laboratory studies and 40 mg of PG F-2-alpha was injected under ultrasonographic guidance. Uterine contractions began 2 hours later and the injection-abortion interval was 8 hours. The administration of meperidine and atropine sulfate to prevent pain and PG-associated side effects was effective. This successful outcome in this case suggests a need for further investigation of intrafetal PG administration.

Topics: Abortion, Induced; Adult; Amniotic Fluid; Dinoprost; Female; Fetal Diseases; Head and Neck Neoplasms; Humans; Hydrops Fetalis; Injections, Intralesional; Lymphangioma; Pregnancy; Pregnancy Trimester, Second; Prenatal Diagnosis; Ultrasonography