dinoprost and Uterine-Rupture

To study the safety of second trimester abortion in women with previous uterine scar.. We screened the records of 518 women who underwent an abortion between 12 and 20 weeks' gestation at the Postgraduate Institute of Medical Education and Research, Chandigarh, India, from January 2000 to December 2010. Methods used for abortion were: (i) vaginal misoprostol with or without pre-treatment with mifepristone, and (ii) intracervical dinoprostol gel or vaginal misoprostol ± extra-amniotic saline ± oxytocin infusion. Seventeen women, aborted by means of a hysterotomy, were excluded from further analysis.. Of the remaining 501 women, 44 had a uterine scar (Group 1) and 457 had none (Group 2). In Group 1, 40/44 (91%) and in Group 2, 452/457 (99%) women aborted successfully. The mean induction-abortion interval (IAI) was similar in the two groups (15.03 ± 10.69 hours and 12.52 ± 9.0 hours in Groups 1 and 2, respectively; p = 0.083). There were three uterine ruptures, 1/44 (2%) in group 1 and 2/457 (0.4%) in group 2 (p = 0.132, NS); all three women had received mifepristone followed by vaginal misoprostol.. In women with a scarred uterus, midtrimester abortion may be successfully achieved using any of the aforementioned regimens.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adult; Case-Control Studies; Cicatrix; Developing Countries; Dinoprost; Female; Humans; India; Mifepristone; Misoprostol; Pregnancy; Pregnancy Trimester, Second; Retrospective Studies; Uterine Diseases; Uterine Rupture

Topics: Abortion, Induced; Arachidonic Acids; Cervix Uteri; Dinoprost; Female; Humans; Labor, Induced; Maternal-Fetal Exchange; Postpartum Hemorrhage; Pregnancy; Prostaglandins; Prostaglandins F, Synthetic; Structure-Activity Relationship; Uterine Contraction; Uterine Rupture

A case of uterine rupture is presented following induction of second-trimester abortion using oxytocin and prostaglandin F2 alpha. A brief review of the literature is given and etiological factors and diagnostic features are discussed.

Topics: Abortion, Therapeutic; Adult; Amnion; Dinoprost; Female; Humans; Injections; Oxytocin; Pregnancy; Pregnancy Trimester, Second; Prostaglandins F; Uterine Rupture

Topics: Adult; Dinoprost; Female; Fetal Death; Humans; Injections, Intravenous; Labor, Induced; Pregnancy; Pregnancy Trimester, Third; Prostaglandins F; Uterine Rupture

Topics: Abortion, Induced; Dinoprost; Female; Humans; Oxytocin; Pregnancy; Pregnancy Trimester, Second; Prostaglandins F; Uterine Rupture

The clinical course of 40 patients with a uterine scar who were undergoing second-trimester abortion induced with either hypertonic saline or prostaglandin F2 alpha, was reviewed. In the 38 patients with a previous cesarean scar, and in the 2 patients with a hysterotomy scar, the uterine contents were evacuated with no evidence of uterine rupture. A review of the literature dealing with uterine rupture subsequent to induced midtrimester abortion revealed that the typical multiparous uterus was more prone to rupture if oxytocin was used in conjunction with or a few hours after instillation of the abortifacient, or if oxytocin was used continuously for more than 12 hours. Although rupture after use of prostaglandin in a previously scarred uterus has been reported, there is no case reported of rupture after use of hypertonic saline. This review and the authors' experience lead them to conclude that hypertonic saline is a safe abortifacient during the second trimester, especially between 18 and 22 weeks' gestation, in a previously scarred uterus when careful monitoring is employed and oxytocic agents are used judiciously.

Topics: Abortifacient Agents; Adult; Cesarean Section; Dinoprost; Female; Humans; Oxytocin; Parity; Pregnancy; Pregnancy Trimester, Second; Prostaglandins F; Saline Solution, Hypertonic; Sodium Chloride; Time Factors; Uterine Rupture

Hysterography was performed on 173 nulliparous patients following termination of midtrimester pregnancy by intra-amniotic prostaglandin F2 alpha (PGF2 alpha). In 21 hysterograms (12%) a pathologically wide internal os was found, compared with three out of one hundred routine hysterograms carried out for infertility examination. A deformed cervical canal with filling defects and synechiae was found in the hysterograms of 28 patients (16%). Only one of the 6 patients with ruptured cervix had a wide internal os. A laminaria tent was inserted more frequently into the cervix of patients whose internal os was of normal wide. The clinical picture of patients and the courses of abortion inductions did not differ in other respects in patients with normal vs. wide internal cervical os. This leads us to believed that there are two types of cervix: a rigid, hypoplastic cervix with high collagen content, which when exposed to the trauma of abortion induction leads to rupture, but not necessarily to incompetence, and a softer type of cervix, very muscular, which leads to wide internal os and incompetence.. Hysterography was performed on 173 nulliparous patients following termination of midtrimester pregnancy by intraamniotic prostaglandin F2alpha (PGF2alpha). In 21 hysterograms (12%), a pathologically wide internal os was found, compared with 3 of 100 routine hysterograms carried out for infertility examinations. A deformed cervical canal with filling defects and synechiae was found in the hysterograms of 28 patients (16%). Only 1 of the 6 patients with a ruptured cervix had a wide internal os. A laminaria tent was inserted more frequently into the cervix of patients whose internal os was of normal size. The clinical picture of patients and the courses of abortion induction did not differ in other respects in patients with normal vs. wide internal cervical os. This leads to the conclusion that there are 2 types of cervixes: a rigid, hypoplastic cervix with high collagen content which, when exposed to the trauma of abortion induction, leads to rupture, but not necessarily to incompetence; and a softer type of cervix, very muscular, which leads to a wide internal os and incompetence.

Topics: Abortion, Induced; Adolescent; Adult; Cervix Uteri; Dinoprost; Female; Follow-Up Studies; Humans; Pregnancy; Pregnancy Trimester, Second; Prostaglandins F; Radiography; Uterine Rupture