gemeprost and Fetal-Death

The introduction of synthetic prostaglandin has revolutionized the treatment protocol for induction of second-trimester abortion and intrauterine death. Gemeprost is the only licensed synthetic prostaglandin analogue for second-trimester abortion in the United Kingdom. However, it is expensive and needs to be stored in a refrigerator. Misoprostol is marketed for use in the prevention and treatment of peptic ulcer. It is inexpensive and can be stored at room temperature. It has been widely used for induction of second-trimester abortion and intrauterine death. Misoprostol, 400 microg given vaginally every 3hours, is probably the optimal regimen for second-trimester abortion. The combination of misoprostol and mifepristone significantly reduced the induction-to-abortion interval when compared with the misoprostol-only regimen. In addition, misoprostol can also be used as a cervical priming agent prior to dilatation and evacuation in second-trimester abortion.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Alprostadil; Cervical Ripening; Dilatation and Curettage; Drug Therapy, Combination; Female; Fetal Death; Forecasting; Humans; Misoprostol; Pregnancy; Pregnancy Trimester, Second

Topics: Abortifacient Agents, Nonsteroidal; Alprostadil; Delivery, Obstetric; Dinoprostone; Female; Fetal Death; Humans; Pessaries; Pregnancy; Time Factors

The only prostaglandin analogue licensed in Italy for induction of labour in spontaneous and therapeutic abortion is gemeprost. The authors report a case of spontaneous uterine rupture of a scarred uterus, for previous caesarean sections, in a woman at 20 weeks of gestation with a diagnosis of spontaneous abortion. She received a pessary of gemeprost every three hours. After the fifth pessary, she complained of severe pain. At the ultrasound examination, uterine cavity appeared empty and the dead fetus was dislocated in the abdomen. Emergency laparotomy was performed and uterine tear was repaired. To induce labour for fetal demise or therapeutic abortion in second trimester in women with scarred uterus, the authors decided to lengthen the time between administrations of pessary from four to five hours depending on patient's symptoms. However the appropriate drug regimen has still to be found and more data are necessary.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Spontaneous; Administration, Intravaginal; Adult; Alprostadil; Female; Fetal Death; Humans; Labor, Induced; Male; Pregnancy; Pregnancy Trimester, Second; Prostaglandins E, Synthetic; Ultrasonography, Prenatal; Uterine Rupture

Determination of the efficacy and side-effects of the synthetic prostaglandin analog gemeprost for termination of pregnancy in the third trimester.. Retrospective record study of 40 women who had undergone third trimester termination of pregnancy before term by serial administration of gemeprost because of intrauterine fetal death or hopeless fetal prognosis. Patients with multiple pregnancy, a Bishop score > 5, contractions or contraindications to prostaglandins were excluded.. Gemeprost vaginal pessaries (1-mg) were given at 6-hourly intervals until labor intervened. The main parameter studied was the induction-delivery interval, the length of time between administration of the first dose and delivery. Statistical analysis was performed with the chi-square and the Mann-Whitney U-test.. The median induction-delivery interval was 14.4 h (range 3-48 h). Delivery occurred within 12 h in 17 women (42.5%), within 24 h in 27 women (67.5%) and within 36 h in 37 women (92.5%). An average of 2.6 doses were given per patient. Multigravidae had a significantly shorter induction-delivery interval than primigravidae (p < 0.01). A total of 87.5% women required analgesia. Side-effects were infrequent.. The administration of gemeprost vaginal pessaries represents an efficient method with few side-effects for the induction of labor in the third trimester, provided patients are chosen carefully and monitored closely.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Administration, Intravaginal; Adult; Alprostadil; Female; Fetal Death; Germany; Gestational Age; Humans; Medical Records; Pessaries; Pregnancy; Pregnancy Trimester, Third; Retrospective Studies; Treatment Outcome

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Abortion, Spontaneous; Adult; Alprostadil; Female; Fertilization in Vitro; Fetal Death; Humans; Ischemia; Pregnancy; Pregnancy Trimester, Second; Prostaglandins; Torsion Abnormality; Treatment Failure; Uterine Diseases; Uterus

To assess the effect of changing the regimen for second trimester induction of labour from gemeprost to mifepristone/misoprostol.. A retrospective study at a university teaching hospital over the 5-year period 1993-1997. SUBJECTS, METHODS and REGIMENS: 68 patients, 34 in the gemeprost group and 34 in the mifepristone/misoprostol group. The gemeprost group received 1mg vaginally every 3h to a maximum of five doses. The mifepristone/misoprostol group were pre-treated with 600 mg mifepristone orally followed by 800 microg misoprostol vaginally and then 400 microg orally every 3h to a maximum of four oral doses.. Induction to abortion interval; delivery within 24h.. The mifepristone/misoprostol group had a lower induction to abortion interval compared to the gemeprost group (median 8.9h versus 19.8h, respectively, p<0.01). The mifepristone/misoprostol regimen was more successful than the gemeprost regimen; 94% versus 68%, respectively, aborted without extra medical or surgical intervention, p=0.02. There were no significant differences in side effects, analgesia requirements or complications between the two groups. Three patients with previous Caesarean sections had a ruptured uterus; two from the gemeprost group and one from the mifepristone/misoprostol group.. The new mifepristone/misoprostol regimen was more effective in second trimester induction of labour. Induction of labour with misoprostol or gemeprost should be used with care in patients with a previous Caesarean section.

Topics: Abnormalities, Multiple; Abortifacient Agents, Nonsteroidal; Abortion, Therapeutic; Administration, Intravaginal; Administration, Oral; Adult; Alprostadil; Female; Fetal Death; Humans; Maternal Age; Middle Aged; Mifepristone; Misoprostol; Pregnancy; Pregnancy Trimester, Second; Reproductive History; Retrospective Studies; Treatment Outcome

This study reports the results obtained in the medical introduction of abortion during the second trimester of pregnancy in 52 patients following intrauterine fetal death or the diagnosis of fetal malformations.. The protocol consisted of the alternate use of intravaginal suppositories of gemeprost and intramuscular injections of sulprostone. The results were analysed using statistical methods and evaluated in relation to the different parameters present (intrauterine fetal death or therapeutic abortion, maternal age, gestation period and parity).. It was seen that the time required to induce abortive labour was significantly shorter in patients with IFD compared to patients with live fetus. The comparison between patients with a gestation period < or > 18 weeks revealed shorter induction times in the former group without reaching statistical significance.. Maternal age (under and over 30) and parity (P = 0 and P > or = 1) did not influence the results obtained.

Topics: Abortifacient Agents; Abortion, Therapeutic; Adult; Alprostadil; Dinoprostone; Female; Fetal Death; Fetus; Gestational Age; Humans; Injections, Intramuscular; Parity; Pregnancy; Pregnancy Trimester, Second; Suppositories

A retrospective study is reported comparing the induction to delivery interval using gemeprost for termination of pregnancy, in the second trimester, in 3 groups of patients. It was observed that the mean induction to delivery interval was significantly longer in 75 pregnancies where there was a fetus with a neural tube defect and or hydrocephalus (31.7 hours) compared with 88 pregnancies with other fetal abnormalities (19.7 hours) and 84 pregnancies where there was an intrauterine death (11.3 hours). There was also an increase in the requirements for further intervention to obtain delivery in the group with a neural tube defect or hydrocephalus (n = 33) compared with where there was an intrauterine fetal death (n = 4) and other abnormality (n = 14). We believe these results should be considered when counselling patients who have requested termination of pregnancy for fetal abnormalities.. Investigated, in this retrospective study, was an observation of hospital staff that use of gemeprost in mid-trimester pregnancy terminations was associated with a longer induction-delivery interval when the fetus had been diagnosed with a neural tube defect or hydrocephalus. The records of a consecutive series of 247 women admitted to Western Suburbs Hospital (Waratah, New South Wales) in the second trimester for gemeprost-induced abortion were reviewed and women were divided into three groups according to indication: Group A (n = 24)--fetal death (not from neural tube defect or hydrocephalus) diagnosed by ultrasound; Group B (n = 88)--all chromosomal and structural abnormalities other than neural tube defect and hydrocephalus; and Group C (n = 75)--neural tube defect and/or hydrocephalus diagnosed by ultrasound. The mean induction interval was 11.3 hours in Group A, 19.7 hours in Group B, and 31.7 hours in Group C. The percentages of women with an induction to delivery interval equal to or exceeding 24 hours were 4.8%, 15.9%, and 43.4%, respectively. The proportion of women requiring further surgical intervention was 4% in Group A, 14% in Group B, and 33% in Group C. These findings should be considered when counseling women who request pregnancy termination for fetal abnormalities. It was hypothesized that fetuses with a neural tube defect or hydrocephalus have a deficiency of the hypothalamic-pituitary-adrenal axis, resulting in decreased corticotrophin-releasing hormone release and difficulty initiating parturition. Use of RU-486, in addition to gemeprost or extra-amniotic prostaglandin, may be indicated in such cases.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adult; Alprostadil; Congenital Abnormalities; Female; Fetal Death; Humans; Hydrocephalus; Neural Tube Defects; Pregnancy; Pregnancy Trimester, Second; Prenatal Diagnosis; Prostaglandins E, Synthetic; Retrospective Studies; Time Factors

The results of the cervical priming with a Dinoprost-containing gel and a Gemeprost-containing vaginal suppository were compared in 68 patients, who required termination of pregnancy beyond 14 weeks because of a severe maternal disease or a fetal abnormality. The priming consisted of either an intracervical application of Dinoprost (500 micrograms) in a tylose-gel in 6-8 hour intervals or a retrocervical application of Gemeprost (1 mg) as a vaginal suppository in 12 hour intervals. Although no significant parameter variances were found in the selected patient groups, abortion was induced in 75% of cases within 24 hours, in 89% within 36 hours using Gemeprost. Mean induction time for Gemeprost was 19.5 hours. Using Dinoprost only 19% of patients had an abortion within 24 hours (44% within 36 hours, respectively), mean induction time was significantly longer (38.8 hours, p < 0.005). These differences remained unchanged, when patients who had a prior caesarean section were not evaluated. Using Gemeprost the additional systemic administration of Sulprost was necessary in 21% of cases, using Dinoprost, in 50% of cases. Severe complications did not occur and minor side effects such as nausea or vomiting were observed in single cases. These results demonstrate that Gemeprost can be used in cervical priming even after 14 weeks of pregnancy and that the longer application interval of 12 hours results in a reduction of side effects without a decrease in efficacy.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Eugenic; Abortion, Induced; Alprostadil; Cervix Uteri; Dinoprostone; Drug Therapy, Combination; Female; Fetal Death; Gels; Humans; Parity; Pregnancy; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Suppositories

Topics: Abortifacient Agents; Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adult; Alprostadil; Female; Fetal Death; Humans; Pessaries; Pregnancy

In 3rd trimester fetal death, when the cervix requires softening, labor may be induced by the administration of intravenous, intra-or extraamniotic, or vaginal prostaglandin E2 or intramuscular injections of synthetic prostaglandins, such as 15(S)-methyl prostaglandin F2 alpha. These methods all have various disadvantages. In 10 women with 3rd trimester intrauterine death, labor was induced by vaginal insertion of a 1 mg gemeprost (16,16-dimethyl-trans delta 2 prostaglandin E1 methyl ester) pessary. The mean number of pessaries s required was 1.9, and the mean duration of labor was 11.7 hours. The women remained mobile during most of the procedure. No patient required additional oxytocin, and the only side effects were mild fever and diarrhea.

Topics: Abortifacient Agents; Abortifacient Agents, Nonsteroidal; Adult; Alprostadil; Female; Fetal Death; Humans; Labor, Induced; Pessaries; Pregnancy; Pregnancy Trimester, Third

In this paper the authors report on the use of a prostaglandin E1 analog to expel fetuses stillborn in utero in the second trimester of pregnancy. Results of this clinical series make it possible to conclude on the efficacy of this agent and its simple utilization. Minor inconsequential side-effect observed coincide with the total absence of any complications.

Topics: Abortifacient Agents; Abortifacient Agents, Nonsteroidal; Abortion, Induced; Administration, Intravaginal; Adult; Alprostadil; Drug Evaluation; Female; Fetal Death; Humans; Pregnancy; Prostaglandins E, Synthetic

Topics: Abortifacient Agents; Abortifacient Agents, Nonsteroidal; Adult; Alprostadil; Female; Fetal Death; Humans; Labor, Induced; Pregnancy; Prostaglandins E, Synthetic; Uterine Rupture

Forty-eight patients affected with missed abortion, intrauterine fetal death and hydatiform mole were treated with vaginal suppositories containing 1 mg of 16,16-dimethyl-trans-delta 2-PGE1 methyl ester (ONO-802). The patients were divided into two treatment groups. The first, Group A, was given one vaginal suppository every 3 h to a maximum of five suppositories. The product of conception was expelled in 95.8% of patients. In Group B the maximum number of suppositories was reduced to three. The product of conception was expelled in 100% of cases and the average duration of treatment was similar to that for the first group. Although side-effects were mild in both groups, they were reduced in the patients of Group B.

Topics: Abortifacient Agents; Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Intravaginal; Adult; Alprostadil; Dose-Response Relationship, Drug; Drug Evaluation; Female; Fetal Death; Humans; Hydatidiform Mole; Middle Aged; Pregnancy; Prostaglandins E, Synthetic; Suppositories; Time Factors; Uterine Neoplasms

ONO-802, a synthetic E1 prostaglandin, was administered intravaginally via pessaries to Dutch belted rabbits at doses of 250, 62.5, and 12.5 micrograms/kg on days 6 through 18 of gestation. Rabbits in a vehicle control group were treated with pessaries that did not contain ONO-802 during the same period. Another group of animals remained untreated throughout gestation. Necropsies were performed on rabbits found dead and on those killed on gestation day 30. Body weight, food and water consumption, and clinical signs were monitored during the experiment. Major organs were weighed when the dams were necropsied on gestation day 30, and litter and fetal data were collected. Abortion and maternal deaths occurred in drug-treated groups. Body weight gains and food and water consumption were adversely affected by treatment particularly at the 250 and 12.5 micrograms/kg dose levels. Wastage (postimplantation loss) was significantly increased among treated groups (all dose levels), while other litter and fetal parameters were unaffected. ONO-802 was not teratogenic at maternal and embryotoxic dose levels.

Topics: Abortifacient Agents; Abortifacient Agents, Nonsteroidal; Alprostadil; Animals; Female; Fetal Death; Litter Size; Pregnancy; Prostaglandins E, Synthetic; Rabbits; Teratogens; Vagina

The synthetic prostaglandin ONO-802 was administered intravaginally to Sprague Dawley rats at doses of 1.0, 0.5, and 0.125 mg/kg on days 6 through 15 of gestation. A vehicle control group was treated with pessaries that did not contain the drug while another group remained untreated. Body weight, food, water consumption, and clinical signs were monitored during the experiment. In Phase One, 20 pregnant animals from each group were sacrificed at term, major organs were weighted, and litter and fetal data were collected. In Phase Two ten dams per group were allowed to deliver their litters, and the offspring were evaluated for survival, growth, developmental signs, and physiological function. Selected F1 offspring were retained to assess learning and emotional behavior or reproductive capacity. Administration of either 0.5 or 1.0 mg/kg of ONO-802 resulted in a slight reduction in food consumption and body weight gain. Water consumption was increased both during and after the dosing period for the mid and high dose dams. Significantly increased weights for the heart, lungs, liver, adrenals, and ovaries and decreased weights for the thymus gland were noted at term sacrifice of the 1.0 mg/kg dams, whereas the 0.5 mg/kg group had increased weights of the adrenals and ovaries only. Litter parameters were unaffected by treatment. Weights of the female fetuses of the 1.0 and 0.5 mg/kg groups were significantly reduced when compared to controls. There were no significant drug-related abnormalities among the F1 offspring and no evidence that treatment of the F0 dams affected the development, behavior, or reproductive performance of the F1 offspring. Thus, ONO-802 was not teratogenic when given to rats by the intravaginal route.

Topics: Abortifacient Agents; Abortifacient Agents, Nonsteroidal; Alprostadil; Animals; Body Weight; Embryo Implantation; Epididymis; Female; Fetal Death; Litter Size; Male; Organ Size; Ovary; Pregnancy; Prostaglandins E, Synthetic; Rats; Rats, Inbred Strains; Teratogens; Testis; Uterus