gemeprost and Fetomaternal-Transfusion

Measurement of alpha-fetoprotein (AFP) was used to investigate the occurrence of feto-maternal haemorrhage in women undergoing medical abortion.. Three groups of women with amenorrhoea of 56 or less days were studied. A control and a mifepristone group had two blood samples taken 48 h apart. Women undergoing medical abortion with gemeprost had two blood samples taken 24 h apart.. Medical Termination Unit, Simpson Memorial Maternity Pavilion, Edinburgh.. Three hundred and thirty-five women requesting abortion.. Blood samples taken at 24 h or 48 h apart.. The rise in concentration of AFP in plasma was much higher (P = 0.01) in the two groups of women in whom abortion was induced by gemeprost or mifepristone than in control women. Whereas only 5% of women in the control group had a significant rise in AFP, 27% and 33% of women in the mifepristone and gemeprost groups, respectively, had a rise in AFP level which exceeded the 95th centile (> or = 38%). The concentration of hCG rose by 48 h in both control and mifepristone groups. Progesterone remained unchanged, and oestradiol decreased (P < 0.02) in the mifepristone group. By 24 h, there was a significant fall in the concentrations of hCG, progesterone and oestradiol in the group who had aborted after being given gemeprost.. Anti-D prophylaxis must be administered to rhesus negative women to avoid rhesus iso-immunisation.. 335 healthy women undergoing termination of 1st trimester pregnancy with amenorrhea of 56 days or less were studied in order to examine the occurrence of feto-maternal hemorrhage in women. The control group comprised 100 women in early pregnancy. Venous blood was taken on day 0 and 48 hours later. The mifepristone group included blood samples from 140 of the 150 women. Each women received a single oral dose of mifepristone of either 200 mg (n = 50), 400 mg (n = 43) or 600 mg (n = 47). Venous blood was taken in similar fashion, but the 2nd sample was taken before insertion of a 1 mg gemeprost pessary. The gemeprost along group included 95 women who had 1 mg gemeprost pessaries inserted to a maximum dose of 3 mg or until abortion occurred. Blood was collected before insertion of the 1st gemeprost pessary (0 hour) and 24 hours later. The rise in alpha-fetoprotein (AFP) concentration was significantly greater in the groups who had a medical abortion (p = 0.01) compared with the control group. In Group 1, there was a moderate rise in the plasma concentration of AFP (P 0.0001), estradiol (P 0.0002), hCG (P 0.0001) and progesterone (NS) over 48 hours. Only 5% of women had an AFP rise of 38% or greater within 48 hours. In group 2, 61 to 69% of women bled following administration of mifepristone. Women had a significant rise in AFP concentration (P 0.001) within 48 hours, and 27% had an AFP rise 38% or greater. A rise in plasma hCG was demonstrated, while plasma progesterone remained unchanged over 48 hours. There was a significant reduction in plasma estradiol 48 hours after taking mifepristone (P 0.02). All women in group 3 bled following insertion of gemeprost, and 89% aborted within 24 hours after the 1st gemeprost pessary. An overall increase in AFP concentration was detected (P 0.0001). 33% of women had an increase of 38% or greater in AFP. A significant reduction in plasma hCG (p 0.0001), estradiol (P 0.0001) and progesterone (P 0.0001) occurred within 24 hours after abortion.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adolescent; Adult; alpha-Fetoproteins; Alprostadil; Chorionic Gonadotropin; Estradiol; Female; Fetomaternal Transfusion; Humans; Mifepristone; Placental Hormones; Pregnancy; Progesterone; Time Factors

The occurrence of fetomaternal haemorrhage was investigated in 30 women by measuring maternal serum alphafetoprotein (AFP) levels before and after the administration of mifepristone (RU 486) for termination of first trimester pregnancy. A significant rise in AFP levels was seen in 21 women (70%), the increase ranging from 6 to 660% of baseline levels. The apparent frequency of fetomaternal haemorrhage was similar to that reported previously for surgical termination of first trimester pregnancies.. Fetomaternal hemorrhage-induced rises in circulating alphafetoprotein (AFP) levels can occur as a result of invasive procedures in the 1st half of pregnancy, including amniocentesis and induced abortion. In this study, 30 women under 9 weeks of gestation were given a single oral dose of 600 mg of RU-486 followed 48 hours later be insertion of a vaginal pessary containing 1 mg of gemeprost. All 30 women aborted within 2-4 hours of gemeprost administration. There was moderate bleeding for 24 hours after the abortion in 2 women. In the 4-hour period following RU-486 administration, subjects did not show any change over baseline values in AFP levels. However, 2 days later, before gemeprost administration, 21 women showed a significant increase (median of 87%, range 6-660%) in AFP. This finding suggests that fetal blood can enter the maternal circulation during pregnancy termination, and the RU-486 is not able to counteract this process. The 70% rate of elevation of AFP with RU-486 is in fact higher than that recorded for surgical termination of 1st-trimester abortion (58%). Surprising was the finding that these changes in circulating AFP occurred before the administration of prostaglandin.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Therapeutic; alpha-Fetoproteins; Alprostadil; Female; Fetomaternal Transfusion; Humans; Mifepristone; Pregnancy; Pregnancy Trimester, First