gemeprost and Uterine-Rupture

Topics: Abortion, Induced; Adult; Alprostadil; Female; Humans; Pregnancy; Pregnancy Trimester, Second; Suppositories; Uterine Rupture

To compare uterine rupture rates in women having a medical abortion receiving gemeprost alone to those receiving mifepristone plus gemeprost.. We reviewed the records of women undergoing medical abortion at 13 0/7-23 6/7 weeks from January 2007 to December 2014 at a single center in Italy. Prior to January 2011, we used gemeprost 1 mg vaginally every 3 h up to a maximum of five doses. After January 2011, we added mifepristone 200 mg orally 24 h prior to the same gemeprost protocol. The primary outcome of the study was the incidence of uterine rupture. We compared the outcome between women receiving gemeprost alone with the combination of gemeprost and mifepristone.. One thousand and sixty-one (58.5%) and 753 (41.5%) women underwent medical abortion in the gemeprost-alone and the gemeprost/mifepristone groups, respectively. Five (0.47%) uterine ruptures occurred in the gemeprost and four uterine ruptures occurred in the gemeprost/mifepristone groups, respectively (0.53%) (p=.89). All uterine ruptures occurred in women with prior cesarean delivery.. We rep orted no difference in the incidence of uterine rupture between the gemeprost-alone and gemeprost and mifepristone groups.. Uterine rupture is a rare complication of second-trimester medical abortion with gemeprost. Use of mifepristone prior to gemeprost does not affect this risk.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adult; Alprostadil; Cesarean Section; Drug Therapy, Combination; Female; Humans; Incidence; Italy; Mifepristone; Pregnancy; Pregnancy Trimester, Second; Retrospective Studies; Uterine Rupture; Young Adult

Uterine rupture is a rare complication in second trimester termination of pregnancy (TOP) with an overall incidence of up to 1.1%. There are concerns that patients with previous caesarean section(s) were at an increased risk of uterine rupture. However, there is no published data in our local population to date. This study aims to identify the incidence and contributing factors for uterine rupture in women undergoing TOP in Singapore.. This is a retrospective review of all women who had TOP between 14. A total of 3385 patients underwent TOP from 2005 to 2014. An estimated 339 patients had a scarred uterus. Seven cases of uterine rupture were identified, with an overall incidence of 0.21% (7/3385). The incidence of uterine rupture in patients with scarred uterus was 2.1% (7/339). Contributing factors identified included higher mean dose of abortifacient, usage of multiple abortifacients and methods, advanced gestation age and short interval between last caesarean section and current TOP.. Second trimester TOP on scarred uterus warrants careful usage of abortifacient with minimal cumulative dosage and should be carried out in early second trimester gestation whenever feasible. Prostaglandin analogues appeared to be safe for TOP in unscarred uteruses.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adult; Alprostadil; Databases, Factual; Female; Humans; Incidence; Pregnancy; Pregnancy Trimester, Second; Retrospective Studies; Risk Factors; Tertiary Care Centers; Uterine Rupture; Young Adult

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

To investigate the effectiveness and complication rate of intravaginal gemeprost, a prostaglandin E(1) analogue, for second-trimester pregnancy termination in women with a scarred uterus.. Of 439 women undergoing induced abortion between the 13th and the 23rd week of pregnancy, 67 had a scarred uterus because of 1 or more cesarean sections or myomectomy. All women received a 1 mg dose of gemeprost intravaginally every 3 h, up to 5 times over 24 h. Those who did not respond received further cycles of gemeprost treatment.. The rate of successful abortions among women with uterine scars was not different from that observed in the nulliparous controls, but previously vaginal delivery was associated with a shorter induction to abortion interval. The rate of severe complications did not differ between the groups, and was about 1%.. The rate of complications following intravaginal administration of a PGE(1) analogue for second-trimester pregnancy termination was similar in women with a scarred or unscarred uterus.

Topics: Abortion, Induced; Administration, Intravaginal; Adult; Alprostadil; Cesarean Section; Cicatrix; Female; Fetal Diseases; Gestational Age; Humans; Pregnancy; Pregnancy Trimester, Second; Prostaglandins E, Synthetic; Retrospective Studies; Uterine Rupture

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Therapeutic; Alprostadil; Female; Humans; Mifepristone; Pregnancy; Pregnancy Trimester, Second; Uterine Rupture

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Therapeutic; Alprostadil; Female; Humans; Mifepristone; Pregnancy; Pregnancy Trimester, Second; Uterine Rupture

We present a case of interstitial pregnancy causing uterine cornual rupture during induction of prostaglandin midtrimester abortion. As the clinical and ultrasonographic diagnosis of advanced ectopic gestation may be difficult, the possibility of ectopic pregnancy should be considered in cases of unsuccessful attempts of induced abortion.. A 30-year old primigravida with a history of drug addiction came to the Rigshospitalet in Copenhagen, Denmark for prenatal care at 15 weeks gestation. Physicians did an amniocentesis because of family history of trisomy 21. Ultrasound examinations in the 17th and 18th weeks of gestation indicated a living fetus with the placenta on the right lateral wall of the uterus, but there was an insufficient amount of amniotic fluid. Maternal alpha fetoprotein serum levels were extremely high (298 kIU/L). Physicians predicted a poor fetal prognosis and advised the woman to undergo an abortion. On the first day, they inserted 4 vaginal pessaries of 1 mg gemeprost and administered 25-30 mg bupivacain through an epidural catheter to control abdominal pain. 8 hours after first insertion, they began intravenous (IV) administration of oxytocin. Her cervix remain closed and uterine tension did not increase. 2 hours after beginning the oxytocin IV, she suffered from an abrupt severe abdominal pain which was transferred to the right shoulder. Heart rate and blood pressure remained normal. 4 hours later, her body temperature rose, so she received 500 m pivampicillin 3 times/day. She experienced no vaginal bleeding and no uterine contractions. Her cervix had still no opened. On the third day, health workers inserted 5 more pessaries. On the fourth day, they administered 75 ml isotonic saline/hour transcervically, but she still did not abort. Her temperature vacillated even though she received antibiotics and the pain continued despite epidural analgesics. On day 5, health workers administered 3.75 mcg prostaglandin F2 alpha/minute transcervically. After 6 hours of no progress, they performed a laparotomy and observed a macerated, malodorous fetus in the peritoneal cavity which continued 1200 ml of blood. The medial part of the left fallopian tube an the left uterine corner had ruptured. They removed the fetus via wedge resection; it had no malformations. Physicians should consider ectopic pregnancy when attempts at induced abortion do not succeed.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adult; Alprostadil; Female; Humans; Oxytocin; Pregnancy; Pregnancy, Tubal; Prostaglandins E, Synthetic; Ultrasonography, Prenatal; Uterine Rupture

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adolescent; Alprostadil; Female; Humans; Intrauterine Devices, Medicated; Pregnancy; Uterine Rupture

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adult; Alprostadil; Female; Humans; Pregnancy; Uterine Rupture

Topics: Abortion, Induced; Alprostadil; Female; Humans; Pregnancy; Pregnancy Trimester, Second; Prostaglandins E, Synthetic; Uterine Rupture

The 1st reported case of uterine rupture in pregnancy termination associated with the administration of gemeprost and oxytocin involved a 24-year-old UK women with 3 previous uncomplicated pregnancies. Pregnancy termination, performed at 16 weeks of gestation, involved the insertion of 1 mg gemeprost vaginal pessaries into the posterior fornix at 3-hour intervals. A total dose of 5 mg of gemeprost was administered in the 1st 24 hours. Another treatment course was instituted the following day, and the patient's cervix remained closed despite the onset of contractions and slight vaginal bleeding. During the 2nd course of 5 pessaries, the patient also received 4 15 mg doses of intramuscular papaveretum. On the 3rd day, a intrauterine pregnancy was visible on ultrasound scan, but no fetal heartbeat was detected. A total dose of 50 IU of oxytocin was then administered over a 22-hour period. The diagnosis of uterine rupture was made on day 4 when vaginal examination revealed a large bulging lower uterine segment anteriorly and a closed cervix posteriorly. The patient's hemoglobin concentration had fallen from an admission value of 11.4 g/dl to 6.5 g/dl. Laparotomy revealed a large left broad ligament hematoma extending anteriorly into which the fetus had been extruded. Total abdominal hysterectomy was required. The uterine rupture is assumed to have occurred during the 2nd course of gemeprost. The absence of previously reported cases of gemeprost-associated uterine rupture may reflect the rarity of this method of pregnancy termination in the 2nd trimester.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Therapeutic; Adult; Alprostadil; Drug Therapy, Combination; Female; Humans; Oxytocin; Pregnancy; Pregnancy Trimester, Second; Uterine Rupture

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