oxytocin and Uterine-Perforation

This article outlines the current modalities of pregnancy termination, as well as their risks and complications, in 3 phases of pregnancy: 1) up to 49 days past the last menstrual period, 2) 8-15 weeks, and 3) 16-24 weeks. Before 8 weeks of pregnancy, suction dilatation and curettage (D and C) is the preferred method. However, a medical approach, possibly self-administered, is viewed as more satisfactory and requires only an improvement in side effects. From 8-15 weeks' gestation, suction D and C and dilatation and evacuation (D and E) are the methods of choice. The use of laminaria tents improves both the facility and safety of these procedures in nulliparous patients and perhaps in multiparous patients. Priming of the cervix with prostaglandin could further decrease the difficulty and risks of these procedures. The use of a hydrogel compound is especially worthy of consideration. There is controversy about the preferred method between 16-20 weeks' gestation. D and E appears to have fewer complications and to be more cost-effective than hypertonic saline injection. Urea-prostaglandin has fewer and less severe complications than saline injection, and seems to be more cost-effective than saline injection in terms of duration of hospitalization. The high frequency of failure and side effects, combined with the possibility of expulsion of a live fetus, make prostaglandin-only injection less desirable. After 20 weeks' gestation, urea-prostaglandin injection is probably the safer method. Given the rapid increase in complications with passing weeks, any delay in providing late abortion services should be avoided. 2nd trimester pregnancy terminations, especially those after 18 weeks' gestation, are associated with increased mortality and morbidity and should be performed at specialized centers where providers are better equipped to manage complications.

Topics: 16,16-Dimethylprostaglandin E2; Abortifacient Agents; Abortion, Induced; Alprostadil; Amnion; Anesthesia; Animals; Arbaprostil; Bacterial Infections; Carboprost; Cervix Uteri; Dilatation and Curettage; Dinoprost; Dinoprostone; Female; Humans; Hypertonic Solutions; Oxytocin; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Progestins; Prostaglandins E; Prostaglandins E, Synthetic; Prostaglandins F; Pulmonary Embolism; Risk; Saline Solution, Hypertonic; Time Factors; Urea; Uterine Hemorrhage; Uterine Perforation

2 groups of patients are at risk of traumatic complication after midtrimester abortion: older multiparous women (uterine ruptures) and young primigravid women (cervical ruptures). While the occurrence of uterine ruptures in the former class can be reduced by selective use of abortifacient agents, and avoidance of amnioinfusions and intravenous oxytocin, the occurrence of cervical ruptures continues to be high. From May 1974 through May 1978, 780 women underwent midtrimester abortion by various techniques. 12 patients (1.5%) sustained cervical injuries, 11 of whom were nulliparous aged 16 to 25 years. Intra-amniotic and extra-ovular methods alike produced cervical injuries. The combined method of induction increases the likelihood of damaging the cervix. Oxytocic augmentation, however, does not appear to increase its incidence. Nor does a shorter induction-abortion interval, according to the evidence. Since laminaria tents did not prevent cervical injuries, none of the presently available methods offers any protection. Nevertheless, it may be that cervical injuries can be prevented if midtrimester abortions are undertaken between 13 and 15 weeks of pregnancy. Cervical ruptures can also go unnoticed and cause future obstetric problems; the authors therefore emphasize the importance of routine cervical inspection in all patients.

Topics: Abortifacient Agents; Abortion Applicants; Abortion, Induced; Age Factors; Asia; Asia, Southeastern; Birth Rate; Cervix Uteri; Demography; Developing Countries; Disease; Family Planning Services; Fertility; India; Organic Chemicals; Oxytocin; Parity; Population; Population Characteristics; Population Dynamics; Pregnancy; Pregnancy Trimester, Second; Prostaglandins; Reproduction; Research; Saline Solution, Hypertonic; Uterine Perforation

Topics: Adult; Cesarean Section; Cicatrix; Female; Humans; Oxytocin; Pregnancy; Surgical Wound Dehiscence; Uterine Perforation; Uterine Rupture