sulprostone and Abortion--Missed

A new prostaglandin E2 (PGE2) derivative, the 16 phenoxy-omega-tetranor PGE2 methylsulphonylamide of Sulprostone, was administered to 56 patients to induce preoperative cervix dilatation (1st trimester) and termination of pregnancy for missed abortion (1st and 2nd trimester), or fetal death (3rd trimester). Different dose schedules have been administered intramuscularly. Hourly side effects were recorded. Among 46 patients, Sulprostone induced cervical dilatation (8 mm or more) in 36 subjects. In the others, the cervix dilated at least 6 mm. With regard to the termination of pregnancy, uterine contractions and discharge occurred within a short time. The incidence of side effects was minimal. Our study seems to indicate the usefulness, efficacy, and acceptability of Sulprostone in the management of different obstetric conditions. (author's modified)

Topics: Abortifacient Agents; Abortion, Induced; Abortion, Missed; Adolescent; Adult; Dinoprostone; Female; Humans; Labor, Induced; Pregnancy; Prostaglandins E, Synthetic

To evaluate the efficacy, safety and influence on subsequent fertility of sulprostone, a prostaglandin E2 analog, in terminating pathological pregnancies via the extraamniotic route.. Forty pregnant women with intrauterine fetal death or major congenital anomalies were enrolled. Sulprostone was instilled into the extraamniotic space through a silicon Foley catheter. The instillation rate was 0.5-1 microgram/min. Instillation was discontinued when the catheter was expelled or when rupture of the membranes occurred. The duration of instillation and the time interval to completion of abortion was recorded. Information about subsequent fertility was collected by telephone or at outpatient clinic visits.. The mean duration of instillation was 7.0 h and the mean dose of sulprostone was 314.8 micrograms. The mean induction-to-abortion interval (IAI) was 17.0 h. In two of the 40 patients, the cervix was not adequately ripened after 48 h and these pregnancies were ultimately terminated by alternative methods. The success rate of termination in 48 h was 92.5% (37/40). No severe side effects were encountered.. To the best of our knowledge, this is the first report in the English literature of administration of sulprostone by extraamniotic instillation for termination of pathological pregnancies. The method is effective and safe and has an insignificant influence on subsequent fertility.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Abortion, Therapeutic; Adult; Amnion; Dinoprostone; Female; Fertility; Fetal Death; Fetus; Humans; Instillation, Drug; Pregnancy; Prospective Studies; Time Factors

Prostaglandins (PG) are currently the drugs of choice to terminate pathological 2nd trimester pregnancies. 6 different dose schedules of were are tested in 100 women with missed abortion, hydatidiform mole, and fetal malformations: extraamniotic PGF2 alpha, intravenous PGE2, intravenous sulprostone (2 schedules), and intramuscular sulprostone (2 schedules). All tested regimens were effective. Induction-to-abortion times and incidence of side effects were different. Extraamniotic PGF2 alpha and intramuscular sulprostone appear to be the most practicable regimens.

Topics: Abortion, Missed; Congenital Abnormalities; Dinoprost; Dinoprostone; Female; Humans; Hydatidiform Mole; Infant, Newborn; Injections, Intramuscular; Injections, Intravenous; Labor, Induced; Pregnancy; Pregnancy Trimester, Second; Prostaglandins; Prostaglandins E; Prostaglandins E, Synthetic; Prostaglandins F

Sulprostone was used for preoperative cervical priming in the first and second trimester in 154 patients with missed abortion, hydatidiform mole, and termination for medical indications. In 61 patients 50 mcg sulprostone was administered into the cervix ("intramural"); in 93 patients sulprostone was administered preoperatively by the intragluteal route (4 injections of 250 micrograms at 4 hour intervals). After intramural injection an abortion score of at least 20 according to Csapo (preoperative) was obtained in 78% of patients, after intragluteal administration in 98%. The intragluteal route of administration of the prostaglandin derivative sulprostone for cervical priming in the first and second trimester is much simpler than the intramural route. The injections into the cervix are painful, the desired effect is not as great, and the incidence of side effects is higher. Cervical priming in the first trimester is also recommended because it avoids the severe complications that can occur during curettage.. Sulprostone was used for preoperative cervical priming in the 1st and 2nd trimesters of pregnancy in 154 patients with missed abortion, hydatidiform mole, and termination for medical reasons. In 61 patients, 50 mcg sulprostone was administered into the cervix (intramural); in 93 patients sulprostone was administered preoperatively by the intragluteal route (4 injections of 250 mcg at 4 hour intervals). After intramural injection, an abortion score of a least 20 according to Csapo (preoperative) was obtained in 78% of the patients, after intragluteal administration in 98%. The intragluteal route of administration of the PG derivative sulprostone for cervical priming in the 1st and 2nd trimester is much simpler than the intramural route. The injections into the cervix are painful, the desired effect is not as great, and the incidence of side effects is higher. Cervical priming in the 1st trimester is also recommended because it avoids the severe complications that can occur during curettage. (author's)

Topics: Abortion, Missed; Administration, Topical; Buttocks; Cervix Uteri; Dilatation and Curettage; Dinoprostone; Female; Fetal Death; Humans; Hydatidiform Mole; Injections, Intramuscular; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Prostaglandins E, Synthetic

Sulprostone was administered to 144 pregnant women to induce either preoperative cervical dilation or uterine evacuation. A comparison was performed to select the drug treatment schedule showing the greatest effects with the lowest incidence of side effects. As for preoperative cervical dilation, the local (intracervical/intramural) injection of 50 + 50 micrograms and the intramuscular treatment with 500 micrograms of sulprostone showed the most favorable effects on the cervix after 12 and 6 hours, respectively. The cervix dilated 8 mm or more in 82.6% of subjects treated locally and in 85.7% of those treated intramuscularly. No patient experienced a serious side effect, but two displayed vomiting after receiving 500 micrograms of the drug. Uterine evacuation was induced by both repeated intramuscular injections (500 micrograms every 4 hours) and continuous intravenous infusion (2.8 micrograms/minute for 6 hours) of sulprostone in more than 90% of the patients with intact pregnancy, missed abortion, or fetal death. The efficacy of the drug was not influenced by gestational age or parity. Gastrointestinal symptoms were the only recorded side effects, with negligible incidence and intensity for both routes of sulprostone administration.

Topics: Abortifacient Agents; Abortifacient Agents, Nonsteroidal; Abortion, Incomplete; Abortion, Induced; Abortion, Missed; Adolescent; Adult; Cervix Uteri; Dilatation and Curettage; Dinoprostone; Drug Administration Schedule; Female; Humans; Infusions, Intravenous; Injections; Injections, Intramuscular; Pregnancy; Uterine Contraction; Uterus

Labor was induced via intravenous infusion of 16-phenoxy-prostaglandin-E2-methylsulphonylamide in 13 cases of missed abortion and 19 cases of intrauterine fetal death. In all cases Bishop score was less than 4. Delivery occurred within 24 hours in all cases, with a minimal frequency of side effects (six cases of erythema above the incannulated vein and 1 case of diarrhea). The interval between the beginning of the infusion and delivery was 9.42 minutes. Uterine curettage was performed in 9 cases.

Topics: Abortion, Missed; Adult; Dinoprostone; Female; Fetal Death; Humans; Labor, Induced; Pregnancy; Prostaglandins E, Synthetic

The prostaglandins used so far in early pregnancy exercise distressingly strong side effects (Table 5). These side effects are closely correlated with the effectiveness of the prostaglandins. 16-phenoxy-prostaglandin-E2 (SHB 286) was employed in 476 women for inducing abortion in intact and disturbed pregnancy and for priming before performing a planned abruptio. During the priming of 64 women before inducing abortion, this was induced in 59% of the women already by a single intramuscular application of 500 micrograms SHB 286-depending on parity, whereas in the remaining cases it was possible to avoid dilatation of the cervix or to substantially facilitate dilatation technique. For inducing abortion during the second trimenon, SHB 286 was applied extra-amnially in 15 cases, intra-amnially in 24, intravenously in 56 and intramuscularly in 99 cases. The dosage was lowest on extra-amnial administration (50 micrograms on the average), and highest on intramuscular application with a mean of 1760 micrograms. The time until induced abortion set in was between 16 hours (intra-amnial application) and 12 hours (intravenous application). The rate of abortions was more than 90% on intra-amnial, intravenous and intramuscular application, and 80% on extra-amnial application. In case of missed abortion and hydatid mole, SHB 286 was applied systemically only. In missed abortion the mean dosage up to expulsion was 1700 micrograms on intravenous administration, whereas it was 1126 micrograms only if given intramuscularly. The dosage for inducing abortion was 8 hours by the IV route and 10 hours by the IM route.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Abortifacient Agents; Abortifacient Agents, Nonsteroidal; Abortion, Induced; Abortion, Missed; Dinoprostone; Female; Humans; Hydatidiform Mole; Pregnancy; Pregnancy Complications; Prostaglandins E, Synthetic

Sulprostone (SHB 286, Schering) was used for the induction of abortion mainly in patients with missed abortion, but also in cases of intrauterine death and hydatid mole (total number: 226). In the first trimester a single injection of 25 or 50 mcg into the cervix ("intramural" injection) in order to obtain preoperative dilatation of the cervix was favoured. In the second and third trimester Sulprostone was administered by the intravenous (mean dosage 925 mcg), the intragluteal (mean dosage 540 mcg) or the extra-amniotic (mean dosage 660 mcg) route. After "intramural" administration an abortion score of at least 20 according to Csapo was obtained in 78% of patients. With the intravenous route the abortion rate was 86%, with the extra-amniotic 74% and with the intragluteal route 70%. The main use of "intramural" application is seen in the first 12 weeks of pregnancy in order to ensure non-traumatic dilatation of the cervix. In the second and third trimester intravenous and intragluteal administration seem to be superior to the extra-amniotic route because of their better tolerance.. Sulprostone (SHB 286, Schering) was used in patients with missed abortion as well as in cases of intrauterine death and hydatid mole (total number=226). In the 1st trimester, a single injection of 25 or 50 mcg was administered into the cervix in order to accomplish preoperative dilatation of the cervix (intramural injection). In the 2nd and 3rd trimesters, Sulprostone was administered either by intravenous (mean dosage, 925 mcg), intragluteal (mean dosage, 540 mcg), or the extraamniotic (mean dosage 660 mcg) routes. After intramural administration, an abortion score of at least 20 according to Csapo was obtained in 78% of the patients. With an intravenous route, the abortion rate was 86%, with an extraamniotic route 74%, and with the intragluteal route 70%. The main use of intramural applications is seen the first 12 weeks of pregnancy in order to ensure nontraumatic dilatation of the cervix. In the 2nd and 3rd trimesters, intravenous and intragluteal administration seem to be superior to the extraamniotic route due to the increased tolerance. (author's)

Topics: Abortion, Eugenic; Abortion, Induced; Abortion, Missed; Adult; Cervix Uteri; Dinoprostone; Female; Gestational Age; Humans; Hydatidiform Mole; Pregnancy; Prostaglandins E, Synthetic; Uterine Contraction; Uterine Neoplasms

Induction of uterine contractions was carried out with an intravenous infusion of sulprostone, a 16-phenoxy derivate of methylsulphonylamid prostaglandin E2 in 21 patients after intrauterine foetal death and in seven patients having hydatidiform mole. The mean total dose of sulprotone was estimated as 1100-1300 microgram in different groups. The mean induction-delivery time was 7-13 hours. Expellation of the foetus occurred in 20 out of 21 cases during 24 hours after commencement of sulprostone infusion. In all patients having molar pregnancy uterine contractions induced with sulprostone opened the uterine cervix for evacuation. The drug was clinically well tolerated without any serious side-effects.

Topics: Abortion, Induced; Abortion, Missed; Adult; Dinoprostone; Female; Fetal Death; Humans; Hydatidiform Mole; Pregnancy; Prostaglandins E, Synthetic; Uterine Neoplasms