sulprostone and Abortion--Spontaneous

Sulprostone, used in a continuous low-dose intravenously, is effective for pregnancy termination. Caution is necessary when using this drug in severely preeclamptic patients.. To evaluate the safety and efficacy of induction of labor with a prostaglandin analogue in women with severe (pre-) eclampsia.. A retrospective analysis of a 12-year cohort in which labor was induced in women with severe (pre-) eclampsia with sulprostone (a prostaglandin E2 analogue) in a continuous intravenous low-dose intravenous dose of 1 microg/min.. In 30 severely preeclamptic and one eclamptic women, labor was induced on maternal indication with sulprostone. The median gestational age at induction was 28 weeks (range 16-37 weeks). The fetuses were either dead (n=19) or considered not viable (n=12). All women delivered vaginally after a median induction-expulsion interval of 14 hr (range 6-57 hr). In all but one woman, a delivery was achieved within 37 hr. Two of the nine women who suffered dyspnea at the time induction was started, experienced deterioration during infusion of sulprostone. In one of these women, infusion had to be discontinued after 2 hr and the pregnancy was terminated by dilatation and evacuation. One woman gave birth after 57 hr of sulprostone infusion. We did not observe any cardiovascular complications. All but one woman recovered after pregnancy termination: a severely eclamptic woman died 10 days after delivery, after developing adult respiratory distress syndrome, sepsis and multiple organ failure.. Sulprostone, in a continuous low-dose intravenously, is effective for termination of pregnancy in the critically ill preeclamptic woman. Our study, including two patients with serious deterioration of pulmonary function during and one maternal death after induction, does not permit definitive conclusions regarding the safety in these patients.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Spontaneous; Adult; Dinoprostone; Female; Humans; Pre-Eclampsia; Pregnancy

Prostaglandins E2 and F2 alpha were measured in decidual tissue of women after spontaneous abortions at pregnancy terms 8 to 10 weeks and after abortions induced by sulprostone, a synthetic prostaglandin E2 analog, at pregnancy term 4-5 weeks. Women in whom pregnancy was terminated surgically at relevant periods were controls. Prostaglandin E2 concentration was found to be 5 times higher and that of prostaglandin F2 alpha 40 times higher in women with spontaneous abortions than in surgical abortion. In sulprostone-induced abortion prostaglandin concentrations in decidual tissue were the same as in controls. These data indicate that a drastic increase of prostaglandin levels in spontaneous abortion is not only a result of myometrial contractions or decidual tissue rejection, but an important component in the chain of events leading to miscarriage.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Abortion, Spontaneous; Decidua; Dinoprostone; Female; Humans; Pregnancy; Prostaglandins

Topics: Abortifacient Agents; Abortifacient Agents, Nonsteroidal; Abortion, Spontaneous; Dinoprostone; Female; Humans; Mifepristone; Misoprostol; Pregnancy

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Incomplete; Abortion, Spontaneous; Adolescent; Adult; Dinoprostone; Female; Follow-Up Studies; Humans; Misoprostol; Pregnancy