sulprostone and Cicatrix

A 30-year old pregnant woman who had had an earlier stillbirth and 2 children, the oldest of whom was delivered by Cesarean section, presented at the National University Hospital in Singapore at 32 weeks because she had not felt fetal movements for 3 days. Doptone did not detect a fetal heart beat and ultrasound confirmed intrauterine death. She did not have any soreness at the previous lower segment Cesarean scar. After she opted to have labor induced, health workers injected 0.5 mg of the prostaglandin E2 analogue, sulprostone, into a muscle every 6 hours. Painful uterine contractions did not start until after the 2nd injection of sulprostone. 20 hours after the 1st injection, her pulse increased to 100/minute, blood pressure fell from 120/70 to 80/50, and she began to perspire. She noted tenderness at the lower segment scar. Abdominal examination did not reveal any free fluid. There was no blood in the urine. 20 minutes after her blood pressure increased to 100/70, the woman had steady abdominal pain and vaginal bleeding. Her abdomen swelled and rebound tenderness occurred. Physicians diagnosed uterine rupture and performed a laparotomy promptly. They found 800 ml of free blood in the peritoneal cavity and a complete rupture all along the Cesarean scar. The removed the dead fetus and repaired the scar. They also applied Filshie clips on her Fallopian tubes since she wanted to be sterilized. She was discharged 7 days after laparotomy and recovered uneventfully. This case report confirms that vaginal delivery at term after lower segment Cesarean section is no guarantee against scar rupture in subsequent pregnancies, particularly when health workers use prostaglandins. Nevertheless, prostaglandins are still a reasonably safe and predictable method of terminating pregnancy even in cases of previous Cesarean section. It is important that health workers supervise closely women who have had a Cesarean section and are being administered a prostaglandin to terminate a pregnancy because of the possibility of uterine rupture.

Topics: Abortifacient Agents; Adult; Cesarean Section; Cicatrix; Dinoprostone; Female; Fetal Death; Humans; Labor, Induced; Pregnancy; Uterine Rupture

We have studied the use of sulprostone in evacuating uterine contents in 32 patients, the majority of whom were in the second trimester of their pregnancies. There are three ways to administer the drug (continuous intravenous, intermittent intravenous, and intramuscular); the best results were obtained when the drug was administered continuously intravenously. It was well tolerated, the use of Nalbuphine reducing pain. There were few side effects. The use of this product is discussed in connection with a few of the cases as well as the possible alternative treatments in difficult cases.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adolescent; Adult; Cicatrix; Contraindications; Dinoprostone; Drug Tolerance; Female; France; Gestational Age; Humans; Hydatidiform Mole; Infusions, Intravenous; Injections, Intramuscular; Injections, Intravenous; Mifepristone; Misoprostol; Polyhydramnios; Pregnancy; Retrospective Studies; Time Factors; Uterine Diseases; Uterine Neoplasms

A preliminary study in 22 patients with uterine scarring was undertaken using sulprostone by intravenous infusion when therapeutic abortion was deemed necessary during the 2nd and 3rd trimesters of pregnancy. The dosage used was 500 micrograms by slow infusion lasting 10 h. There were no cases of ruptured uterus. Adverse reactions were absent. Results were satisfactory. Mean induction-expulsion duration: 11 h. Expulsion rate in 24 h: 63%. With strict monitoring and in a specialized center, this technique may be suggested when a late therapeutic abortion with a scarred uterus is indicated.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Therapeutic; Adult; Cicatrix; Dinoprostone; Female; Humans; Injections, Intravenous; Pregnancy; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Treatment Outcome; Uterine Diseases