sulprostone and Uterine-Neoplasms

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

The diagnosis of molar pregnancy is now easy based upon a triple clinical, laboratory and ultrasonographic approach. Histology provides final confirmation. However treatment is more difficult since uterine evacuation may be very hemorrhagic or traumatic. A clinical case forms the basis here for a review of the main features concerning the diagnosis and treatment of hydatidiform mole.. Molar pregnancy, which results from an anomaly in the development of the trophoblastic tissue, is now easy to diagnose based on clinical evidence, beta hCG level, and sonography, although it must be histologically confirmed. Treatment remains difficult because of the danger of hemorrhage or trauma during uterine evacuation. Hydatidiform mole was diagnosed in the 1st pregnancy of a 27-year-old woman on the basis of a routine 1st trimester sonogram. Clinical examination revealed a voluminous uterus and a long, closed, very tonic cervix. Sulprostone was administered to aid cervical dilatation. An initial intramuscular injection of sulprostone caused uterine contractions without cervical modifications. 5 hours later an intravenous perfusion of sulprostone was started, during which significant contractions and cervical modifications were observed. An aspiration curettage was performed, in which numerous vesicles typical of the hydatidiform mole were evacuated. There was no need for further cervical dilatation and the curettage was rapid and nonhemorrhagic. The postoperative course was uneventful, and a test of beta hCG levels 6 weeks later was negative. The patient complained of pain during uterine contractions despite use of high doses of pethidine. The frequency of hydatidiform mole varies in different countries. It has been estimated at 1/85 in Indonesia and 1/2000 in the US. The clinical picture of hydatidiform mole includes vomiting often nonresponsive to treatment and metrorrhagia of varying volume, a large uterus for the gestational age, and often bilateral ovarian cysts. A vasculorenal syndrome may also begin at 13-16 weeks of amenorrhea. Beta hCG levels are high for the gestational age. Sonography reveals no embryonic structures. Biopsy shows a complete absence of embryo and amniotic sac. The karyotype is diploid and almost always XX. The mechanism is fertilization of an ovocyte whose nucleus is absent or inactive. The 2 chromosome sets are contributed by the father, a circumstance incompatible with embryonic development. Trophoblastic proliferation occurs without embryonic development. Hydatidiform moles may be transformed to invasive moles or chorioepithelioma. Treatment includes uterine evacuation by aspiration under sonographic control if possible. Many authors recommend oxytocin and antibiotic cover. The use of prostaglandin analogs to facilitate uterine evacuation is controversial, with some authors citing the increased

Topics: Abortifacient Agents, Nonsteroidal; Adult; Dilatation and Curettage; Dinoprostone; Female; Humans; Hydatidiform Mole; Pregnancy; Uterine Neoplasms

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