sulprostone and Uterine-Rupture

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

The purpose of this study is to assess the effectiveness and safety of sulprostone (nalador) for labour induction in the event of foetal death or foetal malformations.. Retrospective analysis of 284 women with intrauterine foetal death (n=137), or foetal abnormalities (n=147), who underwent labour induction with sulprostone in a continuous dose of 1microg/min intravenously.. All but three women had a successful vaginal delivery. The median induction-expulsion interval was significantly shorter (12h) in the foetal death group compared to the foetal malformation group (25h). Two uterine ruptures were recorded, one in a woman with a uterine anomaly, and one in a woman with a previous caesarean section. There were no other complications. Gestational age had a significant influence on spontaneous expulsion of the placenta: before 24 weeks 55%, and after 24 weeks 82% spontaneous expulsion. For the chance of a neonate born with signs of life, parity was the only significant determinant.. The use of intravenous sulprostone in a low continuous dose is both effective and safe. In addition, this study does not support former opinions that smoking and advanced maternal age are contraindications.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Congenital Abnormalities; Dinoprostone; Female; Gestational Age; Humans; Labor, Induced; Linear Models; Parity; Postpartum Hemorrhage; Pregnancy; Retrospective Studies; Time Factors; Uterine Rupture; Uterus

The authors report one case of uterine rupture in a non scarred uterus when an analogue of prostaglandin E2 was being transfused. It was Sulprostone used to terminate a pregnancy because of fetal death in utero after 27 weeks of amenorrhea. This case history and an analysis of the literature makes it possible to point out the need to reach the diagnosis before signs become too severe and to show that pharmacological knowledge of the drug has to be improved as well as the ways of administering prostaglandin analogue. This is to be conducted together with improving the ways of terminating pregnancies in the second trimester. It shows that mechanical accidents can occur even where there are no obvious risk factors. In this case, pain continued from the time of the rupture under epidural anaesthesia. The physiopathology is reviewed. Finally, conservative treatment of the uterus should be carried out whenever possible in order to allow a new pregnancy to occur and to lessen the morbidity of the operation.. The authors report a case of uterine rupture in a nonscarred uterus when an analogue of prostaglandin E2 (PGE2) was being transfused. The drug sulprostone was used to terminate a pregnancy due to fetal death in utero after 27 weeks of amenorrhea. This case history and an analysis of the literature makes it possible to point out the need to reach a diagnosis before the symptoms become too severe. It is also to show that pharmacological knowledge about the drug must be improved as well as the ways to administer the PG analogue. This should be done simultaneous to improving ways to terminate pregnancies during the 2nd trimester. It demonstrates that mechanical accidents can occur even where there are no obvious risk factors. In this case, pain continued from the time of the rupture under epidural anesthesia. In this article, physiopathology is reviewed. Finally, conservative treatment of the uterus should be conducted whenever possible in order to allow a new pregnancy to occur and reduce the likelihood of morbidity following the procedure. (author's modified)

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Therapeutic; Dinoprostone; Female; Fetal Death; Humans; Pregnancy; Pregnancy Trimester, Second; Ultrasonography; Uterine Rupture