Induction of abortion by extra-amniotic administration of prostaglandin F2α; a preliminary report

INDUCTION

OF ABORTION

BY EXTRA-AMNIOTIC

OF PROSTAGLANDIN

V.

Hingorani,

A PRELIMINARY

F.R.C.O.G., K.

Department All

F2a;

F.A.C.S.,

Ganesh,

Institute

F.I.C.S.

and Gynaecology

of Medical

New Delhi

REPORT

M.D.

of Obstetrics

India

ADMINISTRATION

16,

Sciences

India

ABSTRACT

Experience amniotic weeks

mute pregnancy

incomplete the

induction

was 6.3

2 patients

pyrexial

reaction.

for publication

F2a administered

induction

Proper selection to the

The avemge

August

30,

1972 VOL. 6 NO. 5

mild

an even

of the nausea

time

patients.

or

interval

to

of prostaglandin

increasing

higher

8-22

complete

amount

of cases and

yield

majority

experienced

between

In 16 cases (80%),

30 hours.

probably

by the extm-

of abortions

19 hours and the avemge

should

was acceptable

as only

NOVEMBER

for

within

was

mg.

investigator

minimal

Accepted

catheter

occurred

of abortion

of the

The method

a Foley

in 20 cases is presented.

abortion

F2a required ence

with the use of prostaglandin

with

experi-

success rate. Side effects

and vomiting

and

were

1 had

1972

353

CONTRACEPTION

INTRODUCT Prostaglandin duction

are associated and

(PG)

of abortion

local

with

o high

erythema

at the

Intra-amniotic (4) and Embrey

%&

lo-14

for

intra-amniotic

weeks,

Wiquist

et 01.

puncture

the

fetal

stage

weeks

when

administrotion

of

of the

In this pregnancy a 30 750

Use

when

the

sac presents

of the

to be a very

diarrhea

itself

is risky

is be-

as a problem

route

wall

via

a Foley

as advocated

method

and particularly

by Bygdeman

pregnancy

extra-amniotic

practical

AND

experience

F2a

The

initial

2 hours

with

th e induction

for

The

30 hours,

in-

doses

such as vomiting,

and the uterine

operation

is presented.

pg every

within

the

for

so for

the

by

induction

pregnancies

and amniotomy

for

of

between

intro-amniotic

feasible.

study,

ml bulb.

for

efficient

has been advocated

However,

amniotic

membrone

voginal

successful

However,

effects,

PGF2,

(5).

METHOD

of prostaglandin

of side

of pregnancy,

is not

(l-3).

of puncture.

and Hillier

(6) appeared

abortion-?&y lo-15

incidence site

administration.

between

to be reasonably

infusion

administration

et al.

catheter

has proved

by intravenous

ION

MATERIAL

20 cases of extra-amniotic

administration

of abortions

weeks

administration

abortion

8-22

was done by o Foley

dose administered

until

between

wos 500 pg

occurred.

(250 pg/ml)

If abortion

did

of

catheter

with

and then

not take

place

no more drug was administered.

RESULTS Of voginally

Details

nally. Tables of

the 20 patients, occurred

I and

PGF2,

with

hysterotomy infusion,

with which

result

354

One

revealed

tubal

of these

of a previous

In the

ligation after fibrotic

At

also

remaining F2a

2 groups

to dilate

In the

had uterine

other

case,

2 cases,

the

In the

hysterotomy, ond stenosed

to

fibromyomota;

a hysterotomy cervix case,

obortion;

on attempt cervix

which

in

administration

failed

In 1 of these

remaining induce

completed

abdomi-

ore shown

after

administration. failed

was easily

wos terminated

in these

failed

patients

was done. PGF2,,

or one which

pregnancy

patients

was performed.

was performed. a rather

the

cervix

of prostaglandin

was given

abortion

of the the

was done.

30 hours

a hysterotomy cervix

treatment

24 hours.

ligation

after

a complete In the other 4,

In 2 patients,

a hysterectomy

tubal

dilate

of the II.

for

therefore,

in 16.

to

2,

an oxytocin therefore,

ot dilation wos possibly

of the the

cauterization.

NOVEMBER

1972

VOL. 6 NO. 5

DETAILS

PERIOD

ION SIDE

After

Temp. 30°C

24

25

9.500

9,500

5.000

5.750

12

22

20

11

9

13

14

was 3 cm

abortion abortion abortion

Incomplete Incomplete Incomplete

Nil Nil Nil

9 15

- Evacuated

- Evacuated

- Evacuated

after 30 min.

aborted

drip was completely

Syntocinon

and patient

dilated.

cervix

24 hr of prostaglandin

administration, administered

8

- Evacuated

IN COMPLETE

abortion

Incomplete

Vomiting

18

6.750

10

6

abortion

Complete

Nil

4.500

10

5

9

3,000

22

4

Nil

4.750

22

2

13

13

REMARKS

RESULTED

abortion

EFFECTS

ROUTE

Complete

(hours)

INTERVAL

OF ABORTION

INDUCT

BY EXTRA-AMNIOTIC

Nil

(mgm)

‘f;;;

PGF2a

abortion

(weeks)

OF

WHERE

ABORTION

OF CASES

OR INCOMPLETE

GESTATION

1.

Complete

NO.

CASE

TABLE

,

10

17

14

12

10

12

6

16

17

18

20

21

22

24

(weeks)

PERIOD OF GESTATION

Continued

14

I.

15

NO.

CASE

TABLE

6.250

5.000

6.500

3.000

9.500

11.000

11,000

5.750

(mgm)

DOSE

TOTAL

20

14

16

20

24

37

20

15

Nil

Nil

Vomiting

Nil

Nil

Nil

Nil

Nil

INTERVAL (hours)

SIDE EFFECTS

INDUCTION OF ABORT ION

Incomplete

Complete

Incomplete

Complete

Complete

with

abortion

abortion

abortion

abortion

abortion

- Evacuated

- Evacuated

drip.

after 30 hrs.

- Evaucated

- Evacuated

Syntocinon

abortion

Inevitable

abortion

abortion

Completed

Incomplete

Incomplete

REMARKS

.

II.

PERIOD

18 wk

10

20

14

7

23

fibroids)

size with

(Uterus

7

3

1

(weeks)

OF

11,000

11.000

8.750

8.750

(mgm)

USED

Nil

Nil

Nil

Nil

EFFECTS

SIDE

HOURS

ABDOMINAL

24-30

WHERE

AFTER DOSE

OF CASES

PERFORMED

DETAILS

WAS

CNA;;E GESTATION

TABLE

SURGERY

In view of

Patient

drip, stricture, cauterization.

had cervical due to previous

remained

ligation

remained

possibly

done.

cervix

follow-up

H ysterotomy

Syntocinon remained closed .

for 12 hrs with

of leak and tubal

tubal

cervix

with

In spite of further

30 hrs of PGF2a, closed.

After

performed.

Hysterotomy

30 hrs of PGF2a,

closed.

After

cervix

Hysterotomy

cervix remained

in the catheter.

performed.

PREGNANCY

was done.

was possibility

ligation

OF

administration,

There

closed.

24 hrs of PGF2,,

hysterectomy

fibroids,

After

remained closed.

24 hrs of PGF2,

cervix

After

REMARKS

OF PGF2a

FOR TERMINATION

ADMINISTRATION

CONTRACEPTION

DISCUSSION The results for

induction

vaginally within

of 20 cases of PGF2a

of abortion

in 80%

of the

30 hours. when

patients

In 4 cases,

had to be used. study

show that

Of

we

these

lacked

within

this

4,

administration

pregnancy 37

hours

therapy

by extra-amniotic

could

foiled

be successfully

and in 75%

of the

and an abdominal

3 had been enrolled

experience

and confidence

in the in the

route terminated

early

patients approach

part

success

of the

of prostaglandin

administration. In 2 early therapy

at this

fibromyomata, this

patient

trial The

probably

patient not

experienced

at the

this

also

which

uterine

not

with time

had an inhibitory

effect

However,

considered The

mild

nauseo

dine

that

In this axytocin

of the

side

in this

and vomiting

was given

for

for

surgical

infusion

and relief

although

cervix,

in this

earlier.

uterine factor series in

the

hove

1, these

of pain.

was used to complete

Incidentally,

conception

implant

been minimal

because

was initially control

was thought

implant

were

1 patient

had already

intervention,

at hysterotomy,

was,

to have

therefore,

is so small

thot

this

failure.

symptoms Only

prostaglandin

ond the

by the

for

this

patient

had been

catheter. for

Initiolly,

action

Perhaps other

as difficulty Foley

of

uterine

catheter

found

trial,

of the

dose disseminated

with

In the

in the

of medraxyprogesterone

on the

effects

fibrotic

introduction

9 months

the

study.

as o leak

included

to be a major

potient,

sufficiently

a stenosed

Termination

pregnancy

to be unpredictable.

in this

hours

hours.

in the

is known

at 24

had an implant inserted

is not

action

have been

had been

removed.

was ended at 24 justifiable

hove been enrolled

wos stopped

should

patient

the trial

was possibly

where should

failure,the -found.

cases,

time

as only

2 patients

attributed

to the

had a pyrexial

helped

of the

to dilate

supplementary

hod pethe-

reaction.

the

cervix

fever, an

the abortion.

REFERENCES 1.

Bygdeman, of the 473,

2.

Karim, F2a.

3.

M.

New

and Wiquist,

York

Academy

N.: of

Early

Science

abortions Meeting

in human.

Transaction

an Prostaglandin

180:

1971. S.M.M. Lancet

Roth-Brandel, Prostaglandin

and Filshie, 1:157, U., for

G.M.:

Therapeutic

abortion

using prastaglandin

1970.

Bygdeman, induction

M.,

Wiquist,

of therapeutic

N.

and Bergstrom,

abortion.

NOVEMBER

Lancet

1972

S.: 1:190,

1970.

VOL. 6 NO. 5

CONTRACEPTION

4.

Bygdeman, trimester Acta

5.

Physiol

Embrey,

N.,

tion”.

Francois,

Jan.

and Wiquist,

B., at

N.:

administration

Induction

of mid-

of prostaglandin

F&.

1971. K.:

of abortion

Paper presented

Stockholm,

NOVEMBER

82:415,

and Hillier,

“Induction

M.

by intra-amniotic

of prostaglandin.

Wiquist, M.:

Toppazada,

Stand.

M.P.

instillation 6.

M., abortion

Brit.

Therapeutic

abortion

Med.

1:558,

Bygdeman,

J. M.,

by extra-amniotic International

by intra-uterine 1971.

Fernstrom,

I.

prostaglandin

Symposium

and Toppazada, administra-

on Prostaglandin,

1972.

1972 VOL. 6 NO. 5

359