Abstract

PIP: This letter comments on a previously published article (August 17, p. 428) relating to the use of prostaglandins for midtrimester abortion. It is estimated that prostaglandin PGF-2-alpha given by the i ntrauterine route has been used in over 5000 patients; 13 cases of cervi cal rupture have been reported. Most ruptrues have occurred in primigravidae. All but 1 of them (who received PGE-2) were given PGF-2-alpha intraamniotically. Periods of gestation have been 15-22 weeks. Large doses of prostaglandins have been used and often supplemented by other oxytocics such as urea or oxytocin. No reported cervical ruptures have followed use of PGE-2 alone, possibly because of its relaxant effect on the cervix. Previous gradual dilatation of the cervix with laminaria tents or with some synthetic prostaglandin analogue is being studied. In first trimester pregnancies prostaglandin analogues given as a single extraamniotic dose 12 or more hours prior to termination has been shown to effect gradual dilatation of the cervix. Of 88 such cases, only 3 required mechanical dilatation of the cervix. It is felt that prostaglandins offer an attractive alternative to hysterotomy or hypertonic saline for terminating second trimester pregnancies when overstimulation of the uterus by large doses is avoided.