Prostaglandin-oxytocin induction of mid-trimester abortion complicated by grand mal-like seizures

Abstract

Mid-trimester therapeutic abortion is performed routinely in several clinics by using a combination of intra-amniotic instillation of prostaglandin F2 alpha, followed by intravenous infusion of oxytocin in 5% glucose. In doses as low as 10 mU/min, oxytocin has an antidiuretic action. Two cases of grand mal-like seizure in connection with this procedure of therapeutic abortion are reported and the background discussed.

PIP: The cases of 2 women undergoing induced abortions in the 16th week of gestation who developed hyponatremia and grand mal-like seizures during administration of oxytocin are described. The women, aged 22 and 16, received 50 mg synthetic prostaglandin F2alpha (PGF2alpha), Amoglandin, intraamniotically, as well as intravenous infusions of 5% glucose with synthetic oxytocin, Syntocinon, 100 I.U./1000 ml. 25 and 26 hours later the 2 patients had typical grand mal-like seizures followed by postictal sleep. The patients had received total doses of 400 and 200 I.U. of oxytocin. The oxytocin infusions were stopped and .9% NaC1 solution was administered intravenously. Both patients were discharged fully recovered after 4 days. Synthetic oxytocin is known to have a dose-dependent antidiuretic effect during intravenous infusion, even in doses as low as 10 mU/minute. The routine use of oxytocin for midtrimester abortion was discontinued by the authors after the cases occurred.