Midtrimester abortion utilizing intraamniotic prostaglandin F2alpha, laminaria and oxytocin

Abstract

The combined use of 40 mg of intraamniotic prostaglandin F2alpha, followed immediately by the insertion of one or more laminaria tents, and of a high-dose oxytocin infusion of 166 milliiunits per minute is a safe, effective, and efficient regime for midtrimester abortion. In 100 consecutive patients between 16 and 20 weeks of gestation, no failures occurred. The mean injection-abortion time was 15.7 hours. Six patients required the reinjection of 20 mg of prostaglandin F2alpha at 24 hours. The placenta was removed with instruments after four hours in 19 patients and done electively in seven patients in less than four hours. Physician-patient contacts were minimized, for all the abortion-initiating techniques were accomplished concomitantly, as opposed to regimes with laminaria pretreatment, or deliberately staggered prostaglandin injections were used. Most of the patients were able to be discharged after one day in the hospital. Thus, the patients' inconvenience and expense were minimized, with no sacrifice in safety.

PIP: To induce midtrimester abortion, 40 mg prostaglandin F2a (PGF2a) was instilled intraamniotically in 100 patients. Immediately thereafter from 1 to 6 laminaria tents were inserted into the cervix; 6 hours postinjection an iv infusion of oxytocin was begun at a rate of 100 ml/hour. All patients aborted successfully, 86% within 24 hours. 6 who did not abort by 24 hours were reinjected with 20 mg PGF2a. The mean injection-abortion interval was 15.7 hours. The placenta was removed surgically in 26% of the cases. Nausea and vomiting were frequent but were controlled by antiemetics, 11 patients developed fevers between 37.8-38.3 C, which were controlled by parenteral antibiotics. Heavy blood loss occurred in 2 patients. It is concluded that the combined regimen used in this series reduced the injection-abortion interval and frequent need for reinjection that occurs when PGF2a is used alone. The results compare favorably with those of saline-induced abortions and attendant morbidity.