[Methods of second trimester pregnancy termination and evacuation of in utero dead fetuses. Value of mifepristone]

Abstract

The authors present a review of the literature on the current methods of second trimester termination of pregnancy and labour induction for fetal death. Prostaglandins are efficient, but may cause side-effects (nausea, vomiting) and painful contractions. Natural PGs (PGF2 alpha and PGE2), induce fetal expulsion in about 80% of cases within 24 h. PG analogues (sulprostone and gemeprost), are, presently, more used, and lead to fetal expulsion in 90% of cases, with less side-effects. Mifepristone, an antiprogesterone steroid, increases uterine activity, sensitizes myometrium to PG action, and induces cervical priming. Several clinical trials point out the advantage of mifepristone use, 24 to 48 h before PG. So, the duration of termination, and the PG dosage are reduced by half. A clinical protocol for second trimester termination, with mifepristone, and PG analogues, is proposed. In case of fetal death, labour induction is now accepted. The expulsion of a dead fetus is easier than a live one. PG and analogues show a good efficacy: > 90% success within 24 h. Mifepristone, alone, leads to fetal expulsion in 2/3 of cases, within 72 h, without side-effects. A clinical protocol of induction with mifepristone and PG in case of fetal death is proposed. In these two difficult clinical cases, mifepristone is of great interest, in reducing duration of termination, and increasing comfort and security for the patients.