Low-dose sulprostone for pregnancy termination in cases of fetal abnormality

Abstract

Thirty-two pregnancies (11 primi- and 21 multi-gravid) with an abnormal fetus were terminated between 16 and 35 weeks (mean 22 weeks; median 20 weeks) and a continuous intravenous infusion of 1 microgram of the prostaglandin analogue sulprostone. All pregnancies were terminated vaginally, 31 of them with this regimen in a median induction-expulsion interval of 23 h (range 8-52 h). Complete expulsion of the placenta occurred in 72 per cent of cases. Median blood loss was 100 ml (range 20-2000 ml). There were only a few side-effects. We conclude that this induction regimen is both appropriate and safe for pregnancy termination in cases of fetal anomaly.

PIP: In the Netherlands, physicians did a controlled trial at the University Hospital Leiden to determine whether administration of a prostaglandin analogue at low-doses could successfully terminate 2nd and 3rd trimester pregnancies of an abnormal fetus (16-35 weeks gestation). Fetal blood sampling, amniocentesis, or ultrasound revealed an abnormal fetus in 32 women. The most frequent fetal anomaly was a chromosomal abnormality. Some other anomalies were anencephaly and multiple malformations. 11 primigravidae and 21 multigravidae received iv infusion of 0.5 mg sulprostone/minute for 60 minutes then 1 mcg sulprostone/minute until the fetus was expelled. 31 women experienced vaginal termination with a median induction-expulsion interval of 23 hours. Endocervical administration of 0.5 mg PGE2 followed by infusion of up to 2 mcg sulprostone/minute caused vaginal delivery 74 hours after treatment in the other woman who was carrying a fetus with trisomy 18. 84% of the women delivered within 36 hours. Induction-expulsion intervals were not associated with gestational age. The physicians had to manually remove the placenta in just 28% of the cases. Median blood loss stood at 100 ml. 9% of the women lost more than 1000 ml of blood but no one needed a blood transfusion. 6 women did not take pain killers. Just 6 women experienced gastrointestinal side effects and they occurred just 1 once. These results showed that administration of sulprostone at low doses is safe and appropriate as a method to terminate pregnancies with fetal anomalies. The physicians considered it even preferable to other regimens they had used in the past.