Hematological studies in induction of abortion by extra-amniotic administration of sulproston

The prostaglandin E2 derivative, Sulproston, was administered extra-amniotically for the induction of abortion in an average dosage of 200 microgram, in ten patients. With a success rate of 50%, the subjective side effects were very slight. Temperature, pulse rate, blood pressure and frequently of breathing did not change markedly. The ADP- and collagen-induced platelet aggregation showed a tendency to increase but disaggregation remained the same. Spontaneous platelet aggregation according to Breddin did not change. The parameters examined of the coagulation and fibrinolytic system showed only a slight increase in fibrinolytic activity during and after induction of abortion. The remaining hematological parameters showed no changes.

Coagulopathy with midtrimester induced abortion: association with hyperosmolar urea administration

Coagulation changes, usually subclinical, have been reported in association with the induction of midtrimester abortion by the administration of intra-amniotic hypertonic sodium chloride, hyperosmolar urea, hyperosmolar urea plus prostaglandin F2alpha, and hyperosmolar ura or hypertonic glucose plus prostaglandin E2. In addition, clinically significant coagulopathy has been described in association with the administration of hypertonic sodium chloride. This study details a three-year experience involving 3,034 cases of midtrimester elective abortion and describes six cases of coagulopathy in association with the administration of hypertonic sodium chloride and two cases in association with the administration of hyperosmolar urea. The significance of these findings and etiologic considerations are discussed.

Abortion deaths associated with the use of prostaglandin F2alpha

Six abortion-related deaths associated with the use of prostaglandin F2alpha were reported through the Center for Disease Control's surveillance of abortion deaths between 1972 and 1975. Prostaglandin may have had only indirect association with these deaths. The patients' ages ranged from 16 to 38 years, their length of gestation ranged from 15 to 24 menstrual weeks, four were white, and three were nulliparous. Four patients had pre-existing conditions that increased their risks and contributed to their death. The estimated death-to-case rate for prostaglandin F2alpha was 10.5 per 100,000 abortions. Although lower than the rate for intra-amniotic saline instillation, this death-to-case rate is only an approximation. The relative safety of intra-amniotic prostaglandin F2alpha as a second-trimester abortifacient, compared to saline, remains to be established.

Intrauterine (extraamniotic) prostaglandins in the management of unsuccessful pregnancy

Extraamniotic administration of prostaglandin E2 or prostaglandin F2alpha has been used in the treatment of 72 cases of unsuccessful pregnancy which included 50 of fetal death in utero, 13 of anencephaly and nine of hydatidiform mole. This management is highly effective in achieving abortion or delivery within 24 hours in almost all cases and results in few side effects. Pyrexia occurred during treatment in three patients, but in none was intrauterine infection observed. Blood loss greater than 250 ml occurred in only two patients, and none required transfusion. We advocate the use of extraamniotic prostaglandins as an active approach to the problem of unsuccessful pregnancy to relieve the patient of emotional distress and avoid the hazards of blood coagulopathy and intrauterine infection, both of which increase the longer a dead fetus is retained in utero.

The possible deleterious effects of the intramyometrial injection of hypertonic urea

Hypertonic urea has been shown to be an effective midtrimester abortifacient. Although safer than hypertonic saline when injected intravascularly, it has not been compared to saline in the case of inadvertent intramyometrial injection. This report documents that intramyometrial injection of hypertonic urea will result in the same type of muscle necrosis as that produced by saline.

Intra-amniotic urea and low-dose prostaglandin E2 for midtrimester termination

The efficacy and morbidity of injecting a standard dose of urea (80 g.) and a lower dose of prostaglandin E2 (P.G.E2) (2-5 MG) than that used previously have been assesed in 110 patients. All aborted--in a mean time of 10 hours 41 minutes. The average inpatient stay was 3-3 days. 5 patients (4-5%) had a cervical laceration.

Management of septic chemical abortion with renal failure. Use of a conservative regimen

The concept that hysterectomy is of value in the management of septic abortion induced by instillation of soap or phenolic antiseptics into the uterus is challenged. Nineteen out of 20 such cases with renal failure were managed with intensive antibiotic therapy, peritoneal dialysis and an absolute minimun of surgical intervention. Seventeen patients recovered, with normal renal function. Of the 11 known to be subsequently exposed to conception seven have achieved normal pregnancies.