A prostaglandin analogue (ONO-802) in treatment of missed abortion, intrauterine fetal death and hydatiform mole: a dose-finding trial.

Forty-eight patients affected with missed abortion, intrauterine fetal death and hydatiform mole were treated with vaginal suppositories containing 1 mg of 16,16-dimethyl-trans-delta 2-PGE1 methyl ester (ONO-802). The patients were divided into two treatment groups. The first, Group A, was given one vaginal suppository every 3 h to a maximum of five suppositories. The product of conception was expelled in 95.8% of patients. In Group B the maximum number of suppositories was reduced to three. The product of conception was expelled in 100% of cases and the average duration of treatment was similar to that for the first group. Although side-effects were mild in both groups, they were reduced in the patients of Group B.

The use of sulprostone, a prostaglandin E2 derivative, in intrauterine fetal death and therapeutic abortion.

The prostaglandin E2 derivative Sulprostone was used in the management of intrauterine fetal death and in therapeutic abortion in advanced pregnancy. While with extraamniotic administration there was a success rate of 50% after 24 hours, the rate of success was 86% after intramuscular administration. A cervix-ripening effect was not always observed by means of intracervical injection of Sulprostone. Such pre-treatment of the cervix did not improve the induction-abortion time after intramuscular administration of Sulprostone. Side effects were only slight following Sulprostone.

PIP: Sulprostone, a prostaglandin E2 derivative, was administered extraamniotically, intracervically, and intrmusculary in a group of 29 pregnant patients (16 to 44 years of age; 13th week to 32nd week of pregnancy) who were being treated either for therapeutic abortion or intrauterine fetal death. The success rate depended mainly on route of administration. Estraamniotic administration had a success rate of 50% after 24 hours compared with the success rate of 89% for intramuscular administration. Intracervical injection did not always result in a cervical ripening effect, although fetal expulsion occurred within 12 hours in 2 cases possibly due to a systemic action of sulprostone. Pretreatment of the cervix did not appear to affect the result substantially. Side effects were greatly reduced compared to those resulting from natural prostaglandins. This study shows that systemic administration of sulprostone is well accepted by patients and doctors alike.

Induction of labour with sulprostone after foetal death and in hydatidiform mole.

Induction of uterine contractions was carried out with an intravenous infusion of sulprostone, a 16-phenoxy derivate of methylsulphonylamid prostaglandin E2 in 21 patients after intrauterine foetal death and in seven patients having hydatidiform mole. The mean total dose of sulprotone was estimated as 1100-1300 microgram in different groups. The mean induction-delivery time was 7-13 hours. Expellation of the foetus occurred in 20 out of 21 cases during 24 hours after commencement of sulprostone infusion. In all patients having molar pregnancy uterine contractions induced with sulprostone opened the uterine cervix for evacuation. The drug was clinically well tolerated without any serious side-effects.

Management of intrauterine fetal death with prostaglandin E2 vaginal suppositories.

The recent Food and Drug Administration's approval of prostaglandin E2 (PGE2) vaginal suppositories provides the clinician with a technique for the immediate management of missed abortion and intrauterine fetal death (IUFD). During a 4-year period at our institution, 78 of 80 patients with gestations ranging from 13 to 42 weeks had pregnancy successfully terminated with PGE2 suppositories with a dose schedule of 20 mg every 2 hours. The mean interval from induction to delivery of the fetus was 8.9 hours. Fifty percent of the patients spontaneously expelled the placenta; active intervention to remove the placenta within 2 hours of delivery of the fetus is recommended to avoid excessive vaginal bleeding. The most frequently encountered side effect was a temperature elevation, which was managed by less frequent administration of the prostaglandin. Gastrointestinal side effects were minimized by premedication with antidiarrheal and antiemetic agents, which also were administered during the induction period when indicated by the patient's symptoms. A concomitant oxytocin infusion was utilized in 38 patients. In gestations of less than 24 weeks the oxytocin was administered via intravenous drip at a rate of 10 U/hour. In the case of a patient with IUFD and a gestation of 24 weeks or more, oxytocin should be administered only with a constant-rate infusion pump starting at a dose schedule of 1 mU/minute with careful titration of the dose against the monitored uterine activity. The availability of the vaginal PGE2 suppositories for missed abortion and IUFD makes it important for the clinician to fully acquaint himself with the drug, its administration, effects, and side effects.

A comparison between vaginal prostaglandin E2 suppositories and intrauterine extra-amniotic prostaglandins in the management of fetal death in utero.

This retrospective study was undertaken to compare the efficacy, side effects, and complications of prostaglandin E2 (PGE2) given as a vaginal suppository with those of PGE2 administered via the intrauterine extra-amniotic route to induce labor after fetal death. The induction-to-delivery intervals were comparable, with 9.2 +/- 3.94 hours and 8.6 +/-4.49 hours, respectively. However, the mean total amount of PGE2 administered was much less via the intrauterine extra-amniotic route (1.8 milligrams) than by the vaginal suppository (45.2 mg). There was a 100% success rate in the patients treated by the intrauterine extra-amniotic route, but only a 91.3% success rate in those patients treated via the vaginal route. The side effects (vomiting, diarrhea, fever) and the complications (incomplete abortion, uterine rupture, oxytocin augmentation) occurred more frequently with the use of PGE2 as a vaginal suppository. The vaginal route of administration of PGE2 is somewhat more convenient, but the intrauterine extra-amniotic route may offer a higher degree of efficacy and safety with fewer side effects in the management of fetal death in utero.

Intravenous prostaglandin E2 and 16-phenoxy prostaglandin E2 methyl sulfonylamide for induction of fetal death in utero.

The efficacy of intravenously administered prostaglandin E2 (PGE2) compared to that of intravenously administered 16-phenoxy-17,18,19,20 tetranor prostaglandin E2 methyl sulfonylamide (SHB 286) for termination of fetal death in utero was evaluated in 20 pregnant women from 14 to 38 weeks' gestation. Ten subjects received 1 microgram of PGE2 per minute intravenously. This rate of infusion was doubled at hourly intervals up to 8 microgram per minute. Ten subjects received 0.25 microgram of SHB 286 per minute. This rate of infusion was doubled at hourly intervals up to 2 microgram per minute. It appears that the dosage schedules of PGE2 and SHB 286 were equally effective in inducing labor. Cumulative expulsion rates and mean induction times were similar in both groups. Rates of emesis were low in both groups. Either fever greater than 38.0 degrees C, or shivering, or phlebitis at the site of infusion was observed in three patients treated with PGE2 but in no patient receiving SHB 286.

[Administration of 15-(S)-15-methyl prostaglandins F2 alpha in intrauterine fetal death, missed abortion and hydatidiform mole (author's transl)]. / Erste Erfahrungen mit 15-(S)-15-Methyl-Prostaglandin F2 alpha bei intrauterinem Fruchttod, Missed abortion und Blasenmole.

10 patients with missed abortion, intrauterine fetal death or hydatifidiform mole were given 15-(S)-15-methyl prostaglandin F2 alpha intramuscularly for the induction of labour or, in 2 cases, to obtain softening of the cervix prior to curettage. The mean time interval between induction and abortion was 6 h 9 min, with a mean dosage of 890 mcg prostaglandin per patient. Vomiting or diarrhoea occurred in 7 patients. Apart from a drop in haemoglobin concentration in 1 patient and a temporary increase in white cell count in 6 patients, no other pathological laboratory findings were detected. We conclude from these results and the relevant literature that the intramuscular administration of 15-(S)-15-methyl prostaglandin is an effective and safe means of inducing labour in missed abortion, intrauterine fetal death and hydratidiform mole.

Vaginal prostaglandin E2 in the management of fetal intrauterine death.

The results of a multicentre clinical trial of prostaglandin E2 (PGE2) administered by the vaginal route in the management of intrauterine fetal death and missed abortion showed an overall efficacy of 97 per cent. The mean induction-abortion interval was 10.7 hours with a mean total dose of 60.4 mg of PGE2. Side effects were tolerated well and there was no evidence of significant alterations in hepatic or renal function.

[Experience of cloprostenol (Estrumate) in dairy cattle (author's transl)]. / Praktijkervaringen met cloprostenol (Estrumate) bij rundvee.

Satisfactory results were obtained using estrumate in the following indications: (1) induction of oestrus in cows not showing any symptoms of oestrus; (2) treatment of cows with chronic endometritis; (3) expulsion of mummified foetuses; (4) termination of early pregnancy; (5) synchronisation of oestrus in heifers. It is conlcuded that estrumate may be regarded as a valuable addition to the armamentarium of therapy available to the veterinarian.

Intra-uterine extra-amniotic prostaglandin F2-alpha in the management of patients with intra-uterine fetal death.

The problems of a conservative approach to the management of patients with intra-uterine fetal death are presented, and the technique of intra-uterine, extra-amniotic infusion of prostaglandin F2-alpha (PGF2alpha) is described. This involves the repeated infusion of a solution of PGF2alpha into the extra-amniotic space to induce labour in patients in whom pregnancy is complicated by intra-uterine fetal death. Pregnancy was successfully terminated by this method in 9 patients with intra-uterine fetal death. The mean induction-delivery interval was 10,2 hours. There were no side-effects, and the results were similar to those reported by other authors who used a similar technique of inducing labour. Past and present methods of inducing labour in patients with intra-uterine fetal death are reviewed and discussed.

Vaginal prostaglandin E2 for missed abortion and intrauterine fetal death.

Vaginal suppositories containing 20 mg. of prostaglandin E2 (PGE2) were given to 50 patients with a diagnosis of either missed abortion or fetal death. A total of 94 percent of the patients (47/50) expelled products of conception, and 84 percent of these expulsions (42/50) were complete. The mean time to expulsion of the fetus was 11.3 hours with a mean dose of 3.6 suppositiries. A total 60 per cent of the patients experienced vomiting, diarrhea, and pyrexia. Four patients had a blood loss in excess of 500 ml., and two of these patients required blood transfusion. Vaginal administration of PGE2 suppositories appeared to be a rapid, safe, and reliable means of managing missed abortion and intrauterine fetal death.

Termination of abnormal intrauterine pregnancies with intramuscular administration of dihomo 15 methyl prostaglandin F 2alpha.

A synthetic compound, 2a, 2b dihomo 15 (S) 15 methyl prostaglandin F 2 alpha methyl ester given 8-hourly by intramuscular injection was used to terminate pregnancies in 72 patients with a missed abortion, intrauterine fetal death, molar or anencephalic pregnancies. Treatment was successful in all cases. A 4 mg dose of loperamide given orally at 15 to 30 minutes before the injection of prostaglandin analogue prevented diarrhoea as a side effect.