Intravenous sulprostone and uterine scarring based upon 22 cases of therapeutic abortion during 2nd and 3rd trimesters of pregnancy.

A preliminary study in 22 patients with uterine scarring was undertaken using sulprostone by intravenous infusion when therapeutic abortion was deemed necessary during the 2nd and 3rd trimesters of pregnancy. The dosage used was 500 micrograms by slow infusion lasting 10 h. There were no cases of ruptured uterus. Adverse reactions were absent. Results were satisfactory. Mean induction-expulsion duration: 11 h. Expulsion rate in 24 h: 63%. With strict monitoring and in a specialized center, this technique may be suggested when a late therapeutic abortion with a scarred uterus is indicated.

Therapeutic abortion during the 2nd and 3rd trimesters of pregnancy using a synthetic derivative of prostaglandin E2, sulprostone, administrated intravenously. Based upon 182 cases.

OBJECTIVE: The purpose of the study is to assess the efficacy of and adverse events linked to the use of intravenous sulprostone during the 2nd or 3rd trimesters of pregnancy for therapeutic abortion. STUDY DESIGN: One hundred eighty-two patients (70 nulliparous, 112 multiparous) were hospitalized for therapeutic abortion. The route of administration was invariably intravenous and one single dose of sulprostone was used: 1000 micrograms of sulprostone diluted in 1 l of isotonic saline solution given as a 10-h infusion. RESULT: Expulsion within the first 24 h was obtained in 70% of cases with a mean induction-expulsion interval of 14 h. In three cases, laparotomy was required for hemorrhagic syndromes. CONCLUSION: Intravenous sulprostone enable evacuation of uterine contents with minimal adverse reaction. Attention should nevertheless be drawn to the existence of hemorrhagic syndromes.

[Rupture of a healthy uterus in a prostaglandin-induced abortion in the second trimester]. / Rupture d'un utérus sain lors d'une interruption de grossesse par prostaglandines au deuxième trimestre.

The authors report one case of uterine rupture in a non scarred uterus when an analogue of prostaglandin E2 was being transfused. It was Sulprostone used to terminate a pregnancy because of fetal death in utero after 27 weeks of amenorrhea. This case history and an analysis of the literature makes it possible to point out the need to reach the diagnosis before signs become too severe and to show that pharmacological knowledge of the drug has to be improved as well as the ways of administering prostaglandin analogue. This is to be conducted together with improving the ways of terminating pregnancies in the second trimester. It shows that mechanical accidents can occur even where there are no obvious risk factors. In this case, pain continued from the time of the rupture under epidural anaesthesia. The physiopathology is reviewed. Finally, conservative treatment of the uterus should be carried out whenever possible in order to allow a new pregnancy to occur and to lessen the morbidity of the operation.

PIP: The authors report a case of uterine rupture in a nonscarred uterus when an analogue of prostaglandin E2 (PGE2) was being transfused. The drug sulprostone was used to terminate a pregnancy due to fetal death in utero after 27 weeks of amenorrhea. This case history and an analysis of the literature makes it possible to point out the need to reach a diagnosis before the symptoms become too severe. It is also to show that pharmacological knowledge about the drug must be improved as well as the ways to administer the PG analogue. This should be done simultaneous to improving ways to terminate pregnancies during the 2nd trimester. It demonstrates that mechanical accidents can occur even where there are no obvious risk factors. In this case, pain continued from the time of the rupture under epidural anesthesia. In this article, physiopathology is reviewed. Finally, conservative treatment of the uterus should be conducted whenever possible in order to allow a new pregnancy to occur and reduce the likelihood of morbidity following the procedure. (author's modified)

[Changes in the cesarean section percentage]. / Evolution du pourcentage des césariennes.

More and more cesarean sections (C/S) are done, rate multiplied by 3 or 4 in occidental countries in these post two decennials, but are really too many done (?), as it is regularly reproched to the obstetricians, even though perineonatal morbidity and mortality rates have improved. By help of files studied in the gynecological and obstetrical Ward of Saint Antoine's Hospital Paris over 60 years, the authors have tried to answer to a few basic questions: The reason to be of the first C/S before labor and during labor, and the reason to be of iterative C/S in the same conditions. What results is: The rate of C/S has barely changed fur the following causes: Important dystocia known before or during labor, or Chronic foetal distress. On the other hand it increased because of: Acute foetal distress revealed during labor by alteration of the foetal heart beat (FHB). Stagnation of dilatation often accompanied by alteration of the FHB. An increase of iterative C/S due themselves to the increased number of scarred uteri. To reduce the progression of the number of C/S, we should therefore try to: Reduce the amount of scarred uteri, therefore have better knowledge of the indication of the first C/S. But is it feasible without compromising the benefits acquired by modern obstetrics, in means of perineonatal mortality and morbidity? Accept more often birth by vaginal route on the scarred uteri, the actual means of surveillance of labor appear to be able to permit it.