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Second Trimester Abortion by Extra‐Amniotic PGF2 alpha Infusion: Experience of 178 Cases
Author(s) -
Peat B.
Publication year - 1991
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1991.tb02764.x
Subject(s) - medicine , obstetrics , abortion , products of conception , pregnancy , prostaglandin analogue , amniocentesis , retained placenta , conceptus , gynecology , uterus , fetus , prostaglandin , prenatal diagnosis , placenta , genetics , biology , endocrinology
EDITORIAL COMMENT: The need for second trimester termination of pregnancy is a reality in modern obstetric practice. However, in spite of the increasing advocacy of routine 17–18 week ultrasonography to identify major fetal malformations, and the increasing use of genetic counselling amniocentesis when indicated, the majority of second trimester terminations are performed for ‘psychosocial’ indications ‐ in 102 of 178 case in Peat's series and 87 of 101 cases in the preceding article by Bennett and colleagues. These 2 papers are complementary and both conclude, after reporting different methods, that surgical evacuation after cervical dilatation with a vaginally inserted prostaglandin pessary is a more satisfactory technique than that using extraamniotic infusion of prostaglandin F 2 alpha. It is a well known and important fact that the operation of dilatation and piecemeal evacuation of the fetus and placenta is abhorrent to both the operator and all members of the nursing staff in attendance. The performance of the procedure under ultrasound control as described in the previous paper seems a major improvement in terms of avoiding damage to the uterus, and problems due to incomplete removal of the conceptus. Hopefully this is not the last word, and further refinement of technique will allow spontaneous expulsion in second trimester abortion ‐ the use of an orally administered antiprogesterone in addition to vaginal Cervagem pessaries (Rodger and Baird, 11), may, by shortening the induction‐abortion interval, result in a regimen more acceptable than surgical evacuation. Summary: here is a continuing need for second trimester induced abortions, most recently due to the increase in the use of antenatal diagnostic procedures, amniocentesis, high resolution ultrasound and cordocentesis. To evaluate the efficacy and safety of extraamniotic infusion of PGF2 alpha for this purpose a retrospective review of 178 procedures was undertaken. There were 4 failures of the technique and the major complication rate was 5.6%. This rate was independent of gestational age The mean induction to abortion interval was 29.6 (+/‐ 16.3) hours. The conclusion reached after comparison with other published data is that extraamniotic PGF2 alpha infusion is a slow and painful but safe and effective technique, but that at gestational ages less than 17 weeks, a comparative trial of Dilatation and Evacuation versus extraamniotic PGF2 alpha infusion would be justified.