Acta Obstet Gynecol Scand 55: 113-1 14, 1976
THE INTRAVENOUS INFUSION O F PROSTAGLANDIN Fza IN THE MANAGEMENT O F INTRAUTERINE DEATH O F THE FETUS Narve Moe From the Department of Obstetrics and Gynaecology (Head: Professor Knut B j ~ o ) , Rikshospitalet. University of Oslo, Norway
Abstract. Prostaglandin F,a (PGF,a) was given intravenously in the treatment of 16 cases of intrauterine death. Delivery was achieved without complications or side effects in 15 out of the 16 patients. A posteriorcervical rupture occurred in one patient treated with cervical dilatation and PGF,a-infusion.
In cases of intrauterine death safe methods are required for the induction of labour. For medical and psychological reasons, delivery is desirable as soon as the diagnosis is made. In this study it is shown that prostaglandin F z a (PGF2a) can be used for the induction of labour in cases of fetal death in the third trimester of pregnancy.
instrument was used for mechanical dilatation of the canal. PGF,a infusion produced strong contractions. After 10 hours, vaginal examination revealed an unchanged cervix and the infusion was stopped. Amniotomy was performed the following day and Hartel’s dilatators were used together with PGFza for 40 hours. Pelvic examinations then revealed a completely effaced cervix, with a 2 cm rigid external cervical 0s. A short time after a fetus was found emerging from the vagina. Inspection revealed an intact cervical 0s and a transverse posterior cervical laceration. The placenta was delivered through the laceration. A repair was carried out vaginally, the patient was given antibiotics, and no postoperative complications occurred.
PATIENTS AND METHODS Sixteen patients were carrying a dead fetus after 196 or more days of pregnancy. The estimated mean duration after intrauterine death was 5.9 days with a range from 1 to 30 days. In most cases amniotomy was done primarily. PGF,a was administered as a solution in normal saline by a Harvard pump infusion through a cannula in a forearm vein. PGF,a was given at an initial rate of 40 mcglminute and increased by hourly increments until a maximum dosage of 80 mcglminute.
RESULTS Fifteen out of the 16 patients were delivered successfully. The average induction-delivery interval was 7 hours and 36 minutes (Table I). Complications OCcurred in none of the cases. Except for a local reaction in the infused vein, side effects such as nausea, vomiting, diarrhoea or pyrexia were not recorded. There was one case of failed induction. Before the start of infusion vaginal examination revealed an elongated firm cervix. Lsvset’s cervical
DISCUSSION There is good evidence for the value of the prostaglandins as agents for induction of labour in cases of intrauterine death. The infusion of prostaglandin Ez (PGE2) has been reported by Karim (4) and by Filshie (2). In these series the mean infusiondelivery intervals were 12 or 8 hours respectively, but side effects such as nausea, vomiting and diarrhoea were common. A simultaneous intravenous infusion of PGE, and oxytocin seems also to be effective and the incidence of gastro-intestinal side effects is reduced ( 5 ) . Another valuable alternative in the treatment of intrauterine death is the extra-amniotic administration of the prostaglandins Fzaor Ez(1). The present study suggests that the intravenous infusion of PGF2a for the induction of labour, in cases of intrauterine death, is a valuable method. In 15 out of 16 cases the induction was successful, the mean infusion-delivery interval was 7 hours and 36 Acta Obstet Gynecol Scand 55 (1976)
114
N. Moe
Table 1. Prostaglandin FZaintravenous infusion in 15 successful cases with intrauterine death of the fetus
Maturity (days) Prostaglandin Fza, total dose (mg) Infusion-delivery interval (hours, minutes)
MeanfS.D.
Range
238k28.20
196-303
20.3 f I 1.80
2.744.4
7.36f4.09
1.15-15.45
minutes, and gastro-intestinal side effects were avoided. In one case of unsuccessful induction a posterior cervical rupture occurred in association with the infusion of PGFz. Similar accidents are reported following intra-amniotic administration of PGFza for mid-trimester abortion ( 3 , 6 , 7 ) . In our case, the infusion had lasted for 50 hours, and should have been abandoned earlier. ACKNOWLEDGEMENT PGFZwas supplied by Upjohn Ltd.
Acta Obstet Gynecol Scand 55 (1976)
REFERENCES 1. Embrey, M. P., Calder, A. A. & Hillier, K.: J Obstet
Gynaecol Br Comm 81: 47, 1974. 2. Filshie, G. M.: J Obstet Gynaecol Br Comm 78:87, I97 1. 3. Kajanoja, P., Jungner, G., Seppala, M.,Karjalainen, 0. & Widholm, 0.: Acta Obstet Gynaecol Scand, 53: Suppl. 37, 1975. 4. Karim, S. M. M.: Br Med J3: 196, 1970. 5. Naismith, W. C . M. K. &Ban-, W.: J Obstet Gynaecol Br Comm 81: 146, 1974. 6. Nyberg, R.: Acta Obstet Gynaecol Scand 53:Suppl. 37, 1975. 7. Wentz, A. C . , Thompson, B. H. & King, T. M.: Am J Obstet Gynaecolll5: 1107, 1973.
Submitted for publication N o v . 12, 1974 Narve Moe Department of Obstetrics and Gynecology Rikshospitalet Oslo Norway
THE INTRAVENOUS INFUSION O F PROSTAGLANDIN Fza IN THE MANAGEMENT O F INTRAUTERINE DEATH O F THE FETUS Narve Moe From the Department of Obstetrics and Gynaecology (Head: Professor Knut B j ~ o ) , Rikshospitalet. University of Oslo, Norway
Abstract. Prostaglandin F,a (PGF,a) was given intravenously in the treatment of 16 cases of intrauterine death. Delivery was achieved without complications or side effects in 15 out of the 16 patients. A posteriorcervical rupture occurred in one patient treated with cervical dilatation and PGF,a-infusion.
In cases of intrauterine death safe methods are required for the induction of labour. For medical and psychological reasons, delivery is desirable as soon as the diagnosis is made. In this study it is shown that prostaglandin F z a (PGF2a) can be used for the induction of labour in cases of fetal death in the third trimester of pregnancy.
instrument was used for mechanical dilatation of the canal. PGF,a infusion produced strong contractions. After 10 hours, vaginal examination revealed an unchanged cervix and the infusion was stopped. Amniotomy was performed the following day and Hartel’s dilatators were used together with PGFza for 40 hours. Pelvic examinations then revealed a completely effaced cervix, with a 2 cm rigid external cervical 0s. A short time after a fetus was found emerging from the vagina. Inspection revealed an intact cervical 0s and a transverse posterior cervical laceration. The placenta was delivered through the laceration. A repair was carried out vaginally, the patient was given antibiotics, and no postoperative complications occurred.
PATIENTS AND METHODS Sixteen patients were carrying a dead fetus after 196 or more days of pregnancy. The estimated mean duration after intrauterine death was 5.9 days with a range from 1 to 30 days. In most cases amniotomy was done primarily. PGF,a was administered as a solution in normal saline by a Harvard pump infusion through a cannula in a forearm vein. PGF,a was given at an initial rate of 40 mcglminute and increased by hourly increments until a maximum dosage of 80 mcglminute.
RESULTS Fifteen out of the 16 patients were delivered successfully. The average induction-delivery interval was 7 hours and 36 minutes (Table I). Complications OCcurred in none of the cases. Except for a local reaction in the infused vein, side effects such as nausea, vomiting, diarrhoea or pyrexia were not recorded. There was one case of failed induction. Before the start of infusion vaginal examination revealed an elongated firm cervix. Lsvset’s cervical
DISCUSSION There is good evidence for the value of the prostaglandins as agents for induction of labour in cases of intrauterine death. The infusion of prostaglandin Ez (PGE2) has been reported by Karim (4) and by Filshie (2). In these series the mean infusiondelivery intervals were 12 or 8 hours respectively, but side effects such as nausea, vomiting and diarrhoea were common. A simultaneous intravenous infusion of PGE, and oxytocin seems also to be effective and the incidence of gastro-intestinal side effects is reduced ( 5 ) . Another valuable alternative in the treatment of intrauterine death is the extra-amniotic administration of the prostaglandins Fzaor Ez(1). The present study suggests that the intravenous infusion of PGF2a for the induction of labour, in cases of intrauterine death, is a valuable method. In 15 out of 16 cases the induction was successful, the mean infusion-delivery interval was 7 hours and 36 Acta Obstet Gynecol Scand 55 (1976)
114
N. Moe
Table 1. Prostaglandin FZaintravenous infusion in 15 successful cases with intrauterine death of the fetus
Maturity (days) Prostaglandin Fza, total dose (mg) Infusion-delivery interval (hours, minutes)
MeanfS.D.
Range
238k28.20
196-303
20.3 f I 1.80
2.744.4
7.36f4.09
1.15-15.45
minutes, and gastro-intestinal side effects were avoided. In one case of unsuccessful induction a posterior cervical rupture occurred in association with the infusion of PGFz. Similar accidents are reported following intra-amniotic administration of PGFza for mid-trimester abortion ( 3 , 6 , 7 ) . In our case, the infusion had lasted for 50 hours, and should have been abandoned earlier. ACKNOWLEDGEMENT PGFZwas supplied by Upjohn Ltd.
Acta Obstet Gynecol Scand 55 (1976)
REFERENCES 1. Embrey, M. P., Calder, A. A. & Hillier, K.: J Obstet
Gynaecol Br Comm 81: 47, 1974. 2. Filshie, G. M.: J Obstet Gynaecol Br Comm 78:87, I97 1. 3. Kajanoja, P., Jungner, G., Seppala, M.,Karjalainen, 0. & Widholm, 0.: Acta Obstet Gynaecol Scand, 53: Suppl. 37, 1975. 4. Karim, S. M. M.: Br Med J3: 196, 1970. 5. Naismith, W. C . M. K. &Ban-, W.: J Obstet Gynaecol Br Comm 81: 146, 1974. 6. Nyberg, R.: Acta Obstet Gynaecol Scand 53:Suppl. 37, 1975. 7. Wentz, A. C . , Thompson, B. H. & King, T. M.: Am J Obstet Gynaecolll5: 1107, 1973.
Submitted for publication N o v . 12, 1974 Narve Moe Department of Obstetrics and Gynecology Rikshospitalet Oslo Norway
