Electroencephalographic changes after intra-amniotic prostaglandin F2alpha and hypertonic saline

Area of Science:

• Obstetrics and Gynecology
• Pharmacology
• Neurology

Background:

• Second-trimester abortion is frequently performed using various methods.
• Intra-amniotic prostaglandin F2alpha (PGF2alpha) is one such agent used for therapeutic abortion.
• Potential neurological side effects of PGF2alpha require careful evaluation.

Purpose of the Study:

• To assess the incidence of major convulsions in patients undergoing second-trimester abortion with intra-amniotic PGF2alpha.
• To evaluate electroencephalogram (EEG) changes following intra-amniotic PGF2alpha and hypertonic saline administration.
• To investigate potential correlations between EEG abnormalities and PGF2alpha levels.

Main Methods:

• A cohort of 555 patients undergoing therapeutic second-trimester abortion with intra-amniotic PGF2alpha was observed.
• Electroencephalograms (EEGs) were performed on patients after treatment with intra-amniotic hypertonic saline or PGF2alpha.
• Peripheral venous levels of PGF2alpha and its metabolite were measured.

Main Results:

• Six major convulsions occurred among 555 patients treated with intra-amniotic PGF2alpha.
• EEG abnormalities were observed in 5 of 21 patients receiving hypertonic saline and 5 of 16 patients receiving PGF2alpha.
• Two patients receiving PGF2alpha showed epileptiform spike activity, while changes in saline patients were minor.

Conclusions:

• While PGF2alpha is effective for second-trimester abortion, neurological monitoring is warranted due to potential adverse events like convulsions and EEG changes.
• The observed EEG changes, including epileptiform activity, suggest a need for further investigation into the neurotoxicity of PGF2alpha.
• No correlation was found between EEG changes and circulating PGF2alpha levels, indicating that local effects or other mechanisms may be involved.