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Low dose sulprostone for termination of second and third trimester pregnancies
M A de Boer1, N van Gemund, S A Scherjon
1Department of Obstetrics, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
Objective:
The purpose of this study is to assess the effectiveness and safety of sulprostone (nalador) for labour induction in the event of foetal death or foetal malformations.
Study Design:
Retrospective analysis of 284 women with intrauterine foetal death (n=137), or foetal abnormalities (n=147), who underwent labour induction with sulprostone in a continuous dose of 1microg/min intravenously.
Results:
All but three women had a successful vaginal delivery. The median induction-expulsion interval was significantly shorter (12h) in the foetal death group compared to the foetal malformation group (25h). Two uterine ruptures were recorded, one in a woman with a uterine anomaly, and one in a woman with a previous caesarean section. There were no other complications. Gestational age had a significant influence on spontaneous expulsion of the placenta: before 24 weeks 55%, and after 24 weeks 82% spontaneous expulsion. For the chance of a neonate born with signs of life, parity was the only significant determinant.
Conclusions:
The use of intravenous sulprostone in a low continuous dose is both effective and safe. In addition, this study does not support former opinions that smoking and advanced maternal age are contraindications.