Management of second-trimester missed abortion with intramuscular 15-methyl-prostaglandin F2 alpha

Midtrimester missed abortion was successfully managed by serial intramuscular injections of 15(S)-15-methyl-prostaglandin F2alpha (PGF2alpha) in 255 patients, the cumulative abortion rates after 24 and 36 hours being 97.6 and 99.6%, respectively. The mean 1st-dose-to-expulsion interval was significantly shorter in the paras, but the period after fetal death was not significant in this respect. In 60% of the cases, abortion was complete. No serious complications occurred. 2/3 of the patients developed gastrointestinal side effects. These side effects were not improved by standardized antiemetic and antidiarrheal treatment, but they were strongly reduced by priming the cervix with extraamniotic PGE2 gel before the PGF2alpha analog was administered.