Prostaglandins for the management of anencephalic pregnancy

In 17 women carrying an anencephalic fetus (3 or them dead) an attempt was made to terminate the pregnancy with either intravaginal suppositories containing 20 mg prostaglandin E2 each or serial intramuscular injections of 250 microgram of 15(S)-15-methyl-prostaglandin F2 alpha. The duration of pregnancy ranged from 18 to 39 weeks (mean: 28.5 weeks). Fifteen women expelled the complete uterine contents after a period ranging from 4:15 to 39:10 h:min (mean: 15:11 h:min) following the initiation of treatment. There were two failures, and in both of these cases labor started spontaneously after cessation of the prostaglandin treatment. No serious complications occurred. The PG treatment induced no changes in routine laboratory values and significant alterations in the mother's vital signs were uncommon. Even though intravaginal prostaglandin E2 and intramuscular 15-methyl-prostaglandin F2 alpha often produced gastro-intestinal side effects, there can be no doubt as to the unique utility of these compounds for the management of anencephalic pregnancies, whatever the duration of gestation and vital status of the fetus.