INTRAAMNIOTIC 15(S)-15-METHYL PROSTAGLANDIN-F(2-ALPHA) AND TERMINATION OF MIDDLE AND LATE 2ND-TRIMESTER PREGNANCY FOR GENETIC INDICATIONS - A CONTEMPORARY APPROACH

OBJECTIVE: Our purpose was to determine whether intraamniotic 15(s)-15-methyl prostaglandin F2alpha could serve effectively and safely as a surrogate for natural prostaglandin F2alpha when used to effect middle and late second-trimester pregnancy termination for genetic indications. Further, we sought to compare efficacy and side effects with those found when intravaginal prostaglandin E2 is used. STUDY DESIGN: A total of 62 patients received intraamniotic 15(s)-15-methyl prostaglandin F2alpha and urea, and intracervical laminaria. Case patients at less-than-or-equal-to 20 weeks' gestation (n = 32) were compared with case patients at >20 weeks (n = 30) and with a matched group (n = 64; 1 :2 ratio) of control patients in whom cervical laminaria and intraamniotic urea were used with prostaglandin E2 vaginal suppositories. RESULTS: The mean induction-to-abortion interval among the case patients (gestational age 16 to 27 weeks) was 13 hours 11 minutes; 60 of 62 (97%) were delivered within 24 hours. There was a statistically significant negative correlation between the induction-to-abortion interval and gestational age (p = 0.04). When patients at less-than-or-equal-to 20 weeks and those at >20 weeks were compared, few differences were noted. The mean induction-to-abortion interval for case patients at less-than-or-equal-to 20 weeks was 13 hours 54 minutes versus 19 hours 34 minutes for control patients (p = 0.001). One of 32 (3%) case patients remained undelivered beyond 24 hours compared with 17 of 64 (27%) control patients (p < 0.01). Immediate and delayed complications were uncommon in either group. CONCLUSION: Our study demonstrates that 15(s)-15-methyl prostaglandin F2alpha can serve safely as a surrogate for prostaglandin F2alpha when used in combination with urea and laminaria for termination of pregnancy. This technique appears safe for use through 27 weeks' gestation; further investigation is encouraged.