Prolonged Induction to Delivery Time in Termination of Pregnancy Using 16,16‐dimethyl‐PGErmethyl ester (gemeprost) for Fetuses with a Neural Tube Defect or Hydrocephalus

Abstract

Summary: A retrospective study is reported comparing the induction to delivery interval using gemeprost for termination of pregnancy, in the second trimester, in 3 groups of patients. It was observed that the mean induction to delivery interval was significantly longer in 75 pregnancies where there was a fetus with a neural tube defect and or hydrocephalus (31.7 hours) compared with 88 pregnancies with other fetal abnormalities (19.7 hours) and 84 pregnancies where there was an intrauterine death (113 hours). There was also an increase in the requirements for further intervention to obtain delivery in the group with a neural tube defect or hydrocephalus (n=33) compared with where there was an intrauterine fetal death (n=4) and other abnormality (n=14). We believe these results should be considered when counselling patients who have requested termination of pregnancy for fetal abnormalities.

To Compare the Methods of Pregnancy Termination for Fetal Abnormality in the First and Second Trimesters

“…The specific fetal anomaly did not influence the abortion duration after controlling for gestation, age, and parity, with the exception of musculoskeletal abnormalities ( P = 0.03). Although prolonged induction was noted in termination of pregnancy with fetal neural tube defect or hydrocephalus in a previous study [19], it was not confirmed in this study. Placental retention occurred in 31.1% of cases, being 53.2% at <16 weeks gestation compared with 40.6% and 12.8% at 16–19 weeks and ≥20 weeks, respectively.…”

“…There were 2 studies that stratify the outcome according to the type of fetal abnormality and they are also excluded in this review [19, 23]. …”

Which factors influence the number of gemeprost pessaries used in inducing second‐trimester abortions?

“…The reason to terminate was fetal acrania. It is of interest that a prolonged induction to delivery time has been reported in termination of pregnancies with fetal neural tube defects (16).…”

Which factors influence the number of gemeprost pessaries used in inducing second-trimester abortions?

“…The introduction of vaginal prostaglandin pessaries was important in minimizing the morbidity of induced midtrimester abortions (4). The prostaglandin agent gemeprost (16,16-dimethyltrans-D 2 -PGE1 methyl ester) is a synthetic prostaglandin E1 (PGE1) analog that causes softening and dilatation of the cervix and the onset of regular uterine contractions. It is administered as a vaginal pessary, usually at 3-6-h intervals (5)(6)(7)(8)(9)(10)(11).…”