Objective: The critical analysis of the authors' standard protocol of termination of pregnancy during the second trimester.
Design: The prospective nonrandomised study.
Setting: Department of Gynecology and Obstetrics, 1th Faculty of Medicine, Prague.
Methods: We used a synthetic prostaglandin analog carboprost, 15-methyl-prostaglandin F2 alpha for induction of abortion during second trimester. It was administered in a single dose 500 micrograms. It was given into the amniotic cavity through the transabdominal puncture. At the same time dinoprostonum gel (0.5 mg) was given into vagine. Peridural analgesia has used since beginning of contractions. We investigated indication, mean period of induction, correlation between the period and indication and week of pregnancy so as a type and number of complication.
Results: From October 1998 till January 2000 128 pregnancy were terminated by intraamniotic prostaglandins administration. After a single administration 67.2% of women aborted within 24 hours. In 32.8% the intraamniotic administration was repeated twice. The mean induction period, i.e. the interval between the administration and abortion of the foetus was 28 hours. We didn't detect a correlation between the period of induction and the week of gestation or indication.
Complications: A major blood loss replaced by transfusion of erythrocyte mass at 4 cases, a rest in uterus at 3 cases, once perforation of uterus during revision of the uterine cavity, once sectio minor for bleeding, once major bleeding conjoined with septic shock, once phlebotrombosis and at three headache (in connection with peridural analgesia).
Conclusion: The therapeutic effect was achieved in all instances. One case of sectio minor was connected with strong vaginal bleeding. The method fulfils condition for second-trimester termination of pregnancy--must be safe, rapid, psychologically feasible and associated with a minimal risk of long-term consequences. The disadvantage of the method is the price of prostaglandins and necessity to repeat administration in 32.8% of patients.