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  • Title: [The use of prostaglandin E2 to induce labor and abortion in the second trimester].
    Author: Khadzhiev A.
    Journal: Akush Ginekol (Sofiia); 1991; 30(1):39-45. PubMed ID: 1793135.
    Abstract:
    Prostaglandin F2 alpha (PGF2 alpha) venous injection was used for the first time for induction of labor in 1968. The success rate by different authors ranged from 63% to 100% with a dose of .5-1.5 mg/hour. Local use of PGE2 for the improvement of uterine cervix conditions was found more suitable than the use of PGF2 alpha. It was first used for induction of labor without side effects in 1973 by instilling transcervical extraamniotic PGE2 in patients with low pelvic scores. Also, a single dose of .2-4 mg of PGE2 extraamnially mixed in a gel such as Hydromellose was used. PGE2 gel was more effective than iv infusion of oxytocin for induction of labor in the unripe uterine cervix. In the case of a well-ripened cervix, both PGE2 gel and oxytocin gave identical results. A 1981 report showed that in the well-ripened cervix local administration of freshly prepared gel with PGE2 resulted in labor in 97% of cases with a time of induction of 6.5 hours. After cervical ripening produced by intracervical PGE2 gel within 6-7 hours, the administration of oxytocin was very effective. Termination of pregnancy in the 1st trimester was also successfully performed after intracervical instillation of PGE2. 10-12 hours later, after sufficient ripening of the cervix, easy dilatation of the cervical canal and curettage ensued. In vaginal use of PGE2 the dose has to be 5-10 times higher than the intracervical dose. Intracervical PGE2 proved to be the most effective for the unripe cervix. The tablet form of PGE2 endocervically is safer than the gel because of its sterility. In the clinical setting PGE2 reduced isthmic-cervical insufficiency that issued from the trauma of cervix from earlier birth or abortion; reduced the number of cesarean sections from 30% to 5% and from 25% to 10%, in respective reports; and it was least traumatic and best tolerated for termination of 1st and 2nd trimester pregnancies as well as for induction of labor.
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