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  • Title: Induction of labor following intrauterine death with intra-amniotic hyperosmolar urea and prostaglandin F2alpha: evaluation of placental endocrine function and changes in coagulation parameters.
    Author: Sher G.
    Journal: Am J Obstet Gynecol; 1979 Jul 01; 134(5):493-7. PubMed ID: 453286.
    Abstract:
    A practicable and reliable method for inducing labor in patients whose pregnancies are complicated by intrauterine death of the fetus is described. The method involves the intra-amniotic instillation of 30 mg of prostaglandin F2alpha with 60 gm of urea. Twenty patients had pregnancies ranging between 22 and 41 weeks and the estimated duration of fetal death ranged between two and eight weeks. Delivery was achieved within 24 hours in all cases. Side effects and complications were minimal. Plasma human placental lactogen (hPL) and progesterone concentrations, as well as several blood coagulation parameters (i.e., plasma fibrinogen, blood platelet count, and serum fibrin degradation products (FDP) concentrations), were measured immediately prior to induction of labor. The latter (i.e., coagulation factors) were repeated at parturition. The presence of residual viable placenta prior to induction did not influence the induction-delivery interval. No statistically significant alterations in blood coagulation parameters that could be attributed to the specific method of induction employed were noted. A practicable and reliable method for inducing labor in patients whose pregnancies are complicated by intrauterine death of the fetus is described. The method involves the intraamniotic instillation of 30 mg of prostaglandin F2alpha with 60 gm of urea. 20 patients were investigated with pregnancies ranging between 22 and 41 weeks and with the estimated duration of fetal death ranging between 2 and 8 weeks. In all cases, delivery was achieved within 24 hours. Prior to the induction of labor, plasma human placental lactogen (hPL); progesterone concentrations; and numerous blood coagulation parameters i.e., plasma fibrinogen, blood platelet count, and serum fibrin degradation products [FDP] concentrations) were measured. No statistically or clinically significant alterations occurred in the first 2 measurements, and FDP concentrations increased during labor in most patients. Side effects and complications were minimal and the induction-delivery interval was not influenced by the presence of residual viable placenta prior to induction. Thus, this method which only requires a single intraamniotic instillation is highly recommended.
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