The recent Food and Drug Administration's approval of
prostaglandin E2 (
PGE2)
vaginal suppositories provides the clinician with a technique for the immediate management of
missed abortion and intrauterine
fetal death (IUFD). During a 4-year period at our institution, 78 of 80 patients with gestations ranging from 13 to 42 weeks had pregnancy successfully terminated with
PGE2 suppositories with a dose schedule of 20 mg every 2 hours. The mean interval from induction to delivery of the fetus was 8.9 hours. Fifty percent of the patients spontaneously expelled the placenta; active intervention to remove the placenta within 2 hours of delivery of the fetus is recommended to avoid excessive
vaginal bleeding. The most frequently encountered side effect was a temperature elevation, which was managed by less frequent administration of the
prostaglandin. Gastrointestinal side effects were minimized by
premedication with
antidiarrheal and
antiemetic agents, which also were administered during the induction period when indicated by the patient's symptoms. A concomitant
oxytocin infusion was utilized in 38 patients. In gestations of less than 24 weeks the
oxytocin was administered via
intravenous drip at a rate of 10 U/hour. In the case of a patient with IUFD and a gestation of 24 weeks or more,
oxytocin should be administered only with a constant-rate
infusion pump starting at a dose schedule of 1 mU/minute with careful titration of the dose against the monitored uterine activity. The availability of the vaginal
PGE2 suppositories for
missed abortion and IUFD makes it important for the clinician to fully acquaint himself with the
drug, its administration, effects, and side effects.