[Cervix ripening and labor induction in therapeutic abortion in the middle and late 2d trimester using intracervical and extra-amniotic prostaglandin gel administration].

In 64 patients for therapeutic abortion between the 17th to 26th week of pregnancy abortion was induced with a standardized two-step procedure. After priming of the cervix with intracervical application of prostaglandin gel, labour was induced with extraamniotic PG-administration under epidural anaesthesia. The priming effect was demonstrated objectively in 10 patients with a mechanical tonometer. Prostaglandin F2 alpha, PGE2 and sulprostone were used in the study. There were no significant differences in the total length of therapy (cervix priming time plus induction of labour to abortion interval) between the three groups of patients. Except for 4 patients who required an instrumental extraction of the fetus, abortion occurred in all the patients within a total time of 30 hours (93.8%). The mean induction of labour to abortion interval was 8.3 hours (range: 1.0 to 17.3 hours) in all patients and there was, again, no significant difference between the three groups. Epidural anaesthesia gave a painless induction of abortion in 60 out of 62 patients, while 2 patients required additional analgesics. In 2 patients epidural anaesthesia was contraindicated. In contrast to the systemic administration of PG the incidence of gastrointestinal side effects was low (10.9%). In one case a cervical lesion was observed due to a tenaculum laceration. Although there was no general antibiotic prophylaxis endometritis occurred in only 3 cases (4.7%). The combination of intracervical PG gel for cervical priming, extraamniotic PG gel for labour induction and epidural anaesthesia presents a gentle and efficient method for the termination of pregnancy in the middle to late second trimester.