Induction of labor following intrauterine death with intra-amniotic hyperosmolar urea and prostaglandin F2alpha: evaluation of placental endocrine function and changes in coagulation parameters.

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.