Title: Uterine rupture with the use of vaginal prostaglandin E2 suppositories.

POPLINE Document Number: 797279

Author(s):

Sandler RZ
Knutzen VK
Milano CM
Gleicher N

Source citation:

AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1979 Jun 1;134:348-50.

Abstract:

A case of spontaneous rupture of the uterus following induction of labor for mid-trimester abortion by intravaginal prostaglandin E2 (PGE2) suppositories is reported. Recent approval of this drug by the Food and Drug Administration for the abortion of mid-trimester pregnancies and induction of labor in association with death in utero and benign molar disease increases the actuality of the present case study report. Prostaglandins increased intrauterine pressure to levels beyond that of normal labor. This case raises questions about the currently unlimited use of vaginal PGE2 suppositories with previously scarred uteri. In retrospect it needs to be assumed that uterine rupture in this case occurred within the first 12 hours of labor, prior to oxytocin stimulation. A decrease in uterine size and cessation of labor represent fairly typical signs of uterine rupture. Other classical signs, such as vaginal bleeding and peritoneal irritation as a consequence of intraperitoneal hemorrhage, severe pain, and unstable vital signs were lacking and resulted in a delay of diagnosis. If PGE2 suppositories are to be used in previously scarred uteri, caution needs to be taken in order to recognize early signs of uterine rupture. The vaginal route of prostaglandin administration may carry the same risk for uterine rupture as reported for the intra-amniotic installation.

Keywords:

Prostaglandins
Vaginal Suppository
Abortion
Pregnancy, Second Trimester
Complications
Endocrine System
Physiology
Biology
Vaginal Spermicides
Contraceptive Methods
Contraception
Family Planning
Fertility Control, Postconception
Pregnancy
Reproduction
Diseases