Uterine rupture in midtrimester abortion. A complication of gemeprost vaginal pessaries and oxytocin. Case report

Article Abstract:

A case is reported of complications associated with gemeprost, a type of prostaglandin (locally-acting hormone) given in the form of vaginal pessaries to terminate pregnancy. The 24-year-old patient had three previous uncomplicated pregnancies and was given gemeprost to terminate a pregnancy at 16 weeks' gestation. Abdominal pain developed with the second pessary, but there was no vaginal bleeding. Five pessaries were given during the first day. Another five were given during the second day, and these resulted in contractions and slight vaginal bleeding, but the cervix stayed closed. An ultrasound scan one day later showed an intrauterine pregnancy with no heartbeat. There was little vaginal bleeding, and oxytocin was administered to expedite contractions. One day later, there was bulging of the lower uterine segment, but the cervix was closed, and the patient was anemic. Uterine rupture was diagnosed, and was confirmed during surgery. The uterus could not be conserved, and therefore a hysterectomy was performed. The patient recovered without complication. This is the first known report of uterine rupture associated with the use of gemeprost and oxytocin. Previous reports of uterine rupture have been related to prostaglandin use in combination with oxytocin, particularly in women with uterine scars or who are multiparous (having had more than one child). No scar was evident during the ultrasound scan of this patient. It is likely that the rupture occurred during the second day of gemeprost treatment, since contractions and bleeding occurred. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Uterus, Uterine perforation, Oxytocin, Synthetic prostaglandins E

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Carbon dioxide laser treatment for vulval papillomatosis (vulvodynia)

Article Abstract:

Vulval papillomatosis, also referred to as vulvodynia, is the widespread formation of papilloma (elevated lesions of epithelial tissue) of the vulva (the external female genital tissue). Signs and symptoms of this disorder include a burning sensation and intense itching of the vulva; pain during sexual intercourse; an aceto-white epithelium; and koilocytosis (abnormal epithelium of the cervix, the opening of the uterus). These symptoms may be a result of infection with human papilloma virus. The carbon dioxide laser, a device that emits an intense beam of one wavelength radiation, has been used to treat various disorders of the vulva. The effectiveness of the carbon dioxide laser in treating vulvodynia was assessed in 16 patients with this disorder, who received treatment for over four years. Although the initial response to treatment at six weeks was encouraging, the recurrence of vulvodynia was high. The average period during which a patient was free of symptoms was four to six months. These findings suggest that carbon dioxide laser treatment is ineffective in treating vulval papillomatosis and should not be offered as a primary method of treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Vulvar diseases, Lasers in medicine, Medical lasers, Papilloma, Papillomas

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Gemeprost vaginal pessaries for inducing third-trimester intrauterine deaths

Article Abstract:

Prostaglandins are hormone-like substances involved in many physiologic processes, including stimulating uterine contractions. A ring inserted into the vagina, a vaginal pessary, containing prostaglandins, is useful in softening the cervix before a termination of pregnancy. Although prostaglandin pessaries have been used in termination procedures during the first 12 weeks of pregnancy, their usefulness during the last three months of pregnancy has not been established. Ten women with known fetal demise during the last 12 weeks of pregnancy were fitted with a pessary containing one milligram of gemeprost (a prostaglandin analogue). Gemeprost proved to be an effective and safe method of inducing labor. The method took an average of 11.7 hours to induce labor, while shortening of the active phase of labor. Some side effects, such as fever (eight women) and diarrhea (two women), were experienced by 40-50 percent of the patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Methods, Prostaglandins, Abortifacients

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