Management of intra-uterine fetal death with vaginal administration of gemeprost or prostaglandin E₂: A random allocation controlled trial

Summary

Sixty-nine patients with a confirmed intra-uterine fetal death in the second or third trimester of pregnancy were allocated at random to receive the prostaglandin E, analogue gemeprost, 1 mg vaginally three hourly for three doses, or a single vaginal insertion of prostaglandin E₂, 25 mg as a pessary or as a gel. Intravenous oxytocin was given 15–20 h later if necessary. All pregnancies were successfully expelled using each of the three regimens employed. There were no differences between the induction-expulsion intervals between the three groups: the median interval for all the patients was 14–4 ± 9–6 h (s.d.). Delivery within 24 h of prostaglandin treatment occurred in 16/20 of the gemeprost patients and 20/27 and 19/22 respectively in the prostaglandin E₂ pessary and gel groups. There were no differences in the incidences of gastrointestinal side effects or analgesic requirements between the three groups. Overall 17/69 patients required surgical evacuation of the uterus for immediate incomplete abortion, but none of these occurred after 28 weeks gestational age. The vaginal administration of gemeprost or prostaglandin E₂ provides a safe, effective, easy to administer alternative to extra-amniotic treatment in pregnancies complicated by intra-uterine fetal death.