USE OF FOLEY’S CATHETER AND PROSTAGLANDIN F-2 ALPHA IN SECOND TRIMESTER TERMINATION OF PREGNANCY
AbstractBackground: Termination of pregnancy (TOP) in the second trimester is associated withthree to five times higher risk of maternal morbidity and mortality than termination duringfirst trimester. The main concern of obstetrician is to provide the most effective and safestregimen which combines the shortest expulsion interval with least side effects. This study wasundertaken to compare the use of Foley’s catheter with extra-amniotic instillation of PGF2alpha for second trimester TOP so that a choice of the safer and cost-effective method couldbe available. Methodology: The study was conducted in Department of Obstetrics andGynecology Unit ‘B’ at Ayub Teaching Hospital Abbottabad between August 2003 and July2004. Sixty patients recommended for TOP (missed abortion or anencephalic fetus confirmedon ultrasonography) were randomly allocated into two groups. In group ‘A’, Foley’s catheteralone was used while in group ‘B’ extra amniotic instillation of Prostaglandin F-2 alpha (PGF2alpha) was done via a Foley’s catheter. After expulsion of catheters in both cases oxytocininfusion containing 30 units were started till the expulsion of fetus, placenta and membranes.The mean induction to expulsion time and the mean induction to delivery time for both groupswere noted as well as total cost of treatment. Results: Difference in time interval with regardto induction to expulsion time of catheter and induction to delivery time between the twogroups was significant being 3 hours and 5 hours respectively less in group ‘B’ (p < 0.001);however only 25% of patients in group ‘B’ had a significant short induction to delivery timeas compared to group ‘A’. The difference in costs of treatment between the groups was alsosignificant (p < 0.001). Conclusion: Use of PGF 2 alpha is preferred, though for poor patientsFoley’s catheter may be used, but only in a tertiary care setting.Key Words: Dinoprost, Abortion, Labor onset, Uterine contraction, Cervical ripening,Balloon dilatation.
Lipitz S, Grisaru D, Libshiz A, Rotstein Z, Schiff E, Lidor
A, et al. Intra amniotic prostaglandin F 2 alpha for
pregnancy termination in second and early third trimester
of pregnancy. J Reprod Med 1997; 42:235-8.
Grudzinskas JG. Miscarriage, ectopic pregnancy and
trophoblastic disease. In : Edmonds K, editor. Dewhurst’s
Textbook of Obstetric & Gynaecology for Postgraduates.
th edition, London: Blackwell Science 1999. p. 64.
J Ayub Med Coll Abbottabad 2006;18(3)
Yapar EG, Senoz S, Urkutur M. Batioglu S, Gokman O.
Second trimester pregnancy termination including fetal
death: comparison of five different methods. Eur J Obstet
Gynecol Reprod Biol 1996; 69:97 -102.
Cunningham FG, MacDonald PG, Gant NF, Leveno KJ,
Gilstrap LC, Hakins GD et al. Williams Obstetrics, 20th
Edition. Connecticut: Appleton & Lange Inc., 1997.
Amjad T, Akhtar S. Termination of pregnancy with fetal
death in second trimester: Foley’s catheter versus extra
amniotic prostaglandin. J Coll Physicians Surg Pak 1999;
Karim SM, Trussell RR, Patel RC, Hillier K. Response of
pregnant uterus to Prostaglandin PGF 2 alpha induction of
labor Br Med J 1968; 4(631):621-3.
Foegh ML, Ranwell Pw. The Eicosanoids: Prostaglandins,
Thromboxanes, Leukotrienes & Related Compounds. In:
Katzung BG, editor. Basic and Clinical Pharmacology,
Singapore: McGraw Hill 2004; 298-313.
Top pozada MK, Shaala SA, Anwar MY, Haiba NA,
Abdrabbo S, el-Absy HM. Termination of pregnancy with
fetal death in the second and third trimester-the double
balloon versus extra amniotic prostaglandin. Int. J
Gynaecol Obstet 1994; 45:269-73.
Mekbib TA. Induction of abortion by condom Foley’s
catheter method in pregnant women with intrauterine fetal
death. Ethiop Med J 1994; 32:107 -13.
Atad J, Hallak M, Auslender R, Porat-Packer T, Zarfati D,
Abramovici H. A randomized comparison of Prostaglandin
E2, Oxytocin and the double balloon device in inducing
labour. Obstet Gynaecol 1996; 87:223-7.
Obed JY, Adewole IF. The unfavourable cervix:
improving the Bishop score with the Foley’s catheter.
West Afr J Med 1994; 13:209-12.
Manabe Y, Manabe A. Abortion at midpregnancy by
catheter or catheter-balloon supplemented by intravenous
oxytocin and PGF 2 alpha. Int J Biol Res Pregnancy 1981;
Sachdev PS. Termination of second trimester pregnancy:
Comparison of prostaglandin vaginal pessaries vs Foley’s
catheter insertion. J Coll Phys Surg Pak 1999; 9: 400-2.
Mukherjee M, Shukla P, Rohatgi P. A trial of intraamniotic and extra-amniotic prostaglandin for medical
termination of pregnancy. J Obstet Gynaecol India 1979;
Mishra J, Jha RK. Role of extra amniotic rubber catheters
in mid trimester pregnancy termination. J Obstet Gynaecol
India 1981; 31(4): 575-8.
Tandon S, Rastogi K, Singh VK. Termination of
pregnancy in second trimester by intra uterine catheter. J
Obstet Gynaecol India 1979; 29(6): 1165-67.
Thavarasah AS, Sivalingam N. Prostaglandin (F2 alpha)
and missed abortion. Adv Contracept Delv Syst 1988; 4(2-
Toppozada M, el- Ghazzawi E, Gaweesh S, el-Abd M,
Samaha A. Effect of Prostaglandins E 2 and 15 methyl F2
alpha on human pregnant and non pregnant cervix. Eur J
Obstet Gynecol Repord Biol 1987; 26(1): 27-32.
Cameron IT, Baird DT. Local Prostaglandin
administration for mid trimester abortion: a retrospective
analysis. J Obstet Gynaecol. 1987 Jan; 7(3): 228-32.
Fait T, Calda P, Zizka Z, Pavlista D, Hrukova H, Zinny J.
Termination of 128 pregnancies in the 2 nd trimester using
prostaglandian 15 methyl F2 alpha. Ceska Gynekol. 2000
Nov; 65(6): 451-5.