Use of intravenous sulprostone for the termination of pregnancy with fetal death in second and early third trimester of pregnancy

Objective: To study the efficacy of intravenous sulprostone (Nalador) for the termination of pregnancy with fetal death in second and early third trimester of pregnancy. Methods: This is a retrospective collection and analysis of data from a cohort of 97 women with fetal death between 12-30 weeks gestation treated with intravenous infusion of a prostaglandin analogue, sulprostone, to achieve expulsion of the products of conception. It was conducted in the Department of Obstetrics and Gynaecology, Sultan Qaboos University Hospital, Oman. The data collected was from January 2000 to December 2005. Sulprostone was started as an intravenous infusion of 15μgm/hr and titrated to a maximum of 240μgm/hr to a total dose of 1500μgm/day, as per the departmental protocol. The patients’ demographic data, gestational age, induction-expulsion interval, the need for evacuation, side effects and complications were studied. Results: Out of the 97 women who received sulprostone, 90 aborted within 24 hours. The average induction-expulsion interval was 11.9 ± 8.0 hours. Sulprostone use was associated with few side effects and was well tolerated by patients. Although most of the patients required evacuation and curettage, the blood loss was minimal. Only six out of 97 women required blood transfusions and two patients needed hysterotomy. Conclusion: We found sulprostone an efficient drug for termination of pregnancy with fetal death in second and early third trimester of pregnancy.