Safety and efficacy of vaginal prostaglandin E2 suppositories in the management of third-trimester fetal demise.

Prostaglandin E2 vaginal suppositories are well established in the management of intrauterine fetal demise in the second trimester of pregnancy. However, approval for their use in the third trimester has been withheld pending evaluation of safety and efficacy. In this study 46 patients with intrauterine fetal demise in the third trimester were managed in a similar fashion except that only a 10-mg dose of prostaglandin E2 was employed. Forty-four of the 46 patients were delivered successfully. One patient experienced a cervical laceration that necessitated a hysterectomy; in her, oxytocin was used to supplement the prostaglandin. It appears that prostaglandin E2 vaginal suppositories can be used safely in the management of fetal demise in the third trimester of pregnancy. Use of a lower dose of the medication as well as tocodynamometry is recommended because the absorption of and sensitivity to this medication vary from patient to patient. The frequency of administering the medication should depend on the patient's response rather than on any given formula.