ABSTRACT
The placental and fetal response to the intra-amniotic injection of prostaglandin F2alpha (PGF2alpha) for midtrimester abortions was evaluated. Maternal blood samples for radioimmunological determinations of serum progesterone, human placental lactogen (HPL) and alpha-fetoprotein (AFP) were taken before and serially until 24 hours after the injection of 40 mg (nine patients) or 75 mg (seven patients) of PGF2alpha. Fetal heart action was monitored ultrasonically during the same period. The average induction-abortion interval was 22-6 hours and was indepedent of the dose of PGF2alpha used. The mean progesterone and HPL levels showed a significant fall half an hour after PGF2alpha. The constant decreases began only at 5 hours and later. The mean AFP levels increased rapidly after 5 hours following injection of PGF2alpha. The feral heart stopped at a mean of 10-4 hours (range 0-5 to 25 hours) after the injection of PGF2alpha. No relationship between the time of fetal death or rises in AFP and the induction-abortion interval could be detected. The primary hormonal response of the placenta and the efficacy of exogenous PGF2alpha were not related, indicating the possibility that the abortifacient property of PGF2alpha is not related to its primary effect on placental hormone synthesis or release.
Subject(s)
Abortion, Induced , Fetus/drug effects , Placenta/drug effects , Prostaglandins F/pharmacology , Adolescent , Adult , Female , Fetal Death/physiopathology , Fetal Heart/physiopathology , Humans , Placental Lactogen/blood , Pregnancy , Pregnancy Trimester, Second , Progesterone/blood , Time Factors , alpha-Fetoproteins/analysisABSTRACT
To evaluate the risks associated with gynaecologic operations on elderly patients (60 years or over) we performed this retrospective study of 573 operations. More than half the patients (53%) were operated on because of uterine prolapse. An abdominal operation was done in 33%, a vaginal approach in 59% and a combined abdominal and vaginal procedure in 9%. (he total amount of postoperative complications was 26% and higher after abdominal (36%) than vaginal operation (19%). Most complications were mild, e.g. fever (16%) and wound complications (4%). Five patients (0.87%) died within one month postoperatively, but only in two cases was death caused by postoperative complication itself, namely cardiac infarction and pulmonary embolism. It appears that our procedures based on co-operation between gynaecologist, internist and anaesthetist yield good results and that the chronologic age in itself is only seldom a contraindication to operative treatment.
