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Letter: Transverse posterior cervical rupture following extra-amniotic prostaglandin F2alpha-induced abortion.


 Therapeutic abortion on the ground of psychiatric indication was performed on a healthy 37-year old woman (gestational age, 21 weeks) gravida 3 with uterine myomas. 1 mg PGF2a was initially administered through an extra-amniotic catheter and followed by intermittent injection of 2 mg PGF2a at hourly intervals. Uterine contractions ensued within 2 hours. Spontaneous rupture of the membranes with release of clear fluid occured at the 9th hour. The cervix was found to be 1 cm-dilated. Fetal (25 cm) and placental delivery occurred 16 hours and 45 later, after a total dose of 28 mg PGF2a. Vaginal examination revealed an intact external cervical os dilated 5 cm, and an 8 cm transverse posterior cervical laceration which did not extend through the internal cervical os. Vaginal repair was done with the use of anesthesia. This case is 1 instance of posterior cervical rupture in a total series of 251 abortions (200 primigravidas with PG2a in first trimester; 25 multigravidas with PGF2 in midtrimester; and 26 primigravidas with PGF2a in 1st trimester) induced by intrauterine extraamniotic prostaglandin administration. In this case, vaginal bleeding was minimal despite delivery of 25 cm-fetus through the cervical defect. Uterine myomas may have caused the cervical rupture. It is suggested that this complication is not typical with prostaglandin induced abortion, and number of cervical lesions following mechanical abortion is in fact higher.
