Noninvasive controlled Noninvasive controlled abortionabortion in the in the

trimester of pregnancytrimester of pregnancy ( (a a 15-15-years years experienceexperience))

NN..VV.О.Оrdzhonikidzerdzhonikidze, , BB..L.L...GurtovoiGurtovoi, , NN.М.Ка.М.Каssааboulatovboulatov

Research centre of ObstetricsResearch centre of Obstetrics,, Gynecology & Gynecology & PerinatologyPerinatology

Russian Academy of Medical SciencesRussian Academy of Medical Sciences High Risk Pregnancy DeptHigh Risk Pregnancy Dept

Main trendsMain trends

Search for reasonable Search for reasonable conservatismconservatism

Maximum safetyMaximum safety Limited operative interventionLimited operative intervention

ObjectivesObjectives

Elaboration of efficient method of Elaboration of efficient method of late induced abortion with the late induced abortion with the purpose to enhance its safety and purpose to enhance its safety and reduce complication ratereduce complication rate..

Stages of noninvasive Stages of noninvasive controlled abortion in the controlled abortion in the II trimesterII trimester

Maturation of the uterine cervixMaturation of the uterine cervix Activation of contractionsActivation of contractions

Neans of cervical Neans of cervical maturationmaturation

ProstaglandinsProstaglandins ( (cerviprostcerviprost, , prepidil-gelprepidil-gel)),, intracervical,intracervical, n=106n=106

Laminaria, intracervical, Laminaria, intracervical, ((dilapandilapan)) n=114n=114

Step by step combination of gel Step by step combination of gel and laminaria and laminaria ((dilapandilapan)), n=80, n=80

Means of uterine Means of uterine contractionscontractions

naladornalador-500 (-500 (sulproston-sulproston-derivative of prostaglandin derivative of prostaglandin E2E2(«(«ScheringSchering», », GermanyGermany), ), n=250n=250

prostinprostin 15/М – 15/М – derivative of derivative of prostaglandin prostaglandin F2-F2-αα ((««UpdjohnUpdjohn»,»,USAUSA),),

n=50n=50

M.S.Burnhill indexes before and M.S.Burnhill indexes before and after tretmentafter tretment

0

1

2

3

4

5

6

before treatment after treatment

laminaria

cerviprost

combination

Duration of abortion depending on Duration of abortion depending on the means of cervical maturation the means of cervical maturation

(hrs(hrs).).

1-1-cerviprost,cerviprost,

2-2-laminaria,laminaria,

3-3-combinationcombination

01

23

45

67

89

10

1 2 3

Estradiol concentration in Estradiol concentration in peripheral blood of women in the peripheral blood of women in the dynamics of late induced abortion dynamics of late induced abortion

(nmol/l)(nmol/l)1,2-1,2- before abortion before abortion

3-3-cervical maturationcervical maturation

4,54,5- progress of late - progress of late abortionabortion

6-6-miscarriagemiscarriage

77-first day after -first day after abortionabortion

0

10

20

30

40

50

60

70

80

90

100

1 2 3 4 5 6 7

Placental lactogene Placental lactogene concentration in peripheral concentration in peripheral blood of women in the process blood of women in the process of late induced abortion of late induced abortion ((nmol/lnmol/l))

0

10

20

30

40

50

60

70

80

90

1 2 3 4 5 6 7

1,2-1,2-before abortionbefore abortion

3-3-cervical maturationcervical maturation

4,5-4,5-progress of late progress of late abortionabortion

6-6-miscarriagemiscarriage

7-7-first day after first day after abortionabortion

Cortisol concentration in peripheral Cortisol concentration in peripheral blood of women in the dynamics of blood of women in the dynamics of

late induced abortion (nmol/l)late induced abortion (nmol/l)

0

200

400

600

800

1000

1200

1400

1 2 3 4 5 6 7

1,2-1,2-before abortionbefore abortion

3-3- cervical maturation cervical maturation

4,5-4,5-progress of late progress of late abortionabortion

6-6-miscarriagemiscarriage

7-7-first day after first day after abortionabortion

17-а-17-а-oxiprogesteron concentration oxiprogesteron concentration in peripheral blood of women in the in peripheral blood of women in the dynamics of late induced abortion dynamics of late induced abortion

(nmol/l)(nmol/l)

0

2

4

6

8

10

12

14

16

18

1 2 3 4 5 6 7

1,2-1,2- before abortion before abortion

3-3- cervical maturation cervical maturation

4,5-4,5-progress of late progress of late abortionabortion

6-6-miscarriagemiscarriage

7-7-first day after first day after abortionabortion