Noninvasive controlled abortion in the trimester of pregnancy (a 15-years experience) N.V.Оrdzhonikidze, B.L..Gurtovoi, N.М.Каsаboulatov Research centre of Obstetrics, Gynecology & Perinatology Russian Academy of Medical Sciences High Risk Pregnancy Dept

Main trends Main trends Search for reasonable conservatism Search for reasonable conservatism Maximum safety Maximum safety Limited operative intervention Limited operative intervention

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

Stages of noninvasive controlled abortion in the II trimester Maturation of the uterine cervix Maturation of the uterine cervix Activation of contractions Activation of contractions

Neans of cervical maturation Prostaglandins (cerviprost, prepidil- gel), intracervical, n=106 Prostaglandins (cerviprost, prepidil- gel), intracervical, n=106 Laminaria, intracervical, (dilapan) n=114 Laminaria, intracervical, (dilapan) n=114 Step by step combination of gel and laminaria (dilapan), n=80 Step by step combination of gel and laminaria (dilapan), n=80

Means of uterine contractions nalador-500 (sulproston-derivative of prostaglandin E2(«Schering», Germany), n=250 nalador-500 (sulproston-derivative of prostaglandin E2(«Schering», Germany), n=250 prostin 15/М – derivative of prostaglandin F2-α («Updjohn»,USA), prostin 15/М – derivative of prostaglandin F2-α («Updjohn»,USA), n=50 n=50

M.S.Burnhill indexes before and after tretment

Duration of abortion depending on the means of cervical maturation (hrs). 1-cerviprost, 2-laminaria, 3-combination

Estradiol concentration in peripheral blood of women in the dynamics of late induced abortion (nmol/l) Estradiol concentration in peripheral blood of women in the dynamics of late induced abortion (nmol/l) 1,2- before abortion 3-cervical maturation 4,5- progress of late abortion 6-miscarriage 7-first day after abortion

Placental lactogene concentration in peripheral blood of women in the process of late induced abortion (nmol/l) Placental lactogene concentration in peripheral blood of women in the process of late induced abortion (nmol/l) 1,2-before abortion 3-cervical maturation 4,5-progress of late abortion 6-miscarriage 7-first day after abortion

Cortisol concentration in peripheral blood of women in the dynamics of late induced abortion (nmol/l) 1,2-before abortion 3- cervical maturation 4,5-progress of late abortion 6-miscarriage 7-first day after abortion

17-а-oxiprogesteron concentration in peripheral blood of women in the dynamics of late induced abortion (nmol/l) 1,2- before abortion 3- cervical maturation 4,5-progress of late abortion 6-miscarriage 7-first day after abortion