Plancental Abruption Following Vaginal Administration of Prostoglandin E2 for Induction of Labour

cervix is still unclear and this action is independent of their stimulant ction on uterine muscle. We have used vaginal pessaries (Prostin E2) containing 2 mgs of Prostaglandin (prepared by our pharmacy) in patients for induction of labour, when the Bishop score was <7 (Bishop 1964) (1). Such usage of Prostin pessaries, under medical supervision, is generally unattended with any known major complications, either in the mother or the baby when given in this routine way. We recently had to deal with an adverse incident in our hospital where administration of 4 milligrams of PGE2 may have caused a significant placental abruption causing severe fetal distress in a previously uncompromised fetus. CASE REPORT Mrs D.C., a 23 year old primigravida, was admitted for an elective induction of labour at the end of the 42nd week of pregnancy. She had an uneventful course in pregnancy until the 40th week when she had complained of bilateral ankle oedema but no other symptoms. She was briefly hospitalised for 24 hours for investigations and observation. Her blood pressure at this stage was 130/70 mg Hg. Her blood pressure at 16 weeks, at antenatal booking was 120/60 mm Hg. The following investigations were performed on her while she was in hospital:-24 hour urine, total protein 0.51 gram/litre and 0.8 gram/24 hours in a volume of 1640 ml. Haemoglobin ll.Ogram/dl, Platelet count 286 x 10y/L, Serum electrolytes, serum urea and urate were within normal range. Cardiotographs showed normal reactive trace. Her general condition and blood pressure remained stable and she returned for planned induction of labour. On the day of induction of labour at 0600 hours, vaginal examination indicated an unfavourable cervix (Bishop score 3). PGE2 2x2mg pessaries were inserted into the vaginal