Indications
1. Failed second trimester abortion with conventional therapy (intra-amniotic PGF2α, oxytocin).

2. Termination of pregnancy in late second trimester and third trimester in cases with minimal or no amniotic fluid.

3. Refractory postpartum or post-abortal bleeding.

Advantages of Carboprost Versus Other Prostaglandins and Oxytocin

1. Higher potency allows more individualized dosing compared with intra-amniotic methods.

2. IM administration is less painful, easier, and less invasive, which reduces the risk of infection.

3. Carboprost can be used with ruptured membranes or in other situations with reduced amniotic fluid volume.

4. Carboprost allows the patient to be ambulatory for a longer period of time.

5. The non-term uterus responds to carboprost; therefore, induction of labour with intra-uterine demise can occur prior to spontaneous labour.

Disadvantages.  These   include   significant   vomiting   and diarrhea.

(e) Concentrated Oxytocin Infusion
Oxytocin has not been commonly used for abortion induction because it was thought not to be efficacious in gestations less than 24 weeks.  However,  administered with increasing concentration, oxytocin has been efficacious in achieving second trimester termination. Oxytocin 50 units in 500 mL 5% dextrose and normal saline is given over three hours, followed by one hour of rest. This is repeated, adding 50 additional units to the next 500 mL of infusion, and the pattern of infusion over three hours followed by one hour of rest is continued until the patient aborts or the maximum concentration of 300 units/500 mL is reached.

The mean induction to delivery interval is 8.2 plus or minus 5.1 hours.

(f) Misoprostol
Misoprostol can be used either orally or vaginally for uterine evacuation for fetal demise or second trimester termination; however, oral administration is associated with more GI side effects, such as nausea and diarrhea.