J Reprod Med
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Prostaglandin E2 vaginal suppositories are well established in the management of intrauterine fetal demise in the second trimester of pregnancy. However, approval for their use in the third trimester has been withheld pending evaluation of safety and efficacy. In this study 46 patients with intrauterine fetal demise in the third trimester were managed in a similar fashion except that only a 10-mg dose of prostaglandin E2 was employed. ⋯ It appears that prostaglandin E2 vaginal suppositories can be used safely in the management of fetal demise in the third trimester of pregnancy. Use of a lower dose of the medication as well as tocodynamometry is recommended because the absorption of and sensitivity to this medication vary from patient to patient. The frequency of administering the medication should depend on the patient's response rather than on any given formula.
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A predictable pattern of grief follows every perinatal death. Because of their lack of training in the area of death and bereavement, physicians have traditionally avoided acknowledging the grief process in patients who have experienced such a loss. Obstetricians must begin to recognize the appropriate intervention that needs to be instituted in the delivery room and postpartum period to help facilitate the normal grieving process. Physicians must also acknowledge and accept their own feelings of grief and helplessness following a perinatal death.