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Mid‐trimester Abortion by Extraamniotic Emcredil Versus Normal Saline
Author(s) -
Zauva B.L.,
Gupta I.,
Dhall G.I.
Publication year - 1989
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1989.tb01747.x
Subject(s) - saline , medicine , abortion , contraindication , obstetrics , gestation , anesthesia , therapeutic abortion , pregnancy , gynecology , biology , alternative medicine , pathology , genetics
EDITORIAL COMMENT: Midtrimester abortion using hypertonic saline (20% sodium chloride) was used extensively in the I950's‐1960's and was abandoned because of maternal deaths associated with seizures, hypernatraemia and coagulation failure, presumably due to accidental intravenous injection of the solution (or its rapid absorption into the intravascular space) resulting in cerebral infarction or haemorrhage (1,2). Intraamniotic instillation of 20% NaCl or 50% glucose was advocated as late as 1966–1969 for induction of labour in cases of intrauterine death, missed abortion, or therapeutic abortion beyond 14 weeks' gestation (3,4). It should be emphasized that normal saline (0.9% sodium chloride) is a physiological, isotonic solution which should have no such ill‐effects. It is always difficult to judge 2 solutions such as described in this paper when the regimens are complicated by use of Syntocinon infusion, which was commenced in both study groups 2 hours after extraamniotic instillation of the 2 solutions whose abortificient actions were being compared. Nonetheless the authors achieved acceptable results with the normal saline‐Syntocinon regimen described here, which justify continued evaluation of the method in a larger series of patients. Second trimester abortion is unfortunately necessary in modern obstetrics and the great variation of published methods indicate that none is entirely satisfactory. Summary: Data is presented for 40 mid‐trimester abortions, induced by 0.1% Emcredil (Group 1 — 20 cases) and normal saline (Group 2 — 20 cases) by instillation in the extraamniotic space. It was observed that the 2 groups were comparable for age, parity and period of gestation. The mean induction‐abortion interval was 18 hours 9 minutes in Group 1 and 19 hours 19 minutes in Group 2. Abortion was complete in 45% and 65% in Group 1 and Group 2, respectively. With a cutoff time of 30 hours, there were 3 failures, 1 in Group 1 and 2 in Group 2. The induction‐abortion interval was significantly less in the more advanced pregnancies in the saline group. There was no complication in either of the 2 groups. It is hypothesized that normal saline also acts by damage of the decidual cells with liberation of pro‐staglandins locally. Also since normal saline is a cheap and easily available commodity with no contraindication for its use and no side‐effects, it seems to hold a lot of promise for induction of mid‐trimester abortion.