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  • Title: Comparative study of midtrimester termination of pregnancy using hypertonic saline, ethacridine lactate, prostaglandin analogue and iodine-saline.
    Author: Allahbadia G.
    Journal: J Indian Med Assoc; 1992 Sep; 90(9):237-9. PubMed ID: 1460314.
    Abstract:
    The study consisted of terminations of 200 cases of second trimester pregnancies ranging from 14 weeks to 20 weeks. Out of these 200 cases, in 50 cases intra-amniotic instillation of 20% hypertonic saline (200 ml) was done after withdrawing 35-200 ml of amniotic fluid. Ethacridine lactate was instilled in 50 cases extra-amniotically. Prostaglandin F2 alpha was injected intramuscularly at regular intervals in 50 cases. Fifty cases of pregnancies were terminated with extra-amniotic instillation of 5% povidone-iodine solution mixed with normal saline. Comparison was made among all the methods regarding instillation-abortion interval, completeness of abortion, failure of the procedure and postoperative complications. Solution of 5% povidone-iodine in normal saline was found to be comparable in all aspects to other methods and above all a much cheaper alternative for poor patients. Success rate was highest with iodine-saline solution (100%) followed by ethacridine lactate (98%), hypertonic saline (96%) and lowest with prostaglandin F2 alpha (90%). In 1989-90 in India, physicians used 4 different methods to induce second trimester abortion (14-20 weeks gestation) in 200 women at the Lokmanya Tilak Municipal General Hospital in Sion in Bombay. In 50 women each, they introduced 200 ml of 20% hypertonic saline into the amniotic sac, after removing 35-200 ml of amniotic fluid; 150 ml of ethacridine lactate extraovularly; prostaglandin F2 intramuscularly at regular intervals; and a cupful of 5% povidone-iodine topical solution in 150 ml of sterile normal saline extraamniotically. Intravenous oxytocin drip was started the morning after induction in all but those women receiving prostaglandin F2 to reduce the induction-abortion interval. 5% povidone-iodine solution successfully induced abortion in 100% of cases. The success rates for ethacridine lactate, hypertonic solution, and prostaglandin F2 were 98, 96 and 90%, respectively. Ethacridine lactate had the highest complete abortion rate (42%) followed closely by 5% povidone-iodine (39%). Prostaglandin F2 resulted in the shortest mean induction-abortion interval (20 hours vs. 38 hours for hypertonic solution, 30 hours for ethacridine lactate, and 32 hours for 5% povidone-iodine solution. 4 (8%) of the 50 women who underwent an abortion induced by hypertonic solution required a blood transfusion. Another woman undergoing hypertonic solution abortion developed disseminated intravascular coagulation and died. The only women who experienced vomiting and loose stools were women receiving prostaglandin F2 (30 women [60%]). The most cost-effective abortion method was 5% povidone-iodine solution in normal saline, indicating that this is the preferred method for poor patients.
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