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  • Title: Midtrimester abortion by hypertonic saline instillation experience in Ramathibodi Hospital.
    Author: Suthutvoravut S, Supacharapongkul V, Bhiromswasdi S.
    Journal: J Med Assoc Thai; 1983 Mar; 66(3):176-82. PubMed ID: 6854178.
    Abstract:
    A retrospective study of midtrimester abortions using the intraamniotic instillation of hypertonic saline solution was conducted. All 62 cases admitted to the Ramathibodi Hospital in Bangkok, Thailand for midtrimester abortion in 1980 were terminated by intraamniotic hypertonic saline instillation. The pregnancies were unwanted in 32 (51.6%) of the cases because of family problems, poor socioeconomic status, and deteriorated psychological health. 15 cases (24.2%) were preganancy from rape; 9 (14.5%) had rubella infection during the 1st trimester; and 3 cases (4.8%) were mentally retarded. There was 1 case of renal staghorn calculi post nephrostomy, 1 of multiparity with history of hemophilia in the family, and 1 of failed IUD contraception. The women were between 16-25 years of age in 39 cases, aged 15 or under in 4 cases (6.5%), and over age 35 in 4 cases. In 49 cases (79%) abortion was performed during 16-20 weeks gestation, in 12 cases (19.1%) at 21-24 weeks, and in 1 case at 25 weeks of gestation. The time interval from hypertonic saline instillation to abortion was analyzed in order to evaluate the effect of parity, amount of amniotic fluid withdrawn, and oxytocin augmentation. The mean instillation to abortion time (I-A) was 30.19 +or- 11.25 hours. There were 3 cases which did not receive oxytocin and who spontaneously aborted within 24 hours. Among cases which received oxytocin augmentation, there were 9 who received oxytocin immediately after instillation and 50 who received it 18-24 hours later. The I-A time was 31.22 +or- 11.63 hours in the group that received oxytocin immediately and 31.09 +or- 10.68 in the group receiving it later. There was no statistical difference between the 2 groups. Among the 50 cases which received oxytocin augmentation 18-24 hours later, there was no statistical difference between groups of nulliparity and multiparity. There were 46 cases in which the amount of amniotic fluid withdrawn was noted. In the group in which more than 200 ml of amniotic fluid was withdrawn, the I-A time was 26.81 +or- 7.28 hours. In comparison to the group in which less than 50 ml of amniotic fluid was withdrawn, the I-A time was 28.88 +or- 16.24 hours. There was no statistical difference between the 2 groups. The longer I-A times were found in groups in which 51-1000 ml and 151-200 ml of amniotic fluid were withdrawn. The most common complication was retained placenta (8 cases). There was only 1 case of hemorrhage. There were 2 cases of fever and 1 case of nausea and vomiting. On follow-up of 46.8% of the cases, 2 cases of cervicitis and 3 cases of vaginitis were found and treated with antibiotic suppositories.
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