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  • Title: [Transcervical extraamniotic Rivanol instillation as a method of avoiding complications in pregnancy interruption].
    Author: Barthel R, Stockhammer P, Haensel W.
    Journal: Fortschr Med; 1978 Sep 21; 96(35):1767-70. PubMed ID: 738689.
    Abstract:
    The number of abortions performed is steadily increasing. According to information available to date from the Federal Statistics Office in the Federal Republic of Germany, pregnancies are still largely terminated by means of cervical dilatation with Hegar dilatators and subsequent curettage. Almost half of all abortions are performed in young women who have not yet given birth. In a great number of cases these patients have a gracile, rigid cervical os which has to be opened abruptly in a few minutes with Hegar's dilatators, often under asserting quite some force. This can result in lacerations of the cervix, cervical insufficiency, inflammation and cicatrization. The transcervical extraamnial Rivanol instillation seems to be a method for avoiding these early and the serious late complications ensuing. Using this method--an alternative to the Prostaglandine application, with its even more serious secondary effects and contraindications--the highest possible degree of success can be achieved in avoiding cervical injuries and in reducing inflammation in the pelvis minor to a minimum, which could later on lead to sterility. Transcervical extraamnial Rivanol instillation (TERI) was performed on 400 women. A Foley catheter was inserted through the cervical canal between the uteral wall and the amniotic cavity. 60-120 ml of .1% Rivanol was then instilled extraamnially, depending on the length of pregnancy. After 24 hours, the cervical canal had dilated spontaneously up to Hegar 12, allowing vacuum aspiration without danger of cervical lesions. 13% of the 400 abortions were performed by vacuum aspiration without TERI on nulliparae less than 8 weeks pregnant. TERI with spontaneous expulsion was used in 9% of the cases, for pregnancies after the 12th week. Hysterectomy was performed in 5% of the cases, and in the remaining 73%, TERI and vacuum aspiration were performed. A complication rate of 7.75% was reported: 1 cervical lesion, 7 cases of inflammation of the pelvis minor, 14 cases of bleeding in excess of 400 ml, and 9 cases of fever above 38 degrees C. This method shows advantages over Hegar dilatation or prostaglandin-induced abortion.
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