Intraamniotic ethacridine lactate instillation versus vaginal PGE1 in second trimester termination of pregnancy.
OBJECTIVE
To report on our experience with intraamniotic injection of ethacridine lactate (EL) for second trimester termination of pregnancy (TOP) and to compare its effectiveness with vaginal PGE1 in this setting.


METHODS
(a) Retrospective analysis of 54 intraamniotic EL-induced TOP. (b) Matched pair analysis of 50 second trimester TOP, using intraamniotic EL in group A (n=25) and vaginal PGE1 suppositories in group B (n=25).


METHODS
success rate, induction-delivery interval, analgesic use, drop in maternal hemoglobin, complications.


RESULTS
(a) TOP with EL alone was successful in 50 cases (93%). Mean duration from instillation to delivery was 40.5 h (range 14-58, S.D.: +/-9.0). Mean analgesic need was low. Mean drop in hemoglobin was low (1.0 g/dl, S.D.: +/-1.1). (b) The matched pair analysis revealed a significantly shorter induction-delivery interval in the vaginal PGE1 group (mean 26.9 h, range 8-80, S.D.: +/-16.8 versus 41.0 h, range 24-55, S.D.: +/-7.3, p<.05). There were no significant differences in analgesic use or drop in hemoglobin. In both groups one case of post partum hemorrhage occurred.


CONCLUSIONS
Intraamniotic instillation of ethacridine lactate in second trimester TOP is safe, cheap and successful in the vast majority of cases. Disadvantages are the longer induction-delivery interval compared to modern prostaglandins and the invasive mode of application. However, by the use of EL the side effects of repeated prostaglandin application can be avoided as well as multiple vaginal examinations. Furthermore, the time of delivery can be predicted in a narrower interval.
Berg
Christoph
C
Department of Obstetrics and Prenatal Medicine, Center for Obstetrics and Gynecology, Rheinische Friedrich-Wilhelms-Universität, Sigmund-Freud-Str. 25, 53105 Bonn, Germany. christoph.berg@ukb.uni-bonn.de
Ludwig
Michael
M
Sturm
Nina
N
Diedrich
Klaus
K
Gembruch
Ulrich
U
Geipel
Annegret
A
D000019:Abortifacient Agents / Q000008:administration & dosage*; D000028:Abortion, Induced / Q000379:methods*; D000282:Administration, Intravaginal; D000527:Alprostadil / Q000008:administration & dosage*; D000650:Amnion; D004975:Ethacridine / Q000008:administration & dosage*; D005260:Female; D005858:Germany; D005865:Gestational Age; D006801:Humans; D007267:Injections; D008499:Medical Records; D011183:Postoperative Complications; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D012189:Retrospective Studies; D016896:Treatment Outcome
D000019:Abortifacient Agents; D000527:Alprostadil; D004975:Ethacridine