Clinical analyses of 66 cases of mid-trimester pregnancy termination in women with prior cesarean / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The rate of cesarean delivery has significantly increased in China in the last decade. Women with prior cesarean history tend to have a higher risk of uterine rupture during termination of the pregnancy in mid-trimester than those without such a history. The aim of our study was to evaluate the influences of the potential risk factors on uterine rupture in women with prior cesarean.</p><p><b>METHODS</b>We conducted this retrospective study of women with prior cesarean section, who underwent mid-trimester pregnancy termination between January 2006 and December 2013 in Peking Union Medical College Hospital. The protocol was oral administration of mifepristone and misoprostol for the patients with the gestational ages below 16 weeks or intra-amniotic injection of ethacridine lactate (EL) for those with at least 16 weeks of gestational ages. The thickness of the lower uterine segment (LUS) was measured before the termination of pregnancy. Logistic regression was used to study the risk factors of uterine rupture.</p><p><b>RESULTS</b>The total rate of successful abortion was 93.9% (62/66). Four patients failed in induction, and one of them received curettage, whereas the other three experienced uterine rupture (4.5%). The successful rates of abortion were 85.7% (30/35) for women treated with mifepristone-misoprostol and 86.1% (31/36) for those treated with EL. There was a significant difference in the mean LUS thickness between the uterine rupture group (3.0 ± 2.0 mm) and the nonrupture group (7.0 ± 3.0 mm) (P < 0.05). The LUS thickness of <3 mm was associated with uterine rupture during mid-trimester pregnancy termination in women with prior cesarean (odds ratio, 94.0; 95% confidence interval 4.2-2106.1) after adjusted maternal age, gestational age, interdelivery interval and prior cesarean section. Severe bleeding that required transfusion occurred in one case (1.5%).</p><p><b>CONCLUSIONS</b>Both the mifepristone-misoprostol and the EL regimens were effective and safe for the termination of mid-trimester pregnancy in women with prior cesarean. A thinner LUS is associated with a relatively high risk of uterine rupture.</p>

Effectiveness and safety of double-balloon catheter versus intra-amniotic injection of ethacridine lactate for termination of second trimester pregnancy in patients with liver dysfunction / 华中科技大学学报（医学）（英德文版）

Severe liver dysfunction in pregnancy (SLDP) is rare but serious complications with high mortality rate. This study compared the effectiveness and safety of double-balloon catheter versus intra-amniotic injection of ethacridine lactate for the termination of second trimester pregnancy in patients with SLD. A total of 55 patients with indications of labor induction were enrolled and analyzed by retrospective control analysis method. Twenty-three cases adopted Cook double balloon dilation as Cook group, and 32 cases received intra-amniotic injection of ethacridine lactate as EL group. The primary outcome was evaluated by successful abortion rate and the difference in the induction-to-abortion interval. Secondary outcomes included liver function recovery and the frequency of adverse events. Both Cook and EL regimens were effective, with successful abortion rate of 87.0% and 93.8%, respectively (P=0.639). The induction-to-delivery interval was similar between Cook group and EL group (38.1 ± 21.5 vs. 41.3 ± 17.4, P=0.543). The liver disease status was more severe in Cook group than in EL group, but it did not show any significant difference after pregnancy termination between the two groups and the improvement rate also did not show any significant difference. Both treatments were safe and there was no significant difference in bleeding and cervical laceration adverse events between the two groups. Our study firstly compared double-balloon catheter and ethacridine lactate for the induction of labor in women with SLD during second trimester pregnancy.

Comparison of combination of dinoprostone suppository and ethacridine and ethacridine alone for induction of mid term pregnancy / 中国医学科学院学报

<p><b>OBJECTIVE</b>To compare the effectiveness and safety of using the combination of dinoprostone suppository and ethacridine and ethacridine alone for the induction of mid-term pregnancy.</p><p><b>METHODS</b>The clinical data of 96 patients at 16-27+6 gestational weeks in Peking Union Medical College Hospital from March 2008 to December 2009 were retrospectively analyzed. Patients were divided into combination group (n=54) and ethacridine alone group (n=42) based on their induction methods. The efficacy and side effect were compared between these two groups after the induction.</p><p><b>RESULTS</b>The effectiveness rate was 70.4% (38/54) in the combination group,which was significantly higher than that in ethacridine alone group (4.8%) (2/42) (P=0.001). The durations of the first and second,and total stage of labor were found to be significantly shorter in combination group [(287∓39) and (513∓39) min)] when compared with ethacridine alone group [(546∓84) and (661∓82) min] (P=0.01). The bleeding volume in the combination group was (69∓4) ml, which was significantly less than that in control group (96∓7) ml (P=0.02). The two groups had no significant differences in terms of in-labor duration (P=0.45), postpartum placenta remnants (P=0.91), and fetal membrane remnants (P=1.31).</p><p><b>CONCLUSION</b>The combination of dinoprostone suppositories and ethacridine is more effective and safer than ethacridine alone for induction of mid-term pregnancy.</p>

Comparative study of midtrimester termination of pregnancy using hypertonic saline, ethacridine lactate, prostaglandin analogue and iodine-saline.

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%).

Midtrimester termination of pregnancy--search for a better method continues.

Every day a new method of termination of second trimester pregnancy clearly indicates that we have still not found a simple, safe, effective and economic method of termination of pregnancy in second trimester. Present study of 855 cases aims at searching out something better from available modalities. Age old hypertonic saline and ethacridine lactate were used with adjuvants like hyaluronidase and a preparation containing isapgol husk to reduce injection abortion interval and failures. Life threatening dangers of hypertonic saline are known. Ethacridine lactate seems to be safe. By giving it intra-amniotically with these adjuvants its major disadvantages could be minimised. There was no mortality. However, there was morbidity in the series.

Inducción del aborto tardío por el método de rivanol: informe de 100 casos / Induction of late abortion using rivanol: report of 100 cases

Durante el período de tiempo de 1977 a 1981 fueron analizadas las historias clínicas de 100 pacientes, a las cuales se les realizó la inducción del aborto en el trimestre medio y se utilizó el método de rivanol. Se recogen los datos referentes a la edad y paridad de las pacientes, tiempo gestacional en semanas, indicación del método, tiempo de expulsión y complicaciones derivadas del mismo. Se concluye que a pesar de ser la inducción del aborto tardío por el método de rivanol un proceder no exento de complicaciones, el mismo es efectivo y ofrece buenos resultados, específicamente después de la 16ta semana de gestación

Studies on Vasectomy: X. Immediate Sterilization Technique Following Vasectomy / 대한비뇨기과학회지

A new technique of immediate sperm clearance has been developed by killing and irrigating residual sperm in the distal ductal system following vasectomy with a spermicidal solution at the time of the operation. For this, biochemical study, histologic study, and clinical study were conducted ,and by this, the need for postoperative contraception, and the need for postoperative semen testing were eliminated. Among the various spermicidal solutions such as tap water, distilled water,KMnO4,acetic acid, lactic acid, rivanol, alcohol, the KMnO4 solution has been proved to be the most suitable for the spermicidal solution, through biochemical study and histologic study. About 10ml of the KMnO4 solution,0.5% were injected into the distal ductal system under pressure, and killed redisual sperm immediately after the application. Number of redisual sperm in the distal ductal systems was significantly reduced by the KMnO4 application. No complication nor harmful effects could be observed after the procedure.