[Effect of rivanol-induced abortion on placental histology: pitfalls in pathological interpretations].

Objective: Placental pathology reflects the health condition of both mother and fetus during pregnancy, providing information about pathogenesis especially in adverse pregnancies, and may provide guidance on subsequent pregnancies. Description on the placental changes after long-term use of rivanol is lacking, and this evaluated the placental changes, with emphasis on the differential diagnosis from other primary placental lesions. Methods: A total of 85 placentas from rivanol induced abortion submitted to the Department of Pathology, Obstetrics and Gynecology Hospital of Fudan University from Januaury 2017 to October 2019 were reviewed; and 81 gestational-age-matched cases of spontaneous abortion or preterm delivery during the same period were also included as the control group. Diagnoses were based on the consensus statement of 2016 Amsterdam Placental Workshop Group. Statistical differences were analyzed by individual diagnostic terms. Results: The maternal age in rivanol group was (30.5±4.1) (range 22-41) years, compared with (30.9±4.3) (range 22-44) years in the control group. Gestational age was (23.2±3.5) (range 17-35) weeks and (23.3±2.8) (range 17-33) weeks in the rivanol and control groups. The incidence of chorioamnionitis in rivanol group was 91.8%, significantly higher than the control (63.0%, P<0.05); and there were more stage 1 (subchorionic) maternal response in rivanol than in the control (61.0% vs.28.6%, P<0.05) groups. In addition, acute deciduitis was also more common in rivanol group (27.1% vs. 13.6%, P<0.05). No significant difference was observed in fetal inflammatory responses (vasculitis of vessels in chorion plate and umbilical cord); maternal malperfusion (narrowing of intervillous space, increased intervillous fibrin deposition, decidual arteriopathy, villous infarction and retroplacental hematoma); and fetal malperfusion (villous stromal hemorrhage and avascular villi). Conclusions: The chemical chorioamnionitis caused by rivanol is characterized by maternal inflammatory response of low stage and high grade. The use of rivanol has no obvious impact on the fetal inflammatory response, maternal malperfusion and fetal malperfusion. Such morphologic changes may reflect the original placental lesions.

Effect of Bathing in a 0.1% Aqueous Solution of Ethacridine Lactate on Selected Physiological Parameters of Cornu Aspersum Müller Edible Snails.

INTRODUCTION: The prohibition of antibiotic use in edible snails obligates breeders to treat bacterial infections by different means, of which a common one is a bath in Gram-positive- and partially Gram-negative-bactericidal ethacridine lactate solution. The aim of the study was to determine the effect of bathing Cornu aspersum Müller snails in a 0.1% aqueous solution of ethacridine lactate on selected physiological parameters of haemolymph. MATERIAL AND METHODS: The study included 80 snails, divided into two equal groups (study and control). The study group was subjected to bathing in ethacridine lactate and the control group to bathing in tap water. Both groups were treated daily for seven days. The number of haemocytes in the haemolymph, the activity of alanine (ALT) and aspartate (AST) aminotransferases, and the concentration of urea were determined. RESULTS: In the study group, after exposure to ethacridine lactate solution an increase in ALT activity, changes in the De Ritis ratio, an increase in the amount of haemocytes, and a decrease in body weight were found. No such changes were detected in the control group snails or in animals after the first bath. CONCLUSION: Multiple applications of a 0.1% ethacridine lactate bath may adversely affect Cornu aspersum Müller snails.

Clinical analysis of different ways to terminate pathological pregnancy / 中国综合临床

Objective To compare the clinical effects of different labor induction methods in the termination of intermediate pathological pregnancy. Methods From January 2015 to December 2016,ninety?two cases of intermediate ( 11-16 weeks ) pathological pregnancy were treated in Huangyan Hospital of Wenzhou Medical University. The patients were treated with different intermediate labor induction program to terminate their pregnancy. Among them,29 cases were treated with mifepristone combined with water bag abortion ( group A) ,47 patients with mifepristone and misoprostol induction( group B) ,16 cases with single rivanol ( group C) . The successful rate of labor induction and the labor induction related indexes ( the onset time of contraction,the total duration of labor,the total amount of bleeding in the hospital,the volume of bleeding in the perioperative period) , the rate of postpartum re?curettage and the adverse events after birth of the two groups were compared. Results The successful rates of labor induction in the three groups were 93. 10% (27/29),100%(47/47) and 87. 50% (14/16) respectively,the difference among the groups was statistically significant (χ2=8. 502,P<0. 05). The onset time in group A was (4. 61±2. 15) h,in group B it was (3. 68±2. 10) h,in group C it was (5. 85±2. 30) h,the difference among the 3 groups was statistically significant (F=6. 05,P =0. 025). The total duration of labor in group A was (10. 45±3. 21) h,in group B was (7. 50±3. 40) h,in group C was (14. 60±4. 89) h,the difference among the 3 groups was statistically significant (F=7. 48,P =0. 013). The total hospitalization time in group A was (4. 70 + 2. 33) d,in group B was (2. 80±1. 7) d,in group C was (6. 05±2. 50) d,the difference among the 3 groups was statistically significant (F=10. 23,P =0. 011). The perioperative bleeding volume in group A,B,C were (64. 88±20. 50) ml,(40. 10±15. 26) ml,(91. 50±31. 73) ml,respectively,the difference was statistically significant (F=8. 70,P=0. 020). The rate of postpartum re?curettage in group A was 7 cases (24. 10%),in group B was 6 cases (12. 80%),in the group C was 9 cases ( 56. 30%) ,the difference was statistically significant (χ2=20. 40,P=0. 003) . The incidence of adverse events in group A and group B were all 0,and in the group C,it was 3 cases ( 18. 75%) ,the difference was statistically significant (χ

Surgical way of pregnancy termination for patients with placenta previa during midtrimester / 局解手术学杂志

Objective To investigate the effect of rivanol induction on pregnancy termination for patients with placenta previa during midtrimester.Methods From January 2010 to December 2015,16 patients of placenta previa underwent pregnancy termination induced by rivanol during midtrimester were regarded as the observation group, and 22 patients with normal placental position were regarded as the control group.The delivery time,amount of postpartum hemorrhage within 24 hours,one-time success rate of induced abortion,caesarean due to massive haemorrhage and postoperative infection of the two groups were recorded to analyze the clinical effect of rivanol.Results There was no statistically significant differences in the success rate,delivery time and caesarean due to massive haemorrhage between the two groups(P>0.05).The amount of intrapartum and postpartum hemorrhage in the observation group was more than that of the control group,with a statistically significant difference(P<0.05),but it was less than 500 mL,which did not significantly increase the related risk for patients.Conclusion Induced abortion by rivanol is a simple,safe and effective method for patients with placenta previa during midtrimester with fewer side effects and less trauma,which is the preferred method for such patients.

Study on psychological intervention on the treatment of the patients with rivanol induced labor in late pregnancy with depressive / 中国生化药物杂志

Objective To investigate psychological intervention on the treatment of the patients with rivanol induced labor in late pregnancy with depressive.Methods From March 2014 to February 2017 in Shaoxing central hospital, 54 cases with late pregnancy as the research object, who were induced labor to terminate pregnancy with rivanol because severe fetal deformity.According to the wishes of this patients, they were randomly divided into the control group and the observation group, 27 cases in each group.The control group were received conventional nursing, at this basis, the observation group were given psychological intervention.Hamilton Depression Scale(HAMD) score in the two groups were observed and compared before and after nursing intervention.Results After nursing intervention, the depression scores were decreased significantly(P<0.05), and the depression scores in the observation group decreased significantly than that in the control group(P<0.05).Conclusion The psychological nursing intervention for patients in late pregnancy with depression Noel induced labor in late pregnancy who were induced labor to terminate pregnancy with rivanol has important significance in the peri operative treatment, which can effectively reduce the negative emotions, improve the prognosis, and is worthy of clinical application.

Comparison of the clinical effects of three artificial abortion methods in mid-term pregnancy / 中国综合临床

Objective To compare the effects of three artificial abortion methods, Mifepriston with Misopro-fil,Rivanol with Mifepristone and Rivanol,in mid-term pregnancy. Methods 235 women who were pregnant for 12 to 28 weeks and volunteered to abort with drugs were selected and observed. The total subjects were randomly divided into three groups,study group Ⅰ (n=80),study group Ⅱ (n=78),and control group (n=77). In study group Ⅰ, each was given Mifepristone 50 mg, po, bid, for 3 days. On the fourth day, Misoprofil 200-1000 μg was administered though vagina. In study group Ⅱ, Rivanol(70-100 mg) was injected into amniotic cavity and at the same tame, Mife-pfistone,75 mg was given bid,po,for each case for 1 day. In study group Ⅲ,each case was injected with Rivanol (70-100 nag) only into amniotic cavity. Results The complete abortion rate in study group Ⅰ, Ⅱ and Ⅲ was 88.75% (71/80), 65.38% (51/78), 38.96% (30/77) respectively. The success rate was 98.75% (79/80), 71.79% (56/78),76.62% (59/77) respectively. The mean time from the initial uterine contraction to the expulsion of the fetus and placenta was (6.85±3.68) h, (8.87±3.58) h, (14.67±3.50) h respectively. The volume of in-trapartum and postpartum vaginal hemorrhage within 2 hours was (80.86±40.28) ml, (94.70±42.35) ml, (120. 68±43.30)ml respectively. The complete abortion rate and success rate in study group Ⅰ was significantly greater than that in study group Ⅱ and study group Ⅲ. In addition, the birth process was shorter and the vaginal hemorrhage was less significantly in study group Ⅰ than those in the other two groups (P<0.01). The complete abortion rate in study group Ⅱ was significantly greater than that in study group Ⅲ (P<0.01). Conclusions Mffepristone admin-istered with Misoprpfil has many advantages usages, such as high complete abortion rate and success rate, short birth process, and less volume of vaginal hemorrhage, when used for artificial abortion in mid-term pregnancy. They are es-pecially suitable for the mid-term artificial abortion under 20-week pregnancy. Rivanol administered with Mifepristone can raise complete abortion rate,shorten labor process and decrease vaginal hemorrhage when they are used in artifi-cial abortion. They are suitable for the mid-term artificial abortion above 16-week pregnancy. The stage of labor lasts long when using only Rivanol for artificial abortion. The pain is relatively heavier and the rate of incomplete abortion is higher.

Clinical study on termination of second-trimester gestation using different doses of combined mifepristone-miso- prostol regimen / 中国基层医药

Objective To evaluate the using of either 225 or 150 microgrammes of mifepristone combined with misoprostol for termination of second-trimester gestation(16～24 weeks).Methods 180 women requesting voluntary induced abortion during gestation 16～24 weeks were randomised to three groups,group 1:oral mifepris- tone 225rag,group 2:oral mifepristone 150mg,and group 3:injected 100rag rivanot by amniocentestis.The total suc- cess rate,once success rate,the interval of having-medicine to uterine-constraction,the volume of bleeding within 2 hours after labour and cervical laceration rate were observed.Results The once success rate of induced labour in group 1 was higher than that in group 2 and group 3(P

Study on the Influence of Antioxygens on Stability of Rivanol Solution / 中国药房

OBJECTIVE:To observe the influence of antioxygens(sodium hydrogen sulphite,sodium thiesulfate,disodium edetate)on the stability of rivanol solution.METHODS:The rivanol content was determined by UV-spectrophotometry,and the stability of the rivanol solutions containing different antioxygens was observed by accelerated test.RESULTS&CON?CLUSION:Sodium hydrogen sulphite,sodium thiesulfate and EDTA can not improve the stability of rivanol solution and sodi?um thiesulfate can reduce the stability of rivanol solution.

Uterine contractility during pregnancy and the effect of abortifacient drugs.

There are a number of compounds in clinical use for termination of pregnancy. Treatment with all of them will result in increased uterine contractility. PGF2 alpha and PGE2 as well as different prostaglandin analogues all have a direct stimulatory effect on the myometrium, while other compounds such as hypertonic saline and Rivanol seem to act mainly through a stimulation of the endogenous production of PGF2 alpha. Treatment with antiprogestins which compete with progesterone at the receptor level or which inhibit progesterone biosynthesis results in an increased uterine contractility probably through a release from progesterone inhibition. If the withdrawal of progesterone also induces an increased endogenous prostaglandin production is unclear. The medical method to induce abortion which best resembles the physiological events during a spontaneous abortion is probably treatment with antiprogestins (receptor blockers or progesterone biosynthesis inhibitors) followed by prostaglandin.

PIP: Factors regulating uterine activity during pregnancy and parturition or abortion, and pharmacological manipulation of uterine activity are the subject of this review. The uterus is normally quiescent during pregnancy. Prostaglandins (PGs) are regarded as intrinsic simulators of uterine contractility: endogenous PGs are correlated with initiating of labor, and considered the last step in the course of events leading to labor. Progesterone is regarded as a local regulator of uterine sensitivity to other oxytocics. OXytocin is not effective alone as a uterine stimulant until the uterus is already stimulated. It binds to receptors in the decidua which promote local PG synthesis. The natural PGs, PGF2alpha and PGE2 stimulate uterine tonus rapidly, eventually leading to onset of regular contractions if administration is continued. PG analogs used routinely in several countries are gemeprost (May & Baker, Dagenham, UK), carboprost (Upjohn, Kalamazoo, USA), and sulprostone (Schering, Berlin). There are more potent, more specific to the uterus rather than the gastrointestinal tract, and can be given by routes other than intravenous. Antiprogestins e.g., RU-486, and progesterone synthesis inhibitors e.g., epostane, act on the myometrium by converting it to a reactive or spontaneously active organ. These agents will terminate early pregnancy if given with PGs. Both hypertonic saline and Rivanol, long used as 2nd trimester abortifacients, act by initiating decidual regression and PG release.

Intrauterine administration of drugs for termination of pregnancy in the second trimester.

Medical methods have been used for many years to terminate mid-trimester pregnancy, ranging from irritant chemicals and traditional plants to ecbolic agents and solutions instilled locally into the uterus. These methods had serious limitations, with relatively high rates of maternal mortality and morbidity. Surgical evacuation requires special skills not available to all practitioners and many doctors consider second trimester dilatation and evacuation as a surgical taboo. In recent years several approaches evolved and reached the clinics, presenting safer and more effective options. Intra-amniotic instillation of hypertonic solutions, particularly saline or urea, proved in many hands to be a good method for pregnancies beyond 15 weeks of gestation. Due to a long latency period after instillation, these agents are often supplemented by an intravenous oxytocin infusion. Extraovular hypertonic saline or ethacridine (Rivanol) have their advocates, particularly in the grey-zone of pregnancy range from 13-15 weeks. In the last two decades, intrauterine prostaglandins were added to the methods in current use. Extra-amniotic prostaglandins (E2, F2 alpha or 15-methyl F2 alpha) were originally given in repeated doses or as a continuous local drip, but later a single instillation was used, usually mixing the drug with a viscous solution or gel. Intra-amniotic prostaglandins, in much higher doses, particularly the 15-methyl analogue, proved highly effective and relatively safe, especially when combined with laminaria tent insertion in the cervix. Various combinations of methods have provided a wide spectrum of data which is difficult to evaluate at present. Studies comparing different methods were mainly attempted in the mid-seventies. The outcome raised many pertinent questions and left many major issues unresolved. Most of the comparisons were not randomized or well-controlled and only referred to the natural prostaglandin compounds. The analogues, however, seem to offer several advantages and the role of additional methods such as laminaria or antiprogestins remains to be further evaluated.

PIP: There are several medical methods of inducing 2nd trimester abortion, each with merits and drawbacks, difficult to compare, especially when supplemental techniques are used. Drugs used are hypertonic saline, urea, natural and synthetic prostaglandins (PGs), mannitol, formalin, ethacridine lactate (Rivanol) and others for intraamniotic route; saline, PGs, Rivanol, utus paste and other extraamniotically; and the above methods combined with oral antiprogestins, iv oxytocics, in or intravaginal PGs, or mechanical cervical dilators. Few double-blind studies exist comparing drugs. About 50,000 mid-trimester abortions are done in the US yearly, about 10% of all terminations, but these cause 2/3 of all complications and half of the deaths. Saline can be used after 15 weeks, can cause hypernatremia or coagulopathy, and takes up to 72 hours unless augmented with ocytocin and/or laminaria. Urea may have less risk of coagulopathy. Rivanol is considered safer than both in some countries, e.g., Scandinavia, Eastern Europe, Israel, India and Japan. It can be instilled transcervically. Various intrauterine PGs have been compared in several doses and routes by WHO Task Force research groups and others. Extraamniotic PGs require a lower dose, cause fewer cervical lacerations, and can be used when membranes are ruptured, in molar pregnancy, at Weeks 13-15, and in cases of fibroids. This route is somewhat less effective than intraamniotic PGs, and may require multiple doses. Intraamniotic PGs act slower but are more effective, after only 1 dose. Laminaria speed up the process, but adding oxytocin increases risk of injury. PGs may be safer than saline, especially if intramuscular route is used, because there is no danger of coagulation, cardiovascular, renal or hypernatremic complications or inadvertent injection. It is possible that some of the higher complications attributed to PGs are related to selection of patients with more severe medical conditions. PGs are more expensive, and require medication for side effects.

Medical management of abnormal pregnancy.

PIP: Medical termination of abnormal pregnancy requires specific techniques since some conditions make therapy more effective, e.g., missed abortion intrauterine death and molar pregnancy, and others less so, e.g. anencephalic pregnancy. In all cases it is best to terminate the pregnancy as soon as possible to reduce anguish and risks of complications such as consumptive coagulopathy. Oxytocin is not consistently effective, but intraamniotic rivanol has oxytocic properties, and prostaglandins (PGs) are effective by several routes. Surgical methods are more popular in Japan and the US. A diagnostic flow chart is included and described. For missed abortion and fetal death vacuum aspiration or dilatation and evacuation are appropriate for early pregnancy, or PGs are used for later pregnancy, unless there are medical contraindications. Anencephalic pregnancy, usually diagnoses in 2nd or 3rd trimester, is resistant to medical therapy and must often be terminated by cesarean section. Molar pregnancy can be managed with vacuum aspiration at any length of gestation, but must be completed by curettage. Intraamniotic PGs are not advised for mole or fetal death. PG analogs can be administered intramuscularly, or vaginally in gel form. Other types of abnormal pregnancy that can be managed with PGs are spina bifida, hydrocephalus, hydrops fetalis, Dandy-Walker syndrome and Down's syndrome. Tubal pregnancy can be evacuated with intratubally administered PGs under laparoscopic control, thereby preserving tubal integrity.^ieng

Lack of coagulation defects after the intraamniotic instillation of ethacridine (Rivanol) for second trimester abortion.

Second trimester abortion was induced by the intraamniotic infusion of ethacridine. Coagulation studies revealed no change in 10 cases. It is felt that the intraamniotic use of ethacridine is probably safe.

PIP: Coagulation assays in 10 women in whom 2nd-trimester abortion was induced through intra-amniotic infusion of ethacridine (Rivanol) suggested a lack of negative side effects. The mean gestational age of the study subjects was 22 weeks. Platelet count, thrombin time, partial thromboplastin time, and prothrombin time were measured in serum samples collected before and 12, 36, and 60 hours after ethacridine instillation. Also measured were soluble fibrin monomer complexes and Factors V, VII, X, and XII. In 9 of the 10 women, labor was induced by 1 dose of ethacridine and a dead fetus was expelled; the 10th woman required a 2nd instillation. The average duration of labor was 2.5 hours (range 0.5-5.0 hours) and induction-to-abortion time averaged 38 hours (range 31-47 hours). All coagulation measures were within normal limits before abortion induction and were not significantly influenced by ethacridine administration at any of the time intervals studied. Of particular interest was the lack of evidence of disseminated intravascular coagulation--a side effect of intra-amniotic instillation of hypertonic saline. The injection of ethacridine also seems to cause less pain than hypertonic saline, hypertonic glucose, or prostaglandin in F2 alpha.

Experimental Studies of Acute and Subchronic Toxioity in Rivanol / 中国输血杂志

The toxioity of rivanol(home product)in animals was investigated according to the standard in Chinese Pharmacopoeia. Acute toxicity ,subacute toxicity and cumulative toxicity in mice,sensi-tization in guinea pigs and subchronic toxicity in dogs were tested. In acute toxicity test,the LD50 (IV)was 18. 494?2. 90mg/kg,which belonged to be a moderate toxic substances. When the dose was 1mg/kg,no toxic effect was observed in any animal. When the dose(IV)increased to 5mg/kg, mild degeneration and focal necrosis of cells,infiltration of inflammatory cells and proliferation of Kuffer'cells were shown in liver of mice while no toxic effect was observed in dogs. In cumulative toxicity test,the LD50 was 19. 3mg/kg which was more than Ld50 suggested that there was some tolerance and cumulative toxicity effect might not be present in mice. There was no sensitization showed in guinea pigs when rivanol was given via abdomenal administration.

Study of Quality of Human Immunoglobulin Separated by the Rivanol-Cold Ethanol Combination Method(R-E) / 中国输血杂志

A comparative observation of the quality of human immunoglobulin separated by the Rivanol-coldethanol combination method(R-E),the cold ethanol method(E)and the Rivanol-Ammoniumsulphate method(R-As)was performed.The experimental data and control data are as follows:Purityof immunoglobulin:96.67?0.93%(R-E,n=10);89.20?5.45%(E,n=8)and 96.22?0.67%(R-As,n=6).Proportion of IgG,IgA and IgM:89.26?0. 81%,6.29?0.38% and 1.16?0.28%(R-E,n=10);88.59?4. 87%,0.34?0.21% and 0.15%?0.09%(E,n=8)and 88.90?1.46%,7.08?1.28% and 0.24?0.29%(R-As,n=6)respectively.Proportion of IgG monomers and dimers,polymers,and fragments:95.96?1.38%,3.04?0.73% and 1.02?1.04%(R—E,n=7)and 98.43?0.57%,0.96?0.25% and 0.62?0.33%(E,n=3)respectively.All the preparations separated bythe three methods have been heated for 4 hours at 57℃,with their appearance being unchanged.

THE KINETICS OF PROLACTIN ( PRL ) RELEASE BY HUMAN DECIDUA CULTURED IN VITRO AND THE EFFECTS OF RIVANOL / 中国药理学通报

The growth and PRL release of human decidual cells of early pregnancy cultured in vitro and the effects of rivanol on them were observed. The results showed that the growth and capacity of PRL release of human decidual cells cultured in serum-free and hormone-free media could be maintained more than 10 d. There was no significant difference between decidual cells cultured with and without calf serum. Insulin and hydrocortisone enhanced the amount and the duration of PRL secretion. The growth and PRL release of the decidual cells were inhibited significantly by the addition of rivanol.

PHARMACOLOGICAL ACTION OF RIVANOL ON THE INDUC-ING LABOUR AT MIDDLE PERIOD / 中国药理学通报

Thirty cases of pathological changes in placenta as a result of inducing labour with rivanol at the middle period of pregnancy. The results of the study indicated that the pharmacological action of rivanol is correlated with its chemical structure,which caused a reduction in the concentration of placenta hormone ( including HCG, pregesterone & estradiol )

[Termination of mid- and late-term gestation with small dose of genkwaninol and rivanol: comparative clinical and pathological analysis].

This paper deals with a comparative study on the clinical aspects of 300 case of mid-late-term abortions induced by small dose and routine dose of alcoholic extract of Flos Genkwa and by rivanol and on 100 cases of fetal autopsies. Clinical aspects of 300 cases of abortions, the therapeutic effective rate, and the fetal mortality rate of the small doses of Flos Genkwa are similar to those of the routine doses of Flos Genkwa but with fewer side effects. As compared with the rivanol group, lower the time of induction of abortion is shorter, the rate of live fetuses and the cases with retention of part of the membranes and placenta are fewer. Pathologic aspects of 100 cases of fetal autopsies -- the predominant pathologic changes of the fetus in the Flos Genkwa group are congestion and hemorrhage in contrast with edema in the rivanol group. Degeneration and necrosis in visceral organs occurred in both groups, but they were severe in the Flos Genkwa group. The predominant pathologic changes of umbilical cord in the Flos Genkwa group were trauma and proliferation of intima, thrombosis, and pan-vesselitis. In the rivanol group, the predominant changes were diffuse infiltration of macrophages in the stroma. In both groups there was degeneration and necrosis of trophoblasts of placenta. In Flos Genkwa group, the vessels in the chorionic villi were highly contracted, even the lumen were closed, while in the rivanol group the vessels were dilated. The inflammation of placentas and decidua and the degeneration and necrosis of decidua were also thoroughly examined, analyzed, and compared.

Second-trimester abortion by extra-amniotic instillation of Rivanol combined with intravenous administration of oxytocin or prostaglandin F2 alpha.

Induction of second-trimester abortion was studied by administration of the acridine derivative Rivanol in combination with an i.v. drip infusion of oxytocin or prostaglandin F2 alpha (PG2 alpha), alone or in combination. It was found that an early onset of the i.v. infusion was of major importance for the outcome. Administration of oxytocin in immediate connection with the Rivanol instillation proved more favorable than administration of PGF2 alpha) or a combined oxytocin PGF2 alpha drip, taking into consideration the induction-abortion time as related to the side effects. A lag phase between the instillation of Rivanol and the start of i.v. infusion such as has earlier been frequently recommended seemed to be of no specific advantage, but caused both a prolonged induction-abortion time and an increased incidence of infection.

PIP: Induction of 2nd trimester abortion was studied by administration of the acridine derivative Rivanol in combination with an intravenous (iv) drip infusion of oxytocin or prostaglandin (PGF2alpha), alone or in combination. It was found that an early onset of the iv infusion was of major importance for the outcome. Administration of oxytocin in immediate connection with the Rivanol instillation proved more favorable than PGF2alpha administration or a combined oxytocin/PGF2alpha drip, taking into consideration the induction-abortion time as related to side effects. A lag phase between Rivanol instillation and the start of the iv infusion such as has earlier been frequently recommended seemed to be of no specific advantage, but caused both a prolonged induction-abortion time and an increased incidence of infection.

A bacterial mutagenicity study of rivanol, an acridine derivative used as an abortifacient.

We have used the forward mutation to resistance to 6 azauracil to test the mutagenicity of rivanol (6,9 diamino 2-ethoxy acridine) on Escherichia coli. Rivanol has been used to induce therapeutic abortions in midpregnancy and is considered safe and effective for this purpose. The findings reported here that rivanol, like other acridines, is a mutagen, at least in procaryotes, suggests that such use of rivanol be reconsidered in light of its possible genetic toxicity.

PIP: Rivanol (6, 9 diamino 2-ethoxy acridine) is used in Asia and Sweden as a mid-trimester abortifacient. Although its apparent safety and lack of side effects have been documented in a series of studies, the longterm effects of this agent have not been evaluated. Acridine compounds are known to bind strongly to DNA and to produce mutations, thus it is appropriate to consider the potential of rivanol to lead to genetic damage or cancer. This study used the forward mutation to resistance to 6 azauracil to test the mutagenicity of rivanol and a related known mutagen, acridine orange, on Escherichia coli. Several generations of E. coli cells were grown in the presence of these 2 agents, and the frequencies of cells with the mutant phenotype (upp) among viable cells in the population were determined. Data from 4 independent experiments were averaged. In all experiments, the rivonal-treated sample had fewer viable cells per ml than untreated controls, but this toxicity was not observed for acridine orange. At concentrations or= 100 mcg/ml, acridine orange did not increase the frequency of upp mutants. However, rivanol exhibited a dose-dependent increase in mutation frequency up to 8-fold at 100 mcg/ml. The selective bacterial toxicity observed in the comparison of these 2 agents is attributed to the fact that rivanol binds 2-5 times more strongly to DNA than acridine orange. The low blood levels of rivanol that have been observed after oral and extraamniotic application may be below the concentration that can cause significant genetic damage or induce malignancies. However, it is possible that mammalian cells are more permeable to rivanol than bacterial cells and that low concentrations may pose significant risks. The results of this study indicate that patients treated with rivanol should be followed to luate the possible longterm effects of this agent.

[Hormone profile in plasma and amniotic fluid during mid-trimester abortion induced by tricosanthin and by Rivanol].

PIP: This paper provides a brief account of the estimation of levels of 6 hormones, both in the plasma and amniotic fluid, by radioimmunoassay during midtrimester abortion induced by Trichosanthin and Rivanol. Results revealed that: 1) the level of plasma hCG declined more quickly than that of estradiol, estriol, and progesterone during abortion induced by Trichosanthin, but that there were no significant relationships between the magnitide of hormone decrease and the duration of abortion; 2) there was no significant difference in the decrease rate between plasma hCG and estradiol, estriol, or progesterone during Rivanol-induced abortion; and 3) there was a remarkable increase in the amniotic fluid of the estradiol and cortisol levels during abortions induced by both methods (P0.02-0.01). Also discussed was the mechanism of abortion induced by Trichosanthin and Rivanol. (author's modified)^ieng