|Year : 1976 | Volume
| Issue : 1 | Page : 23-25
Extra-amniotic mannitol for pregnancy termination - (preliminary report)
Malini A Deshmukh, Sushila Shah, S Shah, Shobha J Joglekar
Department of Obstetrics and Gynecology, K.E.M. Hospital, Parel, Bombay-400012., India
Malini A Deshmukh
Department of Obstetrics and Gynecology, K.E.M. Hospital, Parel, Bombay-400012.
To induce termination of pregnancy, during 11 to 20 , weeks«SQ» period of gestation, extra-amniotic 20% Mannitol solution was used, in 40 patients. The amount of Mannitol varied from 350 ml. to 1290 ml. over a period o f 24 to 48 hours, through a Foley«SQ»s catheter. After the patient started aborting, Pitocin 2 units were given I.M., every half hourly for 4 injections. The success rate was 95%. Mean induction time for abortion was 33.8 hrs. No adverse effects were noted. This is only a preliminary report and further studies in progress will be reported later.
|How to cite this article:|
Deshmukh MA, Shah S, Shah S, Joglekar SJ. Extra-amniotic mannitol for pregnancy termination - (preliminary report).J Postgrad Med 1976;22:23-25
|How to cite this URL:|
Deshmukh MA, Shah S, Shah S, Joglekar SJ. Extra-amniotic mannitol for pregnancy termination - (preliminary report). J Postgrad Med [serial online] 1976 [cited 2022 Aug 11 ];22:23-25
Available from: https://www.jpgmonline.com/text.asp?1976/22/1/23/42827
There is no doubt that termination of pregnancy is associated with some risk which is minimal before 12 weeks, but is considerably increased later. The reason is that we have still not found a safe and cheap method which can be universally used.
Prostaglandins and urea, though safe, are still expensive and yet not available on a large scale to be freely used for the masses.
In this study, we have used by extraamniotic method, 20% Mannitol, which is universally available and fairly cheap. Since it can be given intravenously, it can safely be injected in the extraamniotic space.
Material and Method
Total number of 40 patients were studied. The period of gestation varied from 11 to 20 weeks. Patients were instructed to use antiseptic vaginal tablets twice a day for 5 days before admission. An antibiotic cover was given during the trial till their delivery.
Method of Injection: After vaginal toilet, a 14 gauge Foley's Catheter was introduced through the cervix into the space between the amniotic membrane and the uterine wall. The bulb was inflated to prevent the catheter and the injected fluid from escaping out. The fluid was injected by drip method. Temperature, pulse, respiration, B.P. and urine output were noted at the time of injection and two hourly till delivery. Second dose was not injected if the patient had not passed at least 60 ml. of urine per hour.
After the patient had started aborting, Pitocin 2 units were given I.M. every half hourly for 4 doses. Most of the patients had completed the abortion by the time 1 or 2 injections were given.
This practice was started to minimise operative interference.
[Table 1] shows the doses of mannitol used in this study.
[Table 2] shows the results.
[Table 3] shows the time taken for abortion to occur after the injection.
The longest induction abortion internal was 72 hours. 86.8% of the patients aborted in 48 hours, and 63.1% in 36 hours.
The induction-onset interval varied from 2 hours to 60 hours but in the majority of patients labour started within 24 hours. The mean induction onset interval was 23.2 hours and the pains were extremely mild. Although 13 cases have been shown as incomplete abortions, only 1 case had retained placenta. In the remaining 12 cases when P.V. examination was done to confirm the completion of abortion, few bits of products were felt and D & C was done as a safety measure. No patients required blood transfusion.
[Table 4] shows the effective doses of mannitol in this study.
Patients were encouraged to drink plenty of water to ensure good diuresis. Urine output of the patients varied from 75 to 180 ml. per hour.
When more than 350 ml. of mannitol were injected, patients were given a mixture of potassium citrate two times a day. No patient had any fever or suffered from any side effects.
In this small series, success rate with Mannitol was 95%. This is less than that obtained with hypertonic saline, or prostaglandin. This may be so because correct dosage needed had to be found out by trials. In two cases which failed to respond, the labour had started, and the catheter was expelled due to dilatation of cervix. Further dose of Mannitol could not be given, and both the patients aborted within 48 hours with Pitocin drip.
Mannitol is a polyhydric alcohol which is not metabolised. in the body and acts as an osmotic diuretic. If excessive amount of Mannitol is infused and excreted there is an increase in serum sodium and hence, routine administration of saline with use of Mannitol may create problems of hypernatremia. In oliguric patients unless urine volume exceeds 100 ml/hour, only 100 gms (500 ml) of Mannitol in 24 hours is advised. In cases with renal damage, Mannitol infusion would increase renal perfusion. In cardiac cases Mannitol could be used safely provided proper diuresis is maintained. Use of 20% Mannitol extra-amniotically in MTP cases, seems merit of extended trial. It seems to be better than use of glucose, which supports growth of bacteria. Mechanism of its action is not worked out, but may be on decidual cells similar to one postulated to explain mechanism of hypertonic saline. Encouraged by the favourable experience gained in this small seriesthe study is being further continued.
We thank Dr. V. N. Purandare, Head of the Department of Obstetrics and Gynaecology, K.E.M. Hospital, and Dr. C. K. Deshpande, Dean, K.E.M. Hospital and Seth G. S. Medical College, for allowing us to report the Hospital data.