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 ::  Abstract
 ::  Introduction
 ::  Material And Methods
 ::  Discussion And C...
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ARTICLE
Year : 1979  |  Volume : 25  |  Issue : 3  |  Page : 158-161

Use of intra-amniotic urea as a second trimester abortifacient


Department of Obstetrics and Gynaecology, K.E.M. Hospital and Seth (G.S. Medical College, Parel, Bombay-400012, India

Correspondence Address:
Asha Khare
Department of Obstetrics and Gynaecology, K.E.M. Hospital and Seth (G.S. Medical College, Parel, Bombay-400012
India
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Source of Support: None, Conflict of Interest: None


PMID: 529168

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 :: Abstract 

Seventy cases of mid-trimester pregnancies were terminated by using 200 ml. of 40% intra-amniotic urea, over a 13 month period from 1st August. 1977 to 31st August, 1978.
The success rate was 88.7% and the mean induction-abortion interval was 30.7 hours.
No major complications were observed.



How to cite this article:
Khare A, Deshmukh MA, Vaidya PR, Sayed A, Companywalla RT, Motashaw ND. Use of intra-amniotic urea as a second trimester abortifacient. J Postgrad Med 1979;25:158-61

How to cite this URL:
Khare A, Deshmukh MA, Vaidya PR, Sayed A, Companywalla RT, Motashaw ND. Use of intra-amniotic urea as a second trimester abortifacient. J Postgrad Med [serial online] 1979 [cited 2019 Dec 7];25:158-61. Available from: http://www.jpgmonline.com/text.asp?1979/25/3/158/42133



 :: Introduction Top


No ideal method has yet been found to procure safe and effective midtrimester abortion. Various drugs, their combina­tions and varying dose schedules of drugs have been used from time to time to evaluate their efficacy and safety.

The criteria by which an abortifacient is judged are as follows:

1.Sucess rate.

2. Side effects and complications.

3. The induction-abortion interval.

4. Rate of incomplete abortion.

Intra-amniotic instillation of hypertonic saline with or without oxytocin is com­monly used for terminating midtrimester pregnancy. " Since this can sometimes lead to a fatal complication in the form of intravascular coagulopathy, [1].[2],[4].[5] search is being continued for a safer al­ternative.

Interest has recently arisen over the use of intra-amniotic urea for the same purpose. The mode of action of urea is similar to that of hypertonic saline. There is a decrease in the circulating pro­gesterone level and an increase in pro­staglandin release. [7] It also causes foetal death which may account for part of its action. Urea is a physiological substance and one of the main advantages include the lack of significant complications with inadvertent intravenous infusion of urea. [7]


 :: Material And Methods Top


Seventy cases of midtrimester pregnan­cies were terminated by injection of 200 ml. of urea (40%) intra-amniotically bet­ween the period August 77 to August, 1978.

Selection of patients

Patients with a gestational period of 16-20 weeks were selected for this pro­cedure.

Routine vaginal and abdominal exami­nations were carried out prior to the procedure to confirm pregnancy and determine its duration.

Routine investigations such as Hb, Blood group, Rh factor and urine exami­nations were also carried out.

Procedure

An injection of 0.6 mg atropine, intra­muscularly, was given half an hour be­fore the procedure.

The patient was asked to pass urine and then made to lie down in a supine posi­tion on the operation theatre bed. Amniocentesis was then done. The stillete was removed and a free flow of amniotic fluid obtained.

Freshly prepared 200 ml of 40% urea in distilled water was then instilled by the running drip method. The patients were observed in the ward round the clock.

After twenty four hours the patient was put on a course of intravenous pitocin diluted in 500 ml of 5% glucose. The bottles contained 20, 25 and 30 units of pitocin respectively.

Out of a total of 70 women there were 32 patients belonging to the age group of 20 years and less. There were only 6 cases above the age of 30 years [Table 1].

[Table 2] shows that there is no relation between the induction-abortion interval and the gestation period; only 8 failures were encountered. The success rate was 88.7% .The average induction abortion interval was 30.7 hours. The maximum abortions occurred between 24-48 hours. 13%, of the cases aborted within 24 hours, 57% within 36 hours and 90% within 48 hours, 8 cases who failed to abort within 72 hours were subjected to another method of medical termination of preg­nancy (MTP).


 :: Discussion And Conclusions Top


Urea is being used intravenously in sickle cell crisis for alleviation of pain and prolongation of cell survival time without any notable side effects. [7] It is also given by the same route for neuro­surgical procedures in the dose of 1-1.5 gms/kg of body weight. [6]

Intramural injection of urea does not cause muscle necrosis [7] which occurs with hypertonic saline. Since the concentra­tion of urea also causes immediate foetal death the problem of delivering alive foetus is not encountered. The psycho­logical trauma to the mother is thus avoided. Urea is used alone or in com­bination with various drugs for the pur­pose of mid-trimester abortion. [Table 3] gives the induction abortion interval for urea and saline in different series. whom curettage was done. There were two cases of pelvic infection who were treated conservatively.

Burnett et al [3] in their series of seventy ­four patients who had their pregnancies terminated by a combination of intra-­amniotic urea and intra-venous oxytocin noted the following biochemical changes. Maximum changes in serum electrolyte level occurred 8-12-hours after the injec­tion and included a decrease in the mean concentration of NaCl and CO 2 , and an increase in serum potassium. An in­crease in urinary urea began within four hours. There was a decrease in serum fibrinogen level by about 15% and also an 18-20% drop in the platelet count 8 hours after the procedure. Fibrinogen­fibrin degradation products were signi­ficantly increased in 36 patients with minimal side effects a larger series of 1,000 cases or more is required for as­sessing its safety. Augmenting agents in the form of a pitocin drip or prostaglan­dins may be used to ensure predictably short induction-abortion interval to mini­mise the risk of endometritis or salpingi­tis which may be associated with a pro­longed induction abortion interval.


 :: Acknowledgements Top


We thank Dr. C. K. Deshpande, Dean, K.E.M. Hospital and Dr. V. N. Purandare, Head, Dept. of Obst. & Gynaec., for allow­ing us to use the hospital data. We also thank the Dept. of Pharmacology, K.E.M. Hospital for their continued co-operation in supplying the requisite urea solution.[Table 4] [9]

 
 :: References Top

1.Basak, S, and Konar, M.: Evaluation of M.T.P. deaths, The J. Assoc, Medical Women in India LXVIIF, 32-_17, Jan-April 1978.  Back to cited text no. 1    
2.Berger, G. S., Tietze, C., Pakter, J. and Ketz, S. Maternal mortality associated with legal abortion in New York State (July 1, 1970-June 30, 1972). Obstet, Gynecol,, 43: 315-320, 1974.  Back to cited text no. 2    
3.Burnett, L. S., King, T. M., Antienze, M, F. and Bell, W. R.: Intraamniotic urea as a mid-trimester abortifacient: Clinical results and serum and urinary changes. Amer. J. Obstet. Gynecol., 121: 7-16, 1975.  Back to cited text no. 3    
4.Cates, W . , Grimes, D. A . , Smith, J. C. and Tyler, C. W.: Legal abortion morta­lity in the United States: epidemiologic survey 1972-1974. J. Amer. Med. Assoc., 237: 452-462, 1977.  Back to cited text no. 4    
5.Cohen, E. and Ballard, C. A.: Consump­tion coagulopathy associated with intra amniotic saline instillation and the effects of intravenous oxytocin, Obstet. Gynecol., 43: 300-303, 1974.  Back to cited text no. 5    
6.Goodman, L. S. and Gilman, A.: "The Pharmacological Basis of Therapeutics" 5th Ed. Macmillan Publishing Co., New York, Collier Mac Millan Canada Ltd and Bail­liere Tindall Co. London, 1975, p. 822;.  Back to cited text no. 6    
7.Kawada, C. Y.: Technique of second trimester abortion. Clin. Obstet. Gynecol., 20: 833-847, 1977.  Back to cited text no. 7    
8.Kerenyi, T. D., Madelman, N. and Sharman, D. H.: Five thousand consecu­tive saline inductions. Amer, J. Obstet. Gynecol., 116: 593-600, 1973.  Back to cited text no. 8    
9.King, T. M., Antienze, M. F. and Burnett, L. S.: Synergistic activity of intra amniotic prostaglandin F 2α and urea in mid trimester elective abortion. Amer. J. Obstet. Gynecol., 120: 704-718, 1974  Back to cited text no. 9    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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