The augmentary effect of intramuscular prostaglandins on ethacridine lactateVeena B Roate, R Ananthakrishnan, AC Ganguli, Usha R Krishna
Department of Obstetrics and Gynecology, K.E.M. Hospital, Parel, Bombay 400012., India
Correspondence Address: Source of Support: None, Conflict of Interest: None PMID: 458739
Source of Support: None, Conflict of Interest: None
A combination of 100 ml of 0.1% Ethacridine lactate solution and two intra-muscular injections of prostaglandin (300 µg each of I5-Methyl-PGF 2α)was tried for safe termination of pregnancy. It was found that the success rate (88%) with this combination regimen was better than ethacridine lactate alone but a little inferior to prostaglandins alone. Average abortion interval was also less than with ethacridine lactate. However, the combination did not reduce the gastro-intestinal disturbances associated with prostaglandins.
Ethacridine lactate (0.1%) used extraamniotically has been shown to successfully terminate pregnancy in about 75%  of the cases.
Prostaglandins as intramuscular injection have shown high success rate and short. induction abortion interval,  compared to other abortifacients, but their restricted availability and high cost limits its frequent use. Hence we have attempted to study the augmentary effect of intramuscular injections of prostaglandins in two small doses, on the clinical course of ethacridine lactate. The rationale of this trial was to evolve a method which is safe and is relatively cheaper than prostaglandins alone, with abortion time shorter and success rate higher than that of ethacridine lactate alone.
50 women in the age group of 15-35 years and between 13-20 weeks of gestation were selected for this trial.
A Foley's catheter (No. 14F for nulliparous and 16F for multiparous) was passed extra-amniotically. The bulb of the catheter was inflated with 30 cc of normal saline.
Initially, 100 ml. of 0.1% ethacridine lactate was instilled in all cases. Later at 3hourly interval, 300 µgm of 15-methyl. PGF 2α was given intramuscularly for 2 doses. The catheter was deflated and removed 6˝ hours from initiation of the therapy.
All patients were covered with long acting penicillin 1.2 mega units intramuscularly.
[Table 1] shows the case distribution with respect to gestation weeks. 80% of the cases were in the early mid trimester group.
[Table 2] shows that majority (60%) of the cases were primigravidae, of which 93.3% were unmarried.
In [Table 3] we compare the clinical events of our present trial with that of intramuscular prostaglandins (as reported by Gharse et al  ) and ethacridine lactate (as reported by Purandare et al  ).
We find that the two intramuscular injections of prostaglandin have not only improved the rate of success from 75 (group I) to 88% (group III) but also shortened the abortion interval from 29.54 hours (group I) to 21.26 hours (group III). The incidence of incomplete abortion is only 8% in group III compared to 16% and 48% in groups I and II respectively.
It is surprising that limiting the number of intramuscular injections of prostaglandins to two, did not appreciably reduce the gastro-intestinal disturbances associated with prostaglandins.
Extra-amniotic injection of 0.1% ethacridine lactate has been shown to successfully induce abortion in 75% of the cases with an average induction abortion time of 30 hours  (approximately).
Prostaglandins in multiple intramuscular doses were shown to be successful in 97.8% of the cases with an average induction abortion time of 18.18 hours  .
When two shots of intramuscular prostaglandins have been used with ethacridine lactate the average induction abortion time of ethacridine lactate is decreased to 21.26 hours and the net success is increased to 88%.
We are very grateful to Dr. V. N. Purandare for his guidance and encouragement. We thank Dr. C. K. Deshpande, Dean, K.E.M. Hospital, for allowing us to publish the hospital data. Our sincere thanks are due to Unichem Laboratories Limited, for supplying us the Ethacridine Lactate (Unacredil).
[Table 1], [Table 2], [Table 3]