Journal of Postgraduate Medicine
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Year : 1982  |  Volume : 28  |  Issue : 4  |  Page : 210-3  

Coagulation studies following mid-trimester intra-amniotic urea injection.

MA Deshmukh, MR Prabhoo, AV Sathe, ND Motashaw, KC Gupta, PD Jarag, RS Satoskar 
 

Correspondence Address:
M A Deshmukh





How to cite this article:
Deshmukh M A, Prabhoo M R, Sathe A V, Motashaw N D, Gupta K C, Jarag P D, Satoskar R S. Coagulation studies following mid-trimester intra-amniotic urea injection. J Postgrad Med 1982;28:210-3


How to cite this URL:
Deshmukh M A, Prabhoo M R, Sathe A V, Motashaw N D, Gupta K C, Jarag P D, Satoskar R S. Coagulation studies following mid-trimester intra-amniotic urea injection. J Postgrad Med [serial online] 1982 [cited 2021 Apr 22 ];28:210-3
Available from: https://www.jpgmonline.com/text.asp?1982/28/4/210/5598


Full Text



 INTRODUCTION



Various procedures are used for the termination of a second trimester pregnancy. Hypertonic saline is gradually being replaced by new drugs such as prostaglandins[9],[10],[11],[12] and hyperosmolar usea[6], [9], [10] as hypertonic saline has been known to cause a higher incidence of coagulation changes.[1], [7], [12], [15] This study describes the coagulation changes in patients who received intro-amniotic usea for second trimester abortion.

 MATERIAL AND METHODS



Forty patients between the ages of 16 and 36 years were studied. Their gravid status varied from primigravida to fourth gravida. The period of gestation varied from 16 to 20 weeks. All the patients were admitted to the hospital on the day of the procedure. 150 to 180 ml of a solution of 40% urea (depending on the size of the uterus) were injected intro-amniotically. Ten ml of blood from the antecubital vein was collected, pre-abortal, 12 and 24 hours after urea administration and post-abortal. The following coagulation tests were carried out-(1) prothrombin time[14] (2) partial thromboplastin time (PTT)[1], [2] (3) thrombin time[1], [2], [14] (4) Platelet aggregation[3] (5) platelet adhesiveness[13] (6) fibrinogen (7) platelet count and (8) euglobulin lysis time.[4]

Patients who failed to abort within 24 hours received an oxytocin drip containing 10 units of pitocin in 500 ml of 5% glucose. If there was no expulsion of the foetus, a second and a third unit of glucose containing 20 units and 30 units of pitocin respectively was administered.

 RESULTS



Out of 40 cases receiving intro-amniotic urea, 9 patients aborted within 24 hours; the remaining patients required oxytocin for completion of abortion. Thirty-five cases aborted within 48 hours, giving a success rate of 88%. The mean induction abortion interval was 32.7 hours with a range varying from 14 to 50 hours.

Changes in coagulation factors and platelet functions before and after intra amniotic urea instillation are summarised in [Table 1] & [Table 2] respectively. Statistical analysis of this data revealed no significant changes in various coagulation tests, at 12 hours, 24 hours and post-abortal following urea instillation, as compared to basal values.

Blood urea estimation was carried out in 7 subjects. The mean basal level was 19.9 3.0 mg;/, as compared to 35.8 16.5 mg% following intra-amniotic urea. In all the 7 cases, blood urea showed a significant rise (p < 0.05). However, the various coagulation parameters in these subjects were within normal range.

 DISCUSSION



Alteration in blood coagulation parameters following the intra-amniotic administration of hypertonic saline for midtrimester abortion is well recognised and fatal complications have been reported.[7] Intra-amniotic hyperosmolar urea has been suggested as an alternative to intra-amniotic saline. In the study by Burkman et al,[5] among the 1,133 cases receiving intra-amniotic saline, 6 cases developed coagulopathy, while in 1600 cases receiving hyperosmolar urea only 2 had coagulopathy. Similarly, although the studies by King et al[10] revealed subclinical changes in certain coagulation parameters, in association with amnioinfusion of hyperosmolar urea with or without PGF2-alpha, the frequency of such abnormalities and degree of change appeared much less than those with hypertonic sodium chloride. Our studies indicate that although some changes may appear following amnioinfusion of hypertonic urea, these changes were not statistically significantly different.

Use of intravenous oxytocin appears to increase the incidence of consumptive coagulopathy in cases receiving hypertonic saline. Cohen and Ballard[7] found that coagulopathy is more frequent when oxytocin is immediately begun after intra-amniotic saline, and it is suggested that oxytocin should be withheld for 48 hours after administration of saline. In the present study, oxytocin was started only after 24 hours, and although 31 cases (77%) aborted after 24 hours, there was no case showing clinical evidence of coagulopathy. In this respect, urea may be an effective and a safer abortifacient, as compared to intra-amniotic saline.

Bleeding tendency in renal failure has been documented.[8] It is usually associated with marked nitrogen retention. Changes in blood urea concentration observed in this study, though statistically significant, cannot be considered as very high and they are unlikely to cause abnormalities of platelet function. However, amnioinfusion of urea should be used cautiously in the presence of renal failure.

 ACKNOWLEDGEMENT



We thank Dr. V. N. Purandare, Head of the Department of Obstetrics & Gynaecology, K.E.M. Hospital and Dr. C. K. Deshpande, Dean, K.E.M. Hospital and Seth G.S. Medical College, Bombay-400 012, India, for permitting us to present the hospital data.

References

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3Born, G. V.: Aggregation of blood platelets by adenosine diphosphate and its reversal. Nature, 194: 927-929, 1962.
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5Burkman, R. T., Bell, W. R., Atienza, M. F. and King, T. M.: Coagulopathy with mid-trimester induced abortion associated with hyperosmolar urea administration. Amer. J. Obstet. & Gynecol., 127: 533-536, 1977.
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12MacKenzie. I. Z., Sayers, L., Bonnar, J. and Hillier, K.: Coagulation changes during second trimester abortion induced by intro-amniotic Prostagiandin Ez & hypertonic saline solution Lancet, 2: 10661069, 1915.
13MacKenzie, R. D., Thompson, R. J. and Gleason, E. M.: Evaluation of a quantitative platelet collagen adhesiveness system. Thrombosis Research, 5: 99-105, 1974.
14Quick, A. J.: The prothrombin in hemophilia and in obstructive jaundice. J. Biol. Chem, 109: LXXIII-LXXIV, 1935 (In scientific proceedings of the Society of Biological Chemists).
15Schwartz, R., Greston, W. and Kleiner, G. J.: Dafibrination in saline abortion. Obstet. & Gynecol., 40: 728-737, 1972.

 
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