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Foley, Searle letter etc. -Long.From: =?iso-8859-9?Q?Dr._Bülent_Potur?= (bpotur@rt.net.tr)Mon Aug 28 06:32:43 2000
I have been following the foley thread with interest. I see that many listmates are not very familiar with uterine foley insertions. During my residency between 1986-1990 at Ankara Dr. Zekai Tahir Burak Womens' hospital - a hospital with 25 000 deliveries per year- the standard of care for second trimester abortions was extra amniotic rivanol instillation. If you look at the literature foley name is not emphasized. But for the procedure one first would pass the plain foley catheter into the uterine cavity extraembrionically then inflate it with 30 cc of saline. Then one would apply traction to the foley and hold its lumen closed with clamps while changing the injector of 20-50 ml size until one would inject 100-200 ml of %0.1 rivanol fit for the duration of pregnancy.(10 cc x weeks). Then one would tie the foley with no:2-3 silk to prevent the rivanol solution coming back. Plus one would tape the tied foley with large adhesive tapes under traction, to the median side of the patient's leg . The balloon would usually be expelled within 6-24 hours. Only after this an oxitocin perfusion would be started and it would take several hours more for the abortion and the revison curettage to be completed. What a nuisance for the patient it was to have a taped foley under traction to the leg . The rubber foley balloon inflated with 30 cc would gradually dilate the cervix. It would be a more robust dilator when filled with liquid. Later there were studies showing that there were no significant differences in the duration of labor if the extraamniotic rivanol instillation was added or not. There were also studies showing the increased prostaglandin levels during these procedures. See references below. Then came the era of Cerviprost. Though the drug was somewhat expensive it really was a revolution. In recent years misoprostol has emerged for similar indications such as second trimester dead or malformed fetuses' abortions. In addition to being a cheap drug with its ease of administration it has added much to the armamentarium of the gynecologist. I think that like cerviprost, it should be available for use for such indications only to be used in a hospital setting. Dr. Bülent Potur http://abone.rt.net.tr/bpotur References: 1: Jarnbert A, Klang B, Vinh NT, Ham NN. Comparative study of cervical laminar tents prior to extra-amniotic injection of ethacridine lactate (Rivanol) and a condom-nelathon catheter method for second-trimester pregnancy interruption in Vietnam. Gynecol Obstet Invest. 1999;48(2):113-8. 2: Bokstrom H, Bryman I, Norstrom A, Platz-Christensen JJ. Dilapan tent-gemeprost regimen vs. combinations of extra-amniotic Rivanol-Laminaria/Lamicel and oxytocin for second trimester abortion. Int J Gynaecol Obstet. 1995 Jan;48(1):69-74. 3: Gardo S, Nagy M. Induction of second trimester abortion by intraamniotic instillation of Rivanol (ethacridine) combined with oxytocin infusion. Arch Gynecol Obstet. 1990;247(1):39-41. 4: Gardo S, Nagy M. [Intra-amniotic Rivanol injection for the mid-term interruption of pregnancy]. Orv Hetil. 1989 Nov 5;130(45):2411-3. Review. Hungarian. 5: Zauva BL, Gupta I, Dhall GI. Mid-trimester abortion by extraamniotic Emcredil versus normal saline. Aust N Z J Obstet Gynaecol. 1989 Aug;29(3 Pt 2):299-302. 6: Klinte I, Hamberger L, Wiqvist N. Second-trimester abortion by extra-amniotic instillation of Rivanol combined with intravenous administration of oxytocin or prostaglandin F2 alpha. Acta Obstet Gynecol Scand. 1983;62(4):303-6. 7: Olund A. Extra--amniotic instillation of rivanol in the management of patients with missed abortion and fetal death. Acta Obstet Gynecol Scand. 1981;60(3):313-5. 8: Olund A, Kindahl H, Oliw E, Lindgren JA, Larsson B. Prostaglandins and thromboxanes in amniotic fluid during rivanol-induced abortion and labour. Prostaglandins. 1980 May;19(5):791-803. 9: Olund A. Lysozyme in amniotic fluid during rivanol-induced second trimester abortion. Prostaglandins. 1979 Jan;17(1):149-54. 10: Olund A, Lunell NO. Arachidonic acid in amniotic fluid after extra-amniotic instillation of rivanol for midtrimester abortion. Prostaglandins. 1978 Dec;16(6):989-94. 11: Olund A, Larsson B. Comparison of extra-amniotic instillation of rivanol and PGF2alpha either separately or in combination followed by oxytocin for second trimester abortion. Acta Obstet Gynecol Scand. 1978;57(4):333-6. 12: Potur B, Case Report: A Case of Cystic Hygroma of the Neck Diagnosed at 12 th Week of Pregnancy with Vaginal Ultrasound. http://bpotur.tripod.com/case3700.htm
>----- Original Message -----
> At Sun, 27 Aug 2000, james connerth wrote: P.S. I am leaving for the USA tomorrow for FIGO 2000 so I may not reach my e-mails till 10.Sep.2000.
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