Rivanol induction of labour by amnion cavity injection

Obstetrics and gynecology paper II

Rivanol induction of labour via amniotic cavity injection

A Clinical Analysis of 120 Cases  

Termination of pregnancy for various reasons at any stage is an essential aspect of obstetrics and gynecology. Despite the growing emphasis on family planning measures, the need for pregnancy termination as a remedial action for contraception and sterilization continues to increase. While early pregnancy termination can often be satisfactorily managed via aspiration and curettage, pregnancies extending beyond 13 weeks require artificial labor induction. Numerous methods exist for this purpose, each with its own advantages and drawbacks. From April to October 1980, our institution conducted a concentrated series of labor inductions using Rivanol amniotic cavity injections. Based on encouraging clinical outcomes, we present a comprehensive analysis and discussion of 120 well-documented cases.

Indications and Contraindications

1. Applicable Cases: This method is applicable for pregnancies beyond 18 weeks and up to the point of labor. It is suitable for women who either voluntarily seek or are medically advised to terminate their pregnancies, provided there are no contraindications. However, pregnancies extending beyond 34 weeks may result in viable fetuses, except when early delivery is medically advised for the health of the mother or child, and survival of the fetus is anticipated.

2. Genital Inflammation: For cases where a vaginal approach to labor induction may lead to intrauterine infection, this method is particularly suitable.

3. Physical Deconditioning and Organ Dysfunction: Individuals with compromised heart, kidney, liver, or lung function, as well as those with acute infectious diseases, must undergo active treatment and show improvement before considering this method.

4. Urinary Tract Infections: Patients with acute or chronic urinary tract infections need to be stabilized before induction, as ascending infections may exacerbate their condition.

5. Late Pregnancy Complications: For those in the third trimester with mechanical obstructions in the birth canal, or abnormal fetal positions or malformations, timely interventions like assisted delivery or fetal fragmentation should be considered. Alternatively, labor induction may be abandoned in favor of surgical delivery.

Our analysis offers a nuanced look into the utility and limitations of Rivanol-induced labor, emphasizing its practicality under specific conditions while underscoring the importance of a thorough patient evaluation to determine suitability.

Clinical Data

The study involved 120 participants, ranging in age from 15 to 48 years. Among them, 22 were primiparous (first-time mothers), and 98 had previous pregnancies. The gestational age varied between 18 and 38 weeks. The success rate for one-time induction was remarkably high at 99.11%.

Labor Duration:

• Primiparous women averaged 40.3 hours.
• Women with prior pregnancies averaged 58.5 hours.
• Overall average was 49.4 hours.

Out of 120 cases:

• 88 experienced complete fetal and placental expulsion in one go.
• 24 had retained placental tissue.
• 7 required curettage due to uterine inertia.

One case failed initially but later succeeded with the use of a water-filled balloon for induction. No second doses of medication were needed in this cohort.

Hospital Stay:

• The average length of hospital stay was 5 days.
• 66 patients had a normal temperature during their stay, while 54 experienced low-grade fevers, peaking at 38℃. All normalized post fetal expulsion.

Bleeding:

• Average blood loss was approximately 50 ml.
• No fatalities occurred, although one case of amniotic fluid embolism was successfully managed during curettage.

Efficacy of Labor Induction

Among the 119 successful inductions, 112 were self-expulsions of the fetus, all of which were stillbirths. The remaining seven cases were between 18 and 24 weeks of gestation and required curettage due to uterine inertia or abnormal fetal positioning, with satisfactory outcomes.

Table 1: Relationship between Drainage Time, Gestational Week, and Cases

The drainage time predominantly ranged between 25 and 72 hours, accounting for 88% of the cases. Interestingly, the labor duration tended to shorten as the gestational age increased. This suggests a heightened uterine sensitivity, offering more opportunities for natural childbirth.

References

1. Special Summary of Induced Labor in Second Trimester Pregnancy: Proceedings of National Family Planning Experience Exchange Meeting, 1978.

2. Department of Obstetrics and Gynecology, Bengbu Third Hospital: Summary of 216 Cases of Induced Labor in Second and Third Trimester Pregnancy by Amnion Cavity Injection from Rever Woer. Compilation of Family Planning Data, 1978.

3. Liu Yong et al., 'Amniotic Fluid (Literature Review).' Foreign Medical Materials and References, Gynecology and Obstetrics fascicle 2:41, 1975.

4. Zhou Lijuan et al., 'Effect of Rivanol on Immune Uterus.' Collection of Materials on Rivanol-Induced Labor in the Second Trimester.

5. Wu Hanjing: Analysis of the Effect of Induced Labor in Middle and Late Pregnancy with 525 Cases Treated with Rivanol Amnion Injection. (Internal Data), 1980.

6. Shanghai First Medical University, et al: Gynecology and Obstetrics. P: 61-541 People's Health Press, 1978."

This article was originally published in Proceedings of the First Academic Conference on Obstetrics and Gynecology of Anhui Province,Sept. 1980；
Nanling County Hospital, Li Mingjie & Pan Yaogui

from 利凡诺 (Rivanol) 羊膜腔注射引产术

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