Mrs. S, a 24 year old woman GlzAZL!, presented at 16 week of gestation with ultrasonographically detected fetal spina bifida for termination of pregnancy. She had one vaginal delivery with episiotomy. The infant died due to pneumonitis. Second delivery was by LSCS for fetal distress. The child is alive .and healthy. She had two first trimester spontaneous abortions her Hb was 10.7 gm /dl, blood group A+ve, blood urea 18mg/dL and serum creatinine 0.63mg / dL.
Ethacridine lactate was instilled into the extra-amniotic space. The fetus was expelled after 12 hours and the evacuation was completed. The patient was discharged after 2 days in a satisfactory condition.The next day, she presented with markedly decreased urinary output.
On examination: General condition was fair. She had
pallor +, BP-100/80 mm Hg, pulse-90/min., and good
hydration. There was no pedal edema, Systemic
examination revealed no abnormality. Vaginal bleeding
was minimal. There was no urine output in 18 hours.
Her Hb was 8.7 gm/ dl, lucocyte count-98000 / mL,
differential count -basophils 74, lymphocytes 22,
polymorphs 04, platelet count 1,60,000/ ml. Urine showed
trace of albumin, 3-5 pus cells/ hpf and 4-6 RBC /hpf.
Blood urea was 62mg/ dL. and serum creatinine - 4.21
mg / dL. Serum sodium, potassium and chorides were -
135.3,9andl05 mEq/L respectively. Urinary spotsodium
was 94 mEq/L. Cultures of urine and blood showed no growth. High vaginal swab showed Klebsiellae
pneumoniae. Ultrasound examination was normal. She
was managed conservatively (intravenous fluids,
diuretics, culture specific antibiotics); but urine output
remained nil, so hemodialysis was done. Her urinary
output increased to more than 2000ml/24 hours (diuretic
phase).She had normal urinary output after 3 days, when
her serum creatinine was 1.56mg/ dL and she was
discharged in a satisfactory condition.She was on regular
follow up. She remained asymptomatic and conceived th after 3 months. Her LMP was 30 November, 2000 and
EDO - 6th November, 2001. She attended antenatal high
risk pregnancy clinicregularly. At 16weeks, comprehensive
ultrasound was normal. She had a normal vaginal delivery
(VBAC)at term.The baby's birth weight was 2.75 kg. Her
intrapartum and postpartum periods were uneventful.
Ethacridine lactate provides an effective and safe method
for terminating second trimester pregnancy. Though it is
considered free from cardiac and renal toxicity, even if
absorbed into systemic circulation from the uterus, acute
renal failure has been reported'. It is contraindicated in
patients who are hypersensitive to it and it should be
used with utmost care if there is a history of previous
surgery on the uterus or cervix. Prior renal function tests
and urine output recordings after its instillation can detect
any renal toxic effect in time.
