Self-induced illegal abortion with Rivanol®: A medicolegal-toxicological case report.

Approximately during the 30th week of pregnancy, a woman gave birth to a still-born child in a hospital. After first citing an extraneous cause for the premature still-birth, the woman later admitted to having self-induced the abortion by injecting the antiseptic Rivanol® (active agent: ethacridine lactate) through her abdominal wall into the amniotic cavity. The investigating authorities ordered an autopsy of the fetus along with additional toxicological investigations. To the naked eye, no obvious cause of death was apparent. The main autopsy findings were four skin defects (puncture/stabbing wounds) on the ball of the fetus's left thumb, with slight bleeding around the punctures and into the underlying fatty tissue, and a yellowish discoloration of the fetus's body surface, especially of the umbilical cord and fingernails. On basis of the results, the child would have been viable. Femoral vein blood and urine from the fetus were analyzed for ethacridine, as were an amniotic fluid sample and maternal blood and urine samples, which had been collected as evidence. The concentration of ethacridine in the amniotic fluid was 16mg/l. In the postmortem fetal blood and urine samples, the concentrations were 0.36mg/l and 0.34mg/l, respectively, while concentrations of 0.091mg/l and 0.42mg/l, respectively, were found in the serum and urine samples from the mother. In many countries, foremost in China, ethacridine lactate, to which both mother and child are exposed, is widely used as safe abortion method. Although the ethacridine concentrations found in blood and urine samples of the mother in our case are consistent with published values, we believe to be the first to report postmortem ethacridine concentrations in a fetus. While exposure to ethacridine is not toxicologically relevant for the mother, it is fatal for the fetus because it causes the placental decidua capsularis to separate from the decidua parietalis or decidua placentalis, respectively. Prostaglandins that are then produced induce labor. In medicolegal contexts, the proof for an abortion through the administration of ethacridine lactate lies in the typical yellow discoloration of the fetus in conjunction with the toxicological demonstration of the substance in fetal body fluids, and if possible also in maternal body fluids.

[The determination in cadaveric material of drugs used for the interruption of pregnancy]. / Opredelenie v trupnom materiale lekarstvennykh sredstv, primeniaemykh dlia preryvaniia beremennosti.

A method for detection and measurements in cadaveric material of some drugs used to induce abortions has been developed. The drugs were measured by spectrophotometry, photo-electro-colorimetry, and argentometry. Detection threshold by the said methods was 0.5 to 3 mg%.

Determination of quinacrine (mepacrine) in plasma by high-performance liquid chromatography with fluorimetric detection.

Quinacrine (mepacrine, Atebrine) is an antiparasitic acridine derivative that is currently used as an intrapleural sclerosing agent. It was determined in plasma by reversed-phase high-performance liquid chromatography of a dichloroethane extract. The mobile phase was methanol-phosphate buffer (65:35) with 0.1 mM decylammonium hydrochloride and 8 mM ethanolammonium hydrochloride. Strong base was added post-column, and the detection of quinacrine was by fluorescence at 270/495 nm. Use of ethacridine lactate as internal standard was feasible but without significant advantage. The coefficient of variation for eight determinations of quinacrine was 4% at 3.4 ng/ml and 5% at 17 ng/ml. The stability of quinacrine in blood, plasma, water and dichloroethane solution was satisfactory for practical work. The usefulness of the analytical procedure for pharmacokinetic studies could be demonstrated.