Vaginal cytology and ferning of cervical mucus studies after intra-uterine instillation of solutions for medical termination of pregnancy.

The effectiveness of intrauterine instillation of solutions for midtrimester abortions is well established but the mechanism for triggering the onset of labor is unclear and represents a challenging problem for obstetricians and physiologists. Vaginal cytology reflects the hormonal status. Of the total of 78 cases in this study 20% sodium chloride solution was used in 55 cases glucose 50% in 5 cases and 0.1% unacredil with Foleys catheter in 18 cases. Vaginal smear was taken and stained with Papanicolaous staining method. In the vaginal smear the following aspects were studied: presence of Doderlein bacilli; cytolysis; tendency of the cells to unfold and separate; degenerative changes in the cells inducing perinuclear halo; fragmentation of nuclei; flatness and loss of haziness of cell border; Karyopyknotic index; and parabasal cells. Cervical mucus was taken dried and examined under the microscope for appearances of ferning. The cervical mucus and vaginal smear were taken before instillation and after instillation every 8 hours until abortion. In unacredil no significant changes in vaginal cytology were observed until abortion even when it was repeatedly instilled. The usual changes observed in vaginal cytology were observed until abortion even when it was repeatedly instilled. The usual changes observed in vaginal cytology in this series were within 8-24 hours in all saline instilled cases except the discreteness of cells which was not found in 11 cases until abortion. Karyopyknotic index rising above 10 from the baseline smear was observed in all cases but more than 30 Karyopyknotic index was noted in 26 cases. Parabasal cells appeared prior to abortion in 11 cases. Perinuclear halo was found in 1 case. In hypertonic glucose all identified changes were noted except the appearance of parabasal cells and perinuclear halo. With unacredil the changes in vaginal cytology could not be appreciated until abortion. Ferning in pregnancy indicates placental insuffiency. In this study ferning was positive (atypical) in 2 cases before giving intraamniotic saline. After saline instillation ferning appeared in cervical mucus within 8-40 hours in all cases. In glucose instilled cases ferning appeared in all cases within 16-40 hours. Instillation of hypertonic saline probably is damaging the placenta and thus withdrawing progesterone blocks which is reflected in vaginal cytology and cervical mucus ferning. In cases of hypertonic glucose this placental damage is not as extensive as revealed in vaginal cytology and cervical mucus fern test. In case of unacredil it has no effect on hormonal function of placenta as is evident by no change in vaginal cytology and ferning.