N.T.T. resembles in size and shape with laminaria herbal tent but it has been coated with herbal extracts which are responsible for its action. N.T.T. is available in various thicknesses owing to variable size of each uterus.The doctor has vast choice of selection of size of N.T.T. according to size of uteri. The size of uterus varies according to age and physique of the women, period of gestation and Parity.
Every Test Contains
Mode of Action
The ingredients of outer coating of N.T.T. get dissolved in the mucous present in endometrium within few minutes of its insertion into the uterus via OS. These ingredients produce pains resembling to labor pains. The ulterus undergoes rhythmic contractions and relaxations. The action leads to dilatation of cervix, detachment of embryo and finally expulsion of the contents of uterus.
Although ingredients of N.T.T. mainly plumbagin present in P. Rosea is antiseptic and supposed to keep the device sterile but for 100% safety, immersing of N.T.T. for about 6 to 8 hours of alcohol, anaesthetic ether or chloroform is advised. The ingredients of outer coating of N.T.T dot not dissolve in these disinfectants although these are solvents by nature.
Method of Insertion
The patient is kept in lithotomy position and the cervix is exposed by sim's vaginal speculum. The anterior lip of the cervix is held with a sponge holder and the tent is inserted into the uterus via cervical OS a little beyond the internal OS. As the length of the nongravid uterus is 7.5 cm and N.T.T. measures 6.3 cm. there is no risk of perforation of uterus if properly inserted. A dried sterile gauze is tied between the threads of the tent to make sure that the tent will not slip into the uterine cavity.
Post Insertion Precautions
A course of antibiotic and/ or sulphonamides along with A.T.S. must be given routinely as done during other surgical operation.
Contra - Indication
Carcinoma Cervix, Ectopic gestation, server anaemia, bleeding tendency, during active stage of infection cervictis due to pelvic infection/ physical/ chemical agents.
If there is no response within 12 hours of insertion, second N.T.T may be tried. Diagnosis of pregnancy must be confirmed by urine test routinely in Ist trimester of gestation. In case of misdiagnosis of false pregnancy, N.T.T. may not produce contractions in the uterus, labour like pains and consequently no bleeding. In 2nd trimester of pregnancy diagnosis must be confirmed by radiological or ultrasonographical techniques, to avoid misdiagnosis for ectopic gestation and pelvic/ abdominal tumors/ growth. If profuse bleeding occurs prior to clearance of product of conception (P.O.C) curettage must be performed without further waiting for outcome. If severe bleeding occurs after clearance of P.O.C this is indication of retention of a part or in full of placenta. In such cases after manual examination in completely sterile conditions curettage must be performed. I.V. fluids with Calcium Gluconate such as injection calcium Sandoz be given along with other haemostatic injection and tablets. If after 72 hours of insertion, there is no clearance of P.O.C curettage must be performed to avoid sepsis and related complications.
No major complications such as cervical tear, profuse bleeding p.v. pelvic, sepsis, shocks and mortality has been reported. Rise of mild temperature has been reported by Tripathy et al. in 12% Gangwal and Singh in 6%; Tresa Philomena 16.67% and K.P. Shama in 14% of cases which subsided either on clearance of p.o.c. or by giving analgesics. Vomiting of mild degree has been reported in 35% and 10% by Shivamoorthy and K.P. Sharma, respectively, no perforation of uterus by insertions of NTT has been reported.
Period of Gestation for Safe Termination of Pregnancy
It is possible to terminate pregnancy of any length, with NTT but we advise that a doctor must observe strictly the norms laid down by the Medical Termination of Pregnancy Act, 1971 and Rules 1975 with regulations,
NTT is supplied in packets of 8 Tents each.