Instillation abortion
Encyclopedia
Instillation abortion is a rarely used method of induced abortion
, performed in the second trimester, by injecting a solution into the uterus to cause uterine contractions.
solution
consisting of either saline
, urea
, or prostaglandin
through the abdomen
and into the amniotic sac
. The cervix
is dilated
prior to the injection, and the chemical solution induces uterine contractions which expel the fetus
. Sometimes a dilation and curettage
procedure is necessary to remove any remaining tissue.
Instillation methods can require hospitalization for 12 to 48 hours. In one study, when laminaria
were used to dilate the cervix overnight, the time between injection and completion was reduced from 29 to 14 hours.
. It is most frequently used between the 16th and 24th week of pregnancy
, but its rate of use has declined dramatically in recent years. In 1968, abortion by the instillation of saline solution accounted for 28% of those procedures performed legally in San Francisco, California
. Intrauterine instillation (of all kinds) declined from 10.4% of all legal abortions in the U.S. in 1972 to 1.7% in 1985, falling to 0.8% of the total incidence of induced abortion in the United States during 2002, and 0.1% in 2007.
In a 1998 Guttmacher Institute
survey
, sent to hospitals in Ontario
, Canada
, 9% of those hospital
s in the province which offered abortion services used saline instillations, 4% used urea, and 25% used prostaglandin. A 1998 study of facilities in Nigeria
which provide abortion found that only 5% of the total number in the country use saline.
s and its replacement by procedures which require less time and result in less physical discomfort.
Saline is in general safer and more effective than the other intrauterine solutions because it is likely to work in one dose. However, it poses a risk of medical emergency
if it enters the blood stream
. Prostaglandin is fast-acting, but often requires a second injection, and carries more side effects, such as nausea
, vomiting
, and diarrhea
.
Instillation of either saline or prostaglandin is associated with a higher risk of immediate complications than surgical D&C. Dilation and evacuation
is also reported to be safer than instillation methods. One study found that the risk of complications associated with the injection of a combination of urea and prostaglandin
into the amniotic fluid
was 1.9 times that of D&E.
The rate of mortality
reported in the United States
between 1972 to 1981 was 9.6 per 100,000 for instillation methods. This is in comparison to rates of 4.9 per 100,000 for D&E and 60 per 100,000 for abortion by hysterotomy
and hysterectomy
.
There have been at least two documented cases of unsuccessful instillation abortions that resulted in live births.
Abortion
Abortion is defined as the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability. An abortion can occur spontaneously, in which case it is usually called a miscarriage, or it can be purposely induced...
, performed in the second trimester, by injecting a solution into the uterus to cause uterine contractions.
Procedure
Instillation abortion is performed by injecting a chemicalChemistry
Chemistry is the science of matter, especially its chemical reactions, but also its composition, structure and properties. Chemistry is concerned with atoms and their interactions with other atoms, and particularly with the properties of chemical bonds....
solution
Solution
In chemistry, a solution is a homogeneous mixture composed of only one phase. In such a mixture, a solute is dissolved in another substance, known as a solvent. The solvent does the dissolving.- Types of solutions :...
consisting of either saline
Saline (medicine)
In medicine, saline is a general term referring to a sterile solution of sodium chloride in water but is only sterile when it is to be placed intravenously, otherwise, a saline solution is a salt water solution...
, urea
Urea
Urea or carbamide is an organic compound with the chemical formula CO2. The molecule has two —NH2 groups joined by a carbonyl functional group....
, or prostaglandin
Prostaglandin
A prostaglandin is any member of a group of lipid compounds that are derived enzymatically from fatty acids and have important functions in the animal body. Every prostaglandin contains 20 carbon atoms, including a 5-carbon ring....
through the abdomen
Abdomen
In vertebrates such as mammals the abdomen constitutes the part of the body between the thorax and pelvis. The region enclosed by the abdomen is termed the abdominal cavity...
and into the amniotic sac
Amniotic sac
The amniotic sac is the sac in which the fetus develops in amniotes. It is a tough but thin transparent pair of membranes, which hold a developing embryo until shortly before birth. The inner membrane, the amnion, contains the amniotic fluid and the fetus. The outer membrane, the Chorion,...
. The cervix
Cervix
The cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall...
is dilated
Cervical dilation
Cervical dilation is the opening of the cervix, the entrance to the uterus, during childbirth, miscarriage, induced abortion, or gynecological surgery...
prior to the injection, and the chemical solution induces uterine contractions which expel the fetus
Fetus
A fetus is a developing mammal or other viviparous vertebrate after the embryonic stage and before birth.In humans, the fetal stage of prenatal development starts at the beginning of the 11th week in gestational age, which is the 9th week after fertilization.-Etymology and spelling variations:The...
. Sometimes a dilation and curettage
Dilation and curettage
Dilation and curettage refers to the dilation of the cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus by scraping and scooping . It is a diagnostic gynecological procedure.D&C normally is referred to a procedure involving a curette, also called sharp...
procedure is necessary to remove any remaining tissue.
Instillation methods can require hospitalization for 12 to 48 hours. In one study, when laminaria
Laminaria
Laminaria is a genus of 31 species of brown algae , all sharing the common name "kelp". This economically important genus is characterized by long, leathery laminae and relatively large size. Some species are referred to by the common name Devil's apron, due to their shape, or sea colander, due to...
were used to dilate the cervix overnight, the time between injection and completion was reduced from 29 to 14 hours.
Usage
The method of instillation abortion was first developed in 1934 by Eugen AburelEugen Aburel
Eugene Aburel Bogdan was a Romanian surgeon and obstretician. He introduced innovative techniques in gynecologic surgery.-Works:* Contribuție la tratamentul infecției puerperale...
. It is most frequently used between the 16th and 24th week of pregnancy
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
, but its rate of use has declined dramatically in recent years. In 1968, abortion by the instillation of saline solution accounted for 28% of those procedures performed legally in San Francisco, California
San Francisco, California
San Francisco , officially the City and County of San Francisco, is the financial, cultural, and transportation center of the San Francisco Bay Area, a region of 7.15 million people which includes San Jose and Oakland...
. Intrauterine instillation (of all kinds) declined from 10.4% of all legal abortions in the U.S. in 1972 to 1.7% in 1985, falling to 0.8% of the total incidence of induced abortion in the United States during 2002, and 0.1% in 2007.
In a 1998 Guttmacher Institute
Guttmacher Institute
The Guttmacher Institute is a non-profit organization which works to advance sexual and reproductive health. The institute operates in the United States and globally "through an interrelated program of social science research, policy analysis and public education." According to their mission...
survey
Statistical survey
Survey methodology is the field that studies surveys, that is, the sample of individuals from a population with a view towards making statistical inferences about the population using the sample. Polls about public opinion, such as political beliefs, are reported in the news media in democracies....
, sent to hospitals in Ontario
Ontario
Ontario is a province of Canada, located in east-central Canada. It is Canada's most populous province and second largest in total area. It is home to the nation's most populous city, Toronto, and the nation's capital, Ottawa....
, Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
, 9% of those hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
s in the province which offered abortion services used saline instillations, 4% used urea, and 25% used prostaglandin. A 1998 study of facilities in Nigeria
Nigeria
Nigeria , officially the Federal Republic of Nigeria, is a federal constitutional republic comprising 36 states and its Federal Capital Territory, Abuja. The country is located in West Africa and shares land borders with the Republic of Benin in the west, Chad and Cameroon in the east, and Niger in...
which provide abortion found that only 5% of the total number in the country use saline.
Complications
Once in common practice, abortion by intrauterine instillation has fallen out of favor, due to its association with serious adverse effectAdverse effect
In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery.An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. If it results from an unsuitable or incorrect dosage or...
s and its replacement by procedures which require less time and result in less physical discomfort.
Saline is in general safer and more effective than the other intrauterine solutions because it is likely to work in one dose. However, it poses a risk of medical emergency
Medical emergency
A medical emergency is an injury or illness that is acute and poses an immediate risk to a person's life or long term health. These emergencies may require assistance from another person, who should ideally be suitably qualified to do so, although some of these emergencies can be dealt with by the...
if it enters the blood stream
Blood
Blood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....
. Prostaglandin is fast-acting, but often requires a second injection, and carries more side effects, such as nausea
Nausea
Nausea , is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting...
, vomiting
Vomiting
Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...
, and diarrhea
Diarrhea
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...
.
Instillation of either saline or prostaglandin is associated with a higher risk of immediate complications than surgical D&C. Dilation and evacuation
Dilation and evacuation
Dilation and evacuation literally refers to the dilation of the cervix and surgical evacuation of the contents of the uterus...
is also reported to be safer than instillation methods. One study found that the risk of complications associated with the injection of a combination of urea and prostaglandin
Prostaglandin
A prostaglandin is any member of a group of lipid compounds that are derived enzymatically from fatty acids and have important functions in the animal body. Every prostaglandin contains 20 carbon atoms, including a 5-carbon ring....
into the amniotic fluid
Amniotic fluid
Amniotic fluid or liquor amnii is the nourishing and protecting liquid contained by the amniotic sac of a pregnant woman.- Development of amniotic fluid :...
was 1.9 times that of D&E.
The rate of mortality
Death
Death is the permanent termination of the biological functions that sustain a living organism. Phenomena which commonly bring about death include old age, predation, malnutrition, disease, and accidents or trauma resulting in terminal injury....
reported in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
between 1972 to 1981 was 9.6 per 100,000 for instillation methods. This is in comparison to rates of 4.9 per 100,000 for D&E and 60 per 100,000 for abortion by hysterotomy
Hysterotomy abortion
Hysterotomy abortion is a form of abortion in which the uterus is opened through an abdominal incision and the fetus is removed, similar to a caesarean section, but requiring a smaller incision...
and hysterectomy
Hysterectomy
A hysterectomy is the surgical removal of the uterus, usually performed by a gynecologist. Hysterectomy may be total or partial...
.
There have been at least two documented cases of unsuccessful instillation abortions that resulted in live births.