Instillation abortion

Last updated
Instillation abortion
Background
Abortion typeSurgical
First use1934
Last useUsage has declined in U.S. since the 1970s.
Gestation 16-24 weeks
Usage
United States0.9% (2003)
Infobox references

Instillation abortion is a rarely used method of late-term abortion, performed by injecting a solution into the uterus.

Contents

Procedure

Instillation abortion is performed by injecting a chemical 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. [1] Sometimes a dilation and curettage procedure is necessary to remove any remaining fetal or placenta tissue. [2]

Instillation methods can require hospitalization for 12 to 48 hours. [2] 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. [3]

Usage

The method of instillation abortion was first developed in 1934 by Eugen Aburel. [4] It is most frequently used between the 16th and 24th week of pregnancy, but its rate of use has declined dramatically in recent years. [2] In 1968, abortion by the instillation of saline solution accounted for 28% of those procedures performed legally in San Francisco, California. [5] Intrauterine instillation (of all kinds) declined from 10.4% of all legal abortions in the U.S. in 1972 to 1.7% in 1985, [6] falling to 0.8% of the total incidence of induced abortion in the United States during 2002, [7] and 0.1% in 2007. [8]

In a 1998 Guttmacher Institute survey, sent to hospitals in Ontario, Canada, 9% of those hospitals in the province which offered abortion services used saline instillations, 4% used urea, and 25% used prostaglandin. [9] A 1998 study of facilities in Nigeria which provide abortion found that only 5% of the total number in the country use saline. [10]

Complications

Once in common practice, abortion by intrauterine instillation has fallen out of favor, due to its association with serious adverse effects and its replacement by procedures which require less time and cause less physical discomfort. [11]

Saline is in general safer and more effective than the other intrauterine solutions because it is likely to work in one dose. Prostaglandin is fast-acting, but often requires a second injection, and carries more side effects, such as nausea, vomiting, and diarrhea. [2]

Instillation of either saline or prostaglandin is associated with a higher risk of immediate complications than surgical D&C. [12] Dilation and evacuation is also reported to be safer than instillation methods. [13] 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. [13]

The rate of mortality reported in the United States between 1972 and 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. [13]

There have been at least two documented cases of unsuccessful instillation abortions that resulted in live births. [14] [15]

Related Research Articles

Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus. An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion" and occurs in approximately 30% to 40% of pregnancies. When deliberate steps are taken to end a pregnancy, it is called an induced abortion, or less frequently "induced miscarriage". The unmodified word abortion generally refers to an induced abortion. Although it prevents the birth of a child, abortion is not generally considered birth control.

Dilationand curettage (D&C) refers to the dilation (widening/opening) of the cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus by scraping and scooping (curettage). It is a gynecologic procedure used for diagnostic and therapeutic purposes, and is the most commonly used method for first-trimester miscarriage or abortion.

Intact dilation and extraction is a surgical procedure that removes an intact fetus from the uterus. The procedure is used both after miscarriages and for abortions in the second and third trimesters of pregnancy.

Maternal death Aspect of human reproduction and medicine

Maternal death or maternal mortality is defined in slightly different ways by several different health organizations. The World Health Organization (WHO) defines maternal death as the death of a pregnant woman due to complications related to pregnancy, underlying conditions worsened by the pregnancy or management of these conditions. This can occur either while she is pregnant or within six weeks of resolution of the pregnancy. The CDC definition of pregnancy-related deaths extends the period of consideration to include one year from the resolution of the pregnancy. Pregnancy associated death, as defined by the American College of Obstetricians and Gynecologists (ACOG), are all deaths occurring within one year of a pregnancy resolution. Identification of pregnancy associated deaths is important for deciding whether or not the pregnancy was a direct or indirect contributing cause of the death.

Misoprostol Medication to induce abortion and treat ulcers

Misoprostol is a synthetic prostaglandin medication used to prevent and treat stomach and duodenal ulcers, induce labor, cause an abortion, and treat postpartum bleeding due to poor contraction of the uterus. Misoprostol is taken by mouth when used to prevent gastric ulcers in persons taking NSAIDs. For abortions it is used by itself and with mifepristone or methotrexate. By itself, effectiveness for abortion is between 66% and 90%. For labor induction or abortion, it is taken by mouth, dissolved in the mouth, or placed in the vagina. For postpartum bleeding it may also be used rectally.

Oligohydramnios is a medical condition in pregnancy characterized by a deficiency of amniotic fluid, the fluid that surrounds the fetus in the abdomen, in the amniotic sac. It is typically diagnosed by ultrasound when the amniotic fluid index (AFI) measures less than 5 cm or when the single deepest pocket (SDP) of amniotic fluid measures less than 2 cm. Amniotic fluid is necessary to allow for normal fetal movement, lung development, and cushioning from uterine compression. Low amniotic fluid can be attributed to a maternal, fetal, placental or idiopathic cause and can result in poor fetal outcomes including death. The prognosis of the fetus is dependent on the etiology, gestational age at diagnosis, and the severity of the oligohydramnios.

Labor induction is the process or treatment that stimulates childbirth and delivery. Inducing (starting) labor can be accomplished with pharmaceutical or non-pharmaceutical methods. In Western countries, it is estimated that one-quarter of pregnant women have their labor medically induced with drug treatment. Inductions are most often performed either with prostaglandin drug treatment alone, or with a combination of prostaglandin and intravenous oxytocin treatment.

Hysteroscopy Medical procedure

Hysteroscopy is the inspection of the uterine cavity by endoscopy with access through the cervix. It allows for the diagnosis of intrauterine pathology and serves as a method for surgical intervention.

Cervical dilation is the opening of the cervix, the entrance to the uterus, during childbirth, miscarriage, induced abortion, or gynecological surgery. Cervical dilation may occur naturally, or may be induced surgically or medically.

Vacuum aspiration

Vacuum or suction aspiration is a procedure that uses a vacuum source to remove an embryo or fetus through the cervix. The procedure is performed to induce abortion, as a treatment for incomplete spontaneous abortion or retained fetal and placental tissue, or to obtain a sample of uterine lining. It is generally safe, and serious complications rarely occur.

Dilation and evacuation (D&E) is the dilation of the cervix and surgical evacuation of the uterus after the first trimester of pregnancy. It is a method of abortion as well as a common procedure used after miscarriage to remove all pregnancy tissue.

Hysterotomy abortion is a surgical procedure that removes an intact fetus from the uterus in a process similar to a cesarean section. The procedure is generally used after the failure of another method, or when such a procedure would be medically inadvisable, such as in the case of placenta accreta.

Ethacridine lactate

Ethacridine lactate is an aromatic organic compound based on acridine. Its formal name is 2-ethoxy-6,9-diaminoacridine monolactate monohydrate. It forms orange-yellow crystals with a melting point of 226 °C and it has a stinging smell.

Self-induced abortion Abortion performed by a pregnant person themselves outside the recognized medical system

A self-induced abortion is an abortion performed by the pregnant woman herself, or with the help of other, non-medical assistance. Although the term includes abortions induced outside of a clinical setting with legal, sometimes over-the-counter medication, it also refers to efforts to terminate a pregnancy through alternative, potentially more dangerous methods. Such practices may present a threat to the health of women.

Prelabor rupture of membranes Medical condition

Prelabor rupture of membranes (PROM), previously known as premature rupture of membranes, is breakage of the amniotic sac before the onset of labor. Women usually experience a painless gush or a steady leakage of fluid from the vagina. Complications in the baby may include premature birth, cord compression, and infection. Complications in the mother may include placental abruption and postpartum endometritis.

Cervical cerclage Obstetrics medical procedure

Cervical cerclage, also known as a cervical stitch, is a treatment for cervical weakness, when the cervix starts to shorten and open too early during a pregnancy causing either a late miscarriage or preterm birth. In women with a prior spontaneous preterm birth and who are pregnant with one baby, and have shortening of the cervical length less than 25 mm, a cerclage prevents a preterm birth and reduces death and illness in the baby.

Prostaglandin E<sub>2</sub> Chemical compound

Prostaglandin E2 (PGE2), also known as dinoprostone, is a naturally occurring prostaglandin with oxytocic properties that is used as a medication. Dinoprostone is used in labor induction, bleeding after delivery, termination of pregnancy, and in newborn babies to keep the ductus arteriosus open. In babies it is used in those with congenital heart defects until surgery can be carried out. It is also used to manage gestational trophoblastic disease. It may be used within the vagina or by injection into a vein.

Postterm pregnancy is when a woman has not yet delivered her baby after 42 weeks of gestation, two weeks beyond the typical 40-week duration of pregnancy. Postmature births carry risks for both the mother and the baby, including fetal malnutrition, meconium aspiration syndrome, and stillbirths. After the 42nd week of gestation, the placenta, which supplies the baby with nutrients and oxygen from the mother, starts aging and will eventually fail. Postterm pregnancy is a reason to induce labor.

Osmotic dilator

Osmotic dilators are medical implements used to dilate the uterine cervix by swelling as they absorb fluid from surrounding tissue. They may be composed of natural or synthetic materials. A laminaria stick or tent is a thin rod made of the stems of dried Laminaria, a genus of kelp. Laminaria sticks can be generated from Laminaria japonica and Laminaria digitata. Synthetic osmotic dilators are commonly referred to by their brand names, such as Dilapan. Dilapan-S are composed of polyacrylonitrile, a plastic polymer. The hygroscopic nature of the polymer causes the dilator to absorb fluid and expand.

Septic abortion describes any type of abortion, due to an upper genital tract bacterial infection including the inflammation of the endometrium during or after 20 weeks of gestation. The genital tract during this period is particularly vulnerable to infection, and sepsis in most cases is caused by a combination of factors both due to facility conditions and/or individual predispositions. The infection often starts in the placenta and fetus, with a potential complication of also affecting the uterus, that can result in sepsis spreading to surrounding organs, or pelvic infections.

References

  1. ↑ James, Denise. (2006). Therapeutic Abortion. Retrieved February 24, 2009.
  2. 1 2 3 4 UIHC Medical Museum. (2006) The Facts of Life: Examining Reproductive Health. Retrieved August 14, 2006.
  3. ↑ Stubblefield, Phillip G., Carr-Ellis, Sacheen, & Borgatta, Lynn. (2004). Methods of Induced Abortion Archived 2008-02-27 at the Wayback Machine . Obstetrics & Gynecology, 104 (1), 174-185. Retrieved August 14, 2006.
  4. ↑ Potts DM (January 1970). "Termination of pregnancy". Br. Med. Bull. 26 (1): 65–71. doi:10.1093/oxfordjournals.bmb.a070745. PMID   4904688.
  5. ↑ Goldstein P, Stewart G (May 1972). "Trends in therapeutic abortion in San Francisco". Am J Public Health. 62 (5): 695–9. doi:10.2105/AJPH.62.5.695. PMC   1530244 . PMID   5024298.
  6. ↑ Lawson, Herschel W.; Atrash, Hani K.; Saftlas, Audrey F.; Koonin, Lisa M.; Ramick, Merrell; Smith, Jack C. (September 1989). "Abortion surveillance, United States, 1984-1985". MMWR. CDC Surveillance Summaries. 38 (2): 11–45. PMID   2506423.
  7. ↑ Strauss, Lilo T; Herndon, Joy; Chang, Jeani; Parker, Wilda Y; Bowens, Sonya V; Berg, Cynthia J (25 November 2005). "Abortion surveillance--United States, 2002". Morbidity and Mortality Weekly Report. Surveillance Summaries. 54 (7): 1–31. PMID   16304556.
  8. ↑ Pazol, Karen; Zane, Suzanne; Parker, Wilda Y; Hall, Laura R; Gamble, Sonya B; Hamdan, Saeed; Berg, Cynthia; Cook, Douglas A; Centers for Disease Control and Prevention (CDC) (25 February 2011). "Abortion surveillance - United States, 2007". Morbidity and Mortality Weekly Report. Surveillance Summaries. 60 (1): 1–42. PMID   21346710.
  9. ↑ Ferris LE, McMain-Klein M, Iron K (1998). "Factors influencing the delivery of abortion services in Ontario: a descriptive study". Fam Plann Perspect. 30 (3): 134–8. doi:10.2307/2991628. JSTOR   2991628. PMID   9635262.
  10. ↑ Henshaw, Stanley K.; Singh, Susheela; Oye-Adeniran, Boniface A.; Adewole, Isaac F.; Iwere, Ngozi; Cuca, Yvette P. (December 1998). "The Incidence of Induced Abortion in Nigeria". International Family Planning Perspectives. 24 (4): 156–164. doi:10.2307/2991973. JSTOR   2991973.
  11. ↑ Elective Abortion at eMedicine
  12. ↑ Ferris LE, McMain-Klein M, Colodny N, Fellows GF, Lamont J (June 1996). "Factors associated with immediate abortion complications". CMAJ. 154 (11): 1677–85. PMC   1487918 . PMID   8646655.
  13. 1 2 3 Grimes DA, Schulz KF (July 1985). "Morbidity and mortality from second-trimester abortions". J Reprod Med. 30 (7): 505–14. PMID   3897528.
  14. ↑ Elliott, Jane (6 December 2005). "I survived an abortion attempt". BBC News.
  15. ↑ P. Clarke; J. Smith; T. Kelly; MJ Robinson (January 2005). "An infant who survived abortion and neonatal intensive care". Journal of Obstetrics and Gynaecology. 25 (1): 73–4. doi:10.1080/01443610400025945. hdl: 10019.1/36962 . PMID   16147706. S2CID   6094614.
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