Instillation abortion

Infobox abortion method
name = Instillation abortion
AKA/Abbreviation=
Abortion_type = Surgical
Date_first_use = 1934
Date_last_use = Usage has declined in U.S. since the 1970s.
Gestational_age = 16-24 weeks
Usage_notes =
Use_AU% =
Use_AU_date =
Use_CA% =
Use_CA_date =
Use_NZ% =
Use_NZ_date =
Use_SE% =
Use_SE_date =
Use_UK% =
Use_UK_date =
Use_US% = 0.9
Use_US_date = 2003
Use_ZA% =
Use_ZA_date =
Medical_notes =

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.

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. [James, Denise. (2006). [http://www.emedicine.com/med/topic3311.htm Therapeutic Abortion] . Retrieved August 14, 2006.] 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. [Stubblefield, Phillip G., Carr-Ellis, Sacheen, & Borgatta, Lynn. (2004). [http://www.urmc.rochester.edu/OBGYN/medstudent/media/documents/MethodsforInducedAbortion.pdf Methods of Induced Abortion] . "Obstetrics & Gynecology, 104 (1)," 174-185. Retrieved August 14, 2006. ]

Usage

The method of instillation abortion was first developed in 1934 by Eugen Aburel. [Potts, D.M. (1970). [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=4904688&dopt=Abstract Termination of pregnancy] . "British Medical Bulletin, 26 (1)," 65-71. Retrieved May 10, 2007.] It is most frequently used between the 16th and 24th week of pregnancy. UIHC Medical Museum. (2006) [http://www.uihealthcare.com/depts/medmuseum/galleryexhibits/factsoflife/factsoflife.html The Facts of Life: Examining Reproductive Health] . Retrieved August 14, 2006. ] Intrauterine instillation accounted for 0.8% of the total incidence of induced abortion in the United States during 2002. Strauss, Lilo T., Herndon, Joy, Chang, Jeani, Parker, Wilda Y., Bowens, Sonya V., Berg, Cynthia J. Centers for Disease Control and Prevention. (2005-11-15). [http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5407a1.htm Abortion Surveillance - United States, 2002] . "Morbidity and Mortality Weekly Report". Retrieved 2006-02-20.] The use of such methods in the U.S. declined from 10.4% in 1972 to 1.7% in 1985. [Lawson, Herschel W., Atrash, Hani K., Saftlas, Audrey F., Koonin, Lisa M., Ramick, Merrell, & Smith, Jack C. (1989). [http://www.cdc.gov/mmwr/preview/mmwrhtml/00001467.htm Abortion Surveillance, United States, 1984-1985] . "Morbidity and Mortality Weekly Report". Retrieved August 14, 2006.] In 1968, abortion by the instillation of saline solution accounted for 28% of those procedures performed legally in San Francisco, California. [Goldstein, P., & Stewart, G. (1972). [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=5024298&dopt=Abstract Trends in therapeutic abortion in San Francisco] . "American Journal of Public Health, 62(5)," 695-9. Retrieved August 14, 2006.]

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. [Ferris, Lorraine E., McMain-Klein, Margot, & Iron, Karey. (1998). [http://www.guttmacher.org/pubs/journals/3013498.html Factors Influencing the Delivery of Abortion Services in Ontario: A Descriptive Study] . "Family Planning Perspectives, 30 (3)." Retrieved August 14, 2006.] A 1998 study of facilities in Nigeria which provide abortion found that only 5% of the total number in the country use saline. [Henshaw, Stanley K., Singh, Susheela, Oye-Adeniran, Boniface A., Adewole, Isaac F., Iwere, Ngozi, & Cuca, Yvette P. (1998). [http://www.guttmacher.org/pubs/journals/2415698.html The Incidence of Induced Abortion in Nigeria] . "International Family Planning Perspectives, 24 (4)," 156-164. Retrieved August 14, 2006.]

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 result in less physical discomfort. [Trupin, Suzanne R. (2006). [http://www.emedicine.com/MED/topic5.htm Abortion] . Retrieved August 14, 2006.]

Saline is in general safer and more effective than the other intra-uterine 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. [Ferris, L. E., McMain-Klein, M., Colodny, N., Fellows, G. F., & Lamont, J. (1996). [http://www.cmaj.ca/cgi/content/abstract/154/11/1677 Factors associated with immediate abortion complications] . "Canadian Medical Association Journal, 154 (11)," 1677-1685. Retrieved August 14, 2006.] Dilation and evacuation is also reported to be safer than instillation methods. Grimes, D.A., & Schulz, K.F. (1985). [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3897528&dopt=Abstract Morbidity and mortality from second-trimester abortions] . "The Journal of Reproductive Medicine, 30 (7)," 505-14. Retrieved August 14, 2006.] 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. [Elliott, Jane. " [http://news.bbc.co.uk/2/hi/health/4500022.stm 'I survived an abortion attempt'] ." (December 6, 2005.) "BBC News." Retrieved April 26, 2007.
cite journal | author = P. Clarke, J. Smith, T. Kelly, MJ Robinson | year = 2005 | month = January | title = "An infant who survived abortion and neonatal intensive care" | journal = Journal of Obstetrics and Gynaecology | volume = vol. 25 | issue = 1 | pages = pp. 73–74 | pmid = 16147706 | doi = 10.1080/01443610400025945 | url = http://www.informaworld.com/smpp/content~db=all~content=a713698633~tab=content]

References