Instillation abortion is a rarely used method of

late-term abortion Late termination of pregnancy, also referred to as late-term abortion, describes the termination of pregnancy by induced abortion during a late stage of gestation. In this context, ''late'' is not precisely defined, and different medical publicati ...

, performed by injecting a solution into the

uterus The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The uter ...

Procedure

Instillation abortion is performed by injecting a

chemical A chemical substance is a form of matter having constant chemical composition and characteristic properties. Some references add that chemical substance cannot be separated into its constituent elements by physical separation methods, i.e., wi ...

solution Solution may refer to: * Solution (chemistry), a mixture where one substance is dissolved in another * Solution (equation), in mathematics ** Numerical solution, in numerical analysis, approximate solutions within specified error bounds * Soluti ...

consisting of either saline,

urea Urea, also known as carbamide, is an organic compound with chemical formula . This amide has two amino groups (–) joined by a carbonyl functional group (–C(=O)–). It is thus the simplest amide of carbamic acid. Urea serves an important r ...

, or

prostaglandin The prostaglandins (PG) are a group of physiologically active lipid compounds called eicosanoids having diverse hormone-like effects in animals. Prostaglandins have been found in almost every tissue in humans and other animals. They are derive ...

through the

abdomen The abdomen (colloquially called the belly, tummy, midriff, tucky or stomach) is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the torso. ...

and into the

amniotic sac The amniotic sac, also called the bag of waters or the membranes, is the sac in which the embryo and later fetus develops in amniotes. It is a thin but tough transparent pair of membranes that hold a developing embryo (and later fetus) until shor ...

. The

cervix The cervix or cervix uteri (Latin, 'neck of the uterus') is the lower part of the uterus (womb) in the human female reproductive system. The cervix is usually 2 to 3 cm long (~1 inch) and roughly cylindrical in shape, which changes during ...

is dilated prior to the injection, and the chemical solution induces

uterine contraction Uterine contractions are muscle contractions of the uterine smooth muscle that occur during the menstrual cycle and labour. Uterine contractions occur throughout the menstrual cycle in the non-pregnant state and throughout gestation. Throughout m ...

s which expel the

fetus A fetus or foetus (; plural fetuses, feti, foetuses, or foeti) is the unborn offspring that develops from an animal embryo. Following embryonic development the fetal stage of development takes place. In human prenatal development, fetal deve ...

. Sometimes a

dilation and curettage Dilation (or dilatation) and 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 is necessary to remove any remaining fetal or placenta tissue. Instillation methods can require

hospitalization A hospital is a health care institution providing patient treatment with specialized Medical Science, health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically ...

for 12 to 48 hours. In one study, when

laminaria ''Laminaria'' is a genus of brown seaweed in the order Laminariales (kelp), comprising 31 species native to the north Atlantic and northern Pacific Oceans. This economically important genus is characterized by long, leathery laminae and relativ ...

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 Aburel Eugen Bogdan Aburel (January 23, 1899 16 December 1975) was a Romanian surgeon and obstetrician. He introduced innovative techniques in gynecologic surgery. He was born Galați; his father came from a family of Armenians of Moldavia, while ...

. It is most frequently used between the 16th and 24th week of

pregnancy Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ca ...

, but its rate of use has declined dramatically in recent years.UIHC Medical Museum. (2006
The Facts of Life: Examining Reproductive Health
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 San Francisco (; Spanish for " Saint Francis"), officially the City and County of San Francisco, is the commercial, financial, and cultural center of Northern California. The city proper is the fourth most populous in California and 17th ...

. 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 The Guttmacher Institute is a research and policy NGO that aims to improve sexual and reproductive health and rights worldwide. This research organization was started in 1968 and works to study, educate, and advance sexual and reproductive health ...

survey Survey may refer to: Statistics and human research * Statistical survey, a method for collecting quantitative information about items in a population * Survey (human research), including opinion polls Spatial measurement * Surveying, the techniq ...

, sent to hospitals in

Ontario Ontario ( ; ) is one of the thirteen provinces and territories of Canada.Ontario is located in the geographic eastern half of Canada, but it has historically and politically been considered to be part of Central Canada. Located in Central Ca ...

, Canada, 9% of those

hospital A hospital is a health care institution providing patient treatment with specialized health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically has an emerge ...

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 ( ), , ig, Naìjíríyà, yo, Nàìjíríà, pcm, Naijá , ff, Naajeeriya, kcg, Naijeriya officially the Federal Republic of Nigeria, is a country in West Africa. It is situated between the Sahel to the north and the Gulf o ...

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 effect An adverse effect is an undesired harmful 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. The term complica ...

s and its replacement by procedures which require less time and cause 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. Prostaglandin is fast-acting, but often requires a second injection, and carries more side effects, such as

nausea Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the ...

vomiting Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the Human nose, nose. Vomiting can be the result of ailments like Food-poisoning, foo ...

, and

diarrhea Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin wi ...

. 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 (D&E) is the dilation of the cervix and surgical evacuation of the uterus (potentially including the fetus, placenta and other tissue) after the first trimester of pregnancy. It is a method of abortion as well as a common ...

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

into the

amniotic fluid The amniotic fluid is the protective liquid contained by the amniotic sac of a gravid amniote. This fluid serves as a cushion for the growing fetus, but also serves to facilitate the exchange of nutrients, water, and biochemical products betwee ...

was 1.9 times that of D&E. The rate of

mortality Mortality is the state of being mortal, or susceptible to death; the opposite of immortality. Mortality may also refer to: * Fish mortality, a parameter used in fisheries population dynamics to account for the loss of fish in a fish stock throug ...

reported in the

United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territorie ...

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 A hysterotomy is an incision made in the uterus. This surgical incision is used in several medical procedures, including during termination of pregnancy in the second trimester (or abortion) and delivering the fetus during caesarean section. It i ...

and

hysterectomy Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries (oophorectomy), Fallopian tubes (salpingectomy), and other surrounding structures. Usually performed by a gynecologist, a hysterectomy may b ...

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

References

{{Abortion Methods of abortion