CHEMICAL ABORTION - INSTILLATION METHODS
2nd & 3rd Trimesters
These methods involve the injection of drugs or chemicals through the abdomen or cervix into the amniotic sac to cause the death of the child and his or her expulsion from the uterus. Several drugs have been tried,[1] but the most commonly used are hypertonic saline, urea, and prostaglandins.
SALT (SALINE) POISONING
Otherwise known as "saline amniocentesis," "salting out," or a "hypertonic saline" abortion, this technique is used after 16 weeks of pregnancy, when enough fluid has accumulated in the amniotic fluid sac surrounding the baby.
A needle is inserted through the mother's abdomen and 50-250 ml (as much as a cup) of amniotic fluid is withdrawn and replaced with a solution of concentrated salt.[2] The baby breathes in, swallowing the salt, and is poisoned.[3] The chemical solution also causes painful burning and deterioration of the baby's skin.[4] Usually, after about an hour, the child dies. The mother goes into labor about 33 to 35 hours after instillation and delivers a dead, burned, and shriveled baby.[5] About 97 percent of mothers deliver their dead babies within 72 hours.[6]
Hypertonic saline may initiate a condition in the mother called "consumption coagulopathy" (uncontrolled blood clotting throughout the body) with severe hemorrhage as well as other serious side effects on the central nervous system.[7] Seizures, coma, or death may also result from saline inadvertently injected into the woman's vascular system.[8]
UREA
Because of the dangers associated with saline methods, other instillation methods such as hypersomolar urea are sometimes employed,[9] though these are less effective and usually must be supplemented by oxytocin or a prostaglandin in order to achieve the desired result.[10] Incomplete or failed abortion remains a problem with urea methods, often precipitating the additional risk of surgery.
As with other instillation techniques, gastrointestinal side effects such as nausea or vomiting are frequent, but the most common problem with second trimester techniques is cervical injuries, which range from small lacerations to complete detachments of the anterior or posterior cervix. Between 1 percent and 2 percent of patients using urea must be hospitalized for treatment of endometritis, an infection of the lining oft he uterus.[11]
PROSTAGLANDINS
Prostaglandins are naturally produced chemical compounds which normally assist in the birthing process. The injection of concentrations of artificial prostaglandins prematurely into the amniotic sac induces violent labor and the birth of a child usually too young to survive. Often salt or another toxin is first injected to ensure that the baby will be delivered dead,[12] since some babies have survived the trauma of a prostaglandin birth and been born alive.[13] This method is used during the second trimester.[14]
In addition to risks of retained placenta, cervical trauma, infection, hemorrhage,[15] hyperthermia, bronchoconstriction, tachycardia,[16] more serious side effects and complications from the use of artificial prostaglandins, including cardiac arrest and rupture of the uterus, can be unpredictable and very severe. Death is not unheard of.[17]
REFERENCES
1. Nelson B. Isada, MD., et al, mention potassium chloride and digoxin in "Fetal Intracardiac Potassium Chloride Injection to Avoid the Hopeless Resuscitation of an Abnormal Abortus: I. Clinical Issues," Obstetrics and Gynecology, Vol. 80, No. 2 (August 1992), pp.296, 298, (though they administered this directly into the baby's heart, rather than just the surrounding amniotic sac), and Marc A. Bygdeman mentions, but does not discuss in detail, the use of hypertonic glucose in "Prostaglandin Procedures," Second Trimester Abortion, ed. Gary S. Berger, et al (Boston: Martinus Nijhoff Publishers, 1981), p. 101. Oxytocin, normally used to stimulate contractions in full term pregnancies, can apparently also be used as an abortifacient in mid-trimester pregnancies, if used in high enough doses, according to Stubblefield, "First and Second Trimester Abortion...,"cited in Phillip G. Stubblefield, "First and Second Trimester Abortion," in Gynecologic and Obstetric Surgery, ed. David H. Nichols (Baltimore:
Mosby, 1993) p. 1016. Also, the U.S. Centers for Disease Control (CDC), "Abortion Surveillance: Preliminary Data - United States, 1991, " Morbidity and Mortality Weekly Report, Vol. 43, No. 3, 1994, p. 43, puts the percentage of suction curettage abortions relative to other techniques at 98 percent, though the CDC admits that their numbers include a number of D & E abortions which should be classified otherwise (personal communication with Lisa Koonin,Division of Reproductive Health, CDC, March 6, 1996), p. 1027.
2. Thomas D. Kerenyi, "Hypertonic Saline Instillation," in Second Trimester Abortion, cited above, p. 81.
3. R.S. Galen, P. Chauhan, H. Wietzner, et al, "Fetal pathology and mechanism of fetal death in saline-induced abortion: a study of 143 gestations and critical review of the literature," American Journal of Obstetrics and Gynecology, Vol. 120 (1974), p.347.
4. Jeff Lyon, "Abortion paradox: A live baby," York Daily Record (York, Pennsylvania), August 21, 1982. See also Congressional Record, March 23, 1983, H1680.
5. Stephen L. Corson., M.D., et al, Fertility Control (Boston, MA: Little, Brown, and Company, 1985), pp. 82-83.
6. Thomas D. Kerenyi, Abortion and Sterilization, ed. Hodgson, cited in Jane E. Hodgson, M.D.,"Abortion by vacuum aspiration," Abortion and Sterilization: Medical and social aspects, Jane E. Hodgson, ed. (New York: Academic Press, Grune and Strathon, 1981), p. 362.
7. James R. Scott, M.D., et al, Danforth's Obstetrics and Gynecology, 6th ed. (Philadelphia: J.B. Lippincott, 1990), p. 726.
8. Thomas D. Kerenyi, "Hypertonic Saline Instillation," in Second Trimester Abortion, cited in note 1, p.83; and R. Bolognese and S. Corson, Interruption of Pregnancy - A Total Patient Approach (Baltimore: Wilkins and Wilkins, 1985), p. 136.
9. Marc A. Bygdeman, "Prostaglandin Procedures," in Second Trimester Abortion, cited in note 1, p. 101.
10. Ronald T. Burkman, Theodore M. King, Milagros F. Atienza, "Hyperosmolar Urea," in Second Trimester Abortion,cited in note 1, pp. 109-110.
11. Ibid., pp. 115-116.
12. Nancy K. Rhoden, "The New Neonatal Dilemma: Live Births from Late Abortions," The Georgetown Law Journal, Vol. 72 (1984), p. 1458.
13. Liz Jeffries and Rick Edmonds, "Abortion, The Dreaded Complication," The Philadelphia Inquirer, August 2, 1981, 4 page insert.
14. Warren M. Hern, M.D., Abortion Practice, cited pp. 123, 125 in Warren M. Hern, M.D., Abortion Practice (Philadelphia: J.B. Lipincott Company, 1984), pp. 153-154. See also Human Life Federalism Amendment, cited in U.S. Senate Report of the Committee on the Judiciary, Human Life Federalism Amendment, Senate Joint Resolution 3, 98th Congress, 1st Session, legislative day June 6, 1983, p. 36. (Hereafter to as Human Life Federalism Amendment), p. 36.
15. Ibid., p. 125.
16. James R. Scott, Danforth's Obstetrics and Gynecology, cited in James R. Scott, M.D., et al, Danforth's Obstetrics and Gynecology, 6th ed. (Philadephia: J.B. Lippincott, 1990), p. 726.
17. Willard Cates, M.D. and H.V.F. Jordaan, "Sudden Collapse and Death of Women Obtaining Abortion Induced by Prostaglandin F2 Alpha," American Journal of Obstetrics and Gynecology, Vol. 133 (February 15, 1979), pp. 398-400. See also David Grimes, M.D., et al, "Midtrimester abortion by intra-amniotic prostaglandin F2a: Safer than saline?" Obstet Gynecol, Vol. 49 (1977), p. 612 and A.C. Wentz, et al, "Posterior cervical rupture following prostaglandin-induced midtrimester abortion," American Journal
of Obstetrics and Gynecology, Vol. 115 (1973), p. 1107.
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MoonDragon's ObGyn Womens Health Information: Abortion Index
