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DESCRIPTION
Intra-amniotic instillation of hypertonic urea will kill the fetus and initiate contractions which are then usually accelerated by oxytocin.
Hypertonic saline or glucose are equally effective but 20% saline may cause cerebral hemorrhage in the mother if it reaches her circulation, and glucose greatly increases the risk of severe infection.
The mode of action of hypertonic solutions is not yet understood, but a mild degree of intravascular coagulation is known to occur, with a rise in fibrin degradation products and a fall in plasma fibrinogen and platelet counts. The level of progesterone also falls probably because of damage to the placenta.
TECHNIQUE
The patient is anesthetized or given 20 mg of diazepam intravenously. With full aseptic precautions, 150 ml of amniotic fluid (amniotic liquor) are withdrawn using a 50 ml syringe and a broad bore needle, and 80 g urea in 140 ml saline are injected. 2.5 mg of prostaglandin are sometimes added.
Oxytocin is given by continuous IV infusion, up to 150 mU/min, and abortion may be expected in about 12 hours.
DISADVANTAGES
The uterus has to be at least 16 weeks in size to be technically suitable, and delaying to this stage may distress the patient, especially if she begins to feel movement.
The whole experience is emotionally unpleasant.
Retained placenta and perhaps hemorrhage occurs in about 20% of cases, and an obstetric unit is considered the most suitable place for this procedure.
Cervical tears and even fistula may occur, and the cervix should be inspected on completion.
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LINKS
MoonDragon's Obgyn Information: Abortion - Intra-amniotic Instillation Page
Information obtained from Obstetrics Illustrated, 3rd Edition by Garrey, Govan, Hodge & Callander.
