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DESCRIPTION
Intra-amniotic instillation is a technique of electively terminating a pregnancy. This particular method involves amniocentesis (a procedure where a small amount of amniotic fluid is withdrawn) and injection of various fluids into the "bag of waters" (amniotic sac of fluid surrounding the fetus) to initiate labor. It is recommended only if your pregnancy test was positive and your last menstrual period was 16 to 20 weeks ago. This information and instruction discussion is based on the assumption that you have had counseling and competent guidance in making your decision to seek this procedure for terminating the pregnancy.
REASONS FOR PROCEDURE
Personal concerns about the social or economic aspects that involve an unplanned pregnancy.
Continuing with the pregnancy may pose a threat to the life of the mother.
Mother has a genetic condition which the fetus is at significant risk of acquiring, or the fetus has been tested and is known to have the condition (such as cystic fibrosis).
Pregnancy resulted from a rape.
Fetus is affected with a major disorder such as chromosomal abnormality or birth defect.
Fear that the fetus has been harmed by medications or other conditions.
RISK INCREASES WITH
Obesity.
Smoking.
Poor nutrition.
Recent or chronic illness.
Use of drugs such as anti-hypertensives; muscle relaxants; tranquilizers; sleep inducers; insulin; sedatives; narcotics; beta-adrenergic blockers; or cortisone.
Use of mind-altering drugs, including: narcotics; psychedelics; hallucinogens; marijuana; sedative; hypnotics; or cocaine.
DESCRIPTION OF PROCEDURE
The procedure is performed in a hospital.
The cervix is usually dilated ahead of the procedure using sterile seaweed (luminaria).
Under local anesthesia, the health care practitioner will carefully insert a hollow needle into the uterus through the abdomen. The needle's penetration of the uterus will cause some pain, but it should not last long and should hurt no worse than an injection in any other part of the body.
Urea Instillation Method
Amniotic fluid is withdrawn and a solution is introduced into the cavity either in a single dose, or as 2 doses 6 hours apart.
Contractions begin 12 to 24 hours later and the dead fetus and placenta are delivered. A synthetic hormone may be given to continue contractions until all the tissue has been expelled.
EXPECTED OUTCOME
Termination of the pregnancy.
Expect complete healing without complications. Allow about 1 week for recovery from surgery.
POSSIBLE COMPLICATIONS
Retained placenta (usually can be removed with the use of surgical instruments).
Excessive bleeding.
Perforation or infection of the uterus.
Cervical laceration (tearing).
Failure of the procedure to expel all the tissue.
Cervical tears and even fistula may
occur, and the cervix should be
inspected on completion.
POST-PROCEDURE CARE
GENERAL MEASURES
Following the procedure, rest quietly at home for the remainder of the day.
If you have pain, place a heating pad or hot-water bottle on the abdomen or back. Hot baths frequently promote muscle relaxation and relieve discomfort. Repeat the baths as often as they provide comfort.
Use sanitary pads for bleeding, which may last for several days. If bleeding continues 10-14 days after surgery, you may then use tampons.
If contraception is desired, it can often be initiated shortly after the procedure. If you wish to take birth control pills, begin taking them either on the night you return from surgery or the next day. If you prefer an IUD, diaphragm or cervical cap, the fitting can be made during you next clinical appointment.
Your next menstrual period should begin 4 to 6 weeks after the procedure. If you take birth control pills, your first period will begin after you complete the first cycle of pills.
MEDICATION
Prescription pain medication should generally be required for only 2 to 7 days following the procedure.
You may use non-prescription drugs, such as acetaminophen, for minor pain.
Antibiotics may be prescribed to reduce risk of infection.
Stool softener laxative, if needed to prevent constipation.
ACTIVITY
Have someone drive you home from surgery. Rest quietly there for the remainder of the day. Resume normal activities slowly for the next day, if you feel able.
Do not have sexual relations for 2 weeks after surgery.
DIET
No special diet.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
Any of the following occurs:
Unexplained vaginal bleeding develops.
You develop signs of infection: headache, muscle aches, dizziness or a general ill feeling and a fever temperature of over 100°F orally.
New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
You develop new symptoms, such as nausea, vomiting, constipation, diarrhea or abdominal swelling.
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LINKS
Drawings obtained from Obstetrics Illustrated, 3rd Edition by Garrey, Govan, Hodge & Callander.
