{{Short description|Late term abortion method}} {{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% = <!-- Australia --> | Use_AU_date = | Use_CA% = <!-- Canada--> | 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% = <!-- South Africa --> | Use_ZA_date = | Medical_notes = }} '''Instillation abortion''' is a rarely used method of [[late-term abortion]], performed by injecting a solution into the [[uterus]].
==Procedure== Instillation abortion is performed by injecting a [[chemistry|chemical]] [[Solution (chemistry)|solution]] consisting of either [[Saline (medicine)|saline]], [[urea]], or [[prostaglandin]] through the [[abdomen]] and into the [[amniotic sac]]. The [[cervix]] is [[Cervical dilation|dilated]] prior to the injection, and the chemical solution induces [[uterine contraction]]s which expel the [[fetus]].<ref>James, Denise. (2006). [http://emedicine.medscape.com/article/266440-treatment Therapeutic Abortion]. Retrieved February 24, 2009.</ref> Sometimes a [[dilation and curettage]] procedure is necessary to remove any remaining fetal or placenta tissue.<ref name="UIHC" />
Instillation methods can require [[Inpatient care|hospitalization]] for 12 to 48 hours.<ref name="UIHC" /> 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.<ref>Stubblefield, Phillip G., Carr-Ellis, Sacheen, & Borgatta, Lynn. (2004). [http://www.urmc.rochester.edu/OBGYN/medstudent/media/documents/MethodsforInducedAbortion.pdf Methods of Induced Abortion] {{Webarchive|url=https://web.archive.org/web/20080227213544/http://www.urmc.rochester.edu/OBGYN/medstudent/media/documents/MethodsforInducedAbortion.pdf |date=2008-02-27 }}. ''Obstetrics & Gynecology, 104 (1),'' 174-185. Retrieved August 14, 2006.</ref>
==Usage== The method of instillation abortion was first developed in 1934 by [[Eugen Aburel]].<ref>{{cite journal |author=Potts DM |title=Termination of pregnancy |journal=Br. Med. Bull. |volume=26 |issue=1 |pages=65–71 |date=January 1970 |pmid=4904688 |doi=10.1093/oxfordjournals.bmb.a070745 }}</ref> It is most frequently used between the 16th and 24th week of [[pregnancy]], but its rate of use has declined dramatically in recent years.<ref name="UIHC">UIHC Medical Museum. (2006) [https://web.archive.org/web/20091121041307/http://www.uihealthcare.com/depts/medmuseum/galleryexhibits/factsoflife/abortion/abortion.html The Facts of Life: Examining Reproductive Health]. Retrieved August 14, 2006.</ref> In 1968, abortion by the instillation of saline solution accounted for 28% of those procedures performed legally in [[San Francisco, California]].<ref>{{cite journal |doi=10.2105/AJPH.62.5.695 |vauthors=Goldstein P, Stewart G |title=Trends in therapeutic abortion in San Francisco |journal=Am J Public Health |volume=62 |issue=5 |pages=695–9 |date=May 1972 |pmid=5024298 |pmc=1530244 }}</ref> Intrauterine instillation (of all kinds) declined from 10.4% of all legal abortions in the U.S. in 1972 to 1.7% in 1985,<ref>{{cite journal |last1=Lawson |first1=Herschel W. |last2=Atrash |first2=Hani K. |last3=Saftlas |first3=Audrey F. |last4=Koonin |first4=Lisa M. |last5=Ramick |first5=Merrell |last6=Smith |first6=Jack C. |title=Abortion surveillance, United States, 1984-1985 |journal=MMWR. CDC Surveillance Summaries |date=September 1989 |volume=38 |issue=2 |pages=11–45 |pmid=2506423 |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/00001467.htm }}</ref> falling to 0.8% of the total incidence of induced abortion in the United States during 2002,<ref name="cdc2002">{{cite journal |last1=Strauss |first1=Lilo T |last2=Herndon |first2=Joy |last3=Chang |first3=Jeani |last4=Parker |first4=Wilda Y |last5=Bowens |first5=Sonya V |last6=Berg |first6=Cynthia J |title=Abortion surveillance--United States, 2002 |journal=Morbidity and Mortality Weekly Report. Surveillance Summaries |date=25 November 2005 |volume=54 |issue=7 |pages=1–31 |pmid=16304556 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/ss5407a1.htm }}</ref> and 0.1% in 2007.<ref name="cdc2007">{{cite journal |last1=Pazol |first1=Karen |last2=Zane |first2=Suzanne |last3=Parker |first3=Wilda Y |last4=Hall |first4=Laura R |last5=Gamble |first5=Sonya B |last6=Hamdan |first6=Saeed |last7=Berg |first7=Cynthia |last8=Cook |first8=Douglas A |author9=Centers for Disease Control and Prevention (CDC) |title=Abortion surveillance - United States, 2007 |journal=Morbidity and Mortality Weekly Report. Surveillance Summaries |date=25 February 2011 |volume=60 |issue=1 |pages=1–42 |pmid=21346710 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/ss6001a1.htm }}</ref>
In a 1998 [[Guttmacher Institute]] [[statistical survey|survey]], sent to hospitals in [[Ontario]], Canada, 9% of those [[hospital]]s in the province which offered abortion services used saline instillations, 4% used urea, and 25% used prostaglandin.<ref>{{cite journal |doi=10.2307/2991628 |vauthors=Ferris LE, McMain-Klein M, Iron K |title=Factors influencing the delivery of abortion services in Ontario: a descriptive study |journal=Fam Plann Perspect |volume=30 |issue=3 |pages=134–8 |year=1998 |pmid=9635262 |url=http://www.guttmacher.org/pubs/journals/3013498.html |jstor=2991628|url-access=subscription }}</ref> A 1998 study of facilities in [[Abortion in Nigeria|Nigeria]] which provide abortion found that only 5% of the total number in the country use saline.<ref>{{cite journal |last1=Henshaw |first1=Stanley K. |last2=Singh |first2=Susheela |last3=Oye-Adeniran |first3=Boniface A. |last4=Adewole |first4=Isaac F. |last5=Iwere |first5=Ngozi |last6=Cuca |first6=Yvette P. |title=The Incidence of Induced Abortion in Nigeria |journal=International Family Planning Perspectives |date=December 1998 |volume=24 |issue=4 |pages=156–164 |doi=10.2307/2991973 |jstor=2991973 |url=http://www.guttmacher.org/pubs/journals/2415698.html |url-access=subscription }}</ref>
==Complications== Once in common practice, abortion by intrauterine instillation has fallen out of favor, due to its association with serious [[adverse effect]]s and its replacement by procedures which require less time and cause less physical discomfort.<ref>{{EMedicine|article|252560|Elective Abortion}}</ref>
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]], [[vomiting]], and [[diarrhea]].<ref name="UIHC" />
Instillation of either saline or prostaglandin is associated with a higher risk of immediate complications than surgical [[dilatation and curettage|D&C]].<ref>{{cite journal |vauthors=Ferris LE, McMain-Klein M, Colodny N, Fellows GF, Lamont J |title=Factors associated with immediate abortion complications |journal=CMAJ |volume=154 |issue=11 |pages=1677–85 |date=June 1996 |pmid=8646655 |pmc=1487918 }}</ref> [[Dilation and evacuation]] is also reported to be safer than instillation methods.<ref name="grimes">{{cite journal |vauthors=Grimes DA, Schulz KF |title=Morbidity and mortality from second-trimester abortions |journal=J Reprod Med |volume=30 |issue=7 |pages=505–14 |date=July 1985 |pmid=3897528 }}</ref> 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.<ref name="grimes" />
The rate of [[death|mortality]] reported in the [[United States]] 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 abortion|hysterotomy]] and [[hysterectomy]].<ref name="grimes" />
There have been at least two documented cases of unsuccessful instillation abortions that resulted in live births.<ref>{{cite news |last1=Elliott |first1=Jane |title=I survived an abortion attempt |url=https://news.bbc.co.uk/2/hi/health/4500022.stm |work=BBC News |date=6 December 2005 }}</ref><ref> {{cite journal |author1=P. Clarke |author2=J. Smith |author3=T. Kelly |author4=MJ Robinson |date=January 2005 | title = An infant who survived abortion and neonatal intensive care | journal = Journal of Obstetrics and Gynaecology | volume = 25 | issue = 1 | pages = 73–4 | pmid = 16147706 | doi = 10.1080/01443610400025945 |hdl=10019.1/36962 |s2cid=6094614 |hdl-access=free }}</ref>
==References== {{reflist}}
{{Abortion}}
[[Category:Methods of abortion]]