# Instillation abortion

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Late term abortion method

Instillation abortion Background Abortion type Surgical First use 1934 Last use Usage has declined in U.S. since the 1970s. Gestation 16-24 weeks Usage United States 0.9% (2003) Infobox references

**Instillation abortion** is a rarely used method of [late-term abortion](/source/Late-term_abortion), performed by injecting a solution into the [uterus](/source/Uterus).

## Procedure

Instillation abortion is performed by injecting a [chemical](/source/Chemistry) [solution](/source/Solution_(chemistry)) consisting of either [saline](/source/Saline_(medicine)), [urea](/source/Urea), or [prostaglandin](/source/Prostaglandin) through the [abdomen](/source/Abdomen) and into the [amniotic sac](/source/Amniotic_sac). The [cervix](/source/Cervix) is [dilated](/source/Cervical_dilation) prior to the injection, and the chemical solution induces [uterine contractions](/source/Uterine_contraction) which expel the [fetus](/source/Fetus).[1] Sometimes a [dilation and curettage](/source/Dilation_and_curettage) procedure is necessary to remove any remaining fetal or placenta tissue.[2]

Instillation methods can require [hospitalization](/source/Inpatient_care) for 12 to 48 hours.[2] In one study, when [laminaria](/source/Laminaria) were used to dilate the cervix overnight, the time between injection and completion was reduced from 29 to 14 hours.[3]

## Usage

The method of instillation abortion was first developed in 1934 by [Eugen Aburel](/source/Eugen_Aburel).[4] It is most frequently used between the 16th and 24th week of [pregnancy](/source/Pregnancy), but its rate of use has declined dramatically in recent years.[2] In 1968, abortion by the instillation of saline solution accounted for 28% of those procedures performed legally in [San Francisco, California](/source/San_Francisco%2C_California).[5] Intrauterine instillation (of all kinds) declined from 10.4% of all legal abortions in the U.S. in 1972 to 1.7% in 1985,[6] falling to 0.8% of the total incidence of induced abortion in the United States during 2002,[7] and 0.1% in 2007.[8]

In a 1998 [Guttmacher Institute](/source/Guttmacher_Institute) [survey](/source/Statistical_survey), sent to hospitals in [Ontario](/source/Ontario), Canada, 9% of those [hospitals](/source/Hospital) in the province which offered abortion services used saline instillations, 4% used urea, and 25% used prostaglandin.[9] A 1998 study of facilities in [Nigeria](/source/Abortion_in_Nigeria) which provide abortion found that only 5% of the total number in the country use saline.[10]

## Complications

Once in common practice, abortion by intrauterine instillation has fallen out of favor, due to its association with serious [adverse effects](/source/Adverse_effect) and its replacement by procedures which require less time and cause less physical discomfort.[11]

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](/source/Nausea), [vomiting](/source/Vomiting), and [diarrhea](/source/Diarrhea).[2]

Instillation of either saline or prostaglandin is associated with a higher risk of immediate complications than surgical [D&C](/source/Dilatation_and_curettage).[12] [Dilation and evacuation](/source/Dilation_and_evacuation) is also reported to be safer than instillation methods.[13] One study found that the risk of complications associated with the injection of a combination of urea and [prostaglandin](/source/Prostaglandin) into the [amniotic fluid](/source/Amniotic_fluid) was 1.9 times that of D&E.[13]

The rate of [mortality](/source/Death) reported in the [United States](/source/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](/source/Hysterotomy_abortion) and [hysterectomy](/source/Hysterectomy).[13]

There have been at least two documented cases of unsuccessful instillation abortions that resulted in live births.[14][15]

## References

1. **[^](#cite_ref-1)** James, Denise. (2006). [Therapeutic Abortion](http://emedicine.medscape.com/article/266440-treatment). Retrieved February 24, 2009.

1. ^ [***a***](#cite_ref-UIHC_2-0) [***b***](#cite_ref-UIHC_2-1) [***c***](#cite_ref-UIHC_2-2) [***d***](#cite_ref-UIHC_2-3) UIHC Medical Museum. (2006) [The Facts of Life: Examining Reproductive Health](https://web.archive.org/web/20091121041307/http://www.uihealthcare.com/depts/medmuseum/galleryexhibits/factsoflife/abortion/abortion.html). Retrieved August 14, 2006.

1. **[^](#cite_ref-3)** Stubblefield, Phillip G., Carr-Ellis, Sacheen, & Borgatta, Lynn. (2004). [Methods of Induced Abortion](http://www.urmc.rochester.edu/OBGYN/medstudent/media/documents/MethodsforInducedAbortion.pdf) [Archived](https://web.archive.org/web/20080227213544/http://www.urmc.rochester.edu/OBGYN/medstudent/media/documents/MethodsforInducedAbortion.pdf) 2008-02-27 at the [Wayback Machine](/source/Wayback_Machine). *Obstetrics & Gynecology, 104 (1),* 174-185. Retrieved August 14, 2006.

1. **[^](#cite_ref-4)** Potts DM (January 1970). "Termination of pregnancy". *Br. Med. Bull*. **26** (1): 65–71. [doi](/source/Doi_(identifier)):[10.1093/oxfordjournals.bmb.a070745](https://doi.org/10.1093%2Foxfordjournals.bmb.a070745). [PMID](/source/PMID_(identifier)) [4904688](https://pubmed.ncbi.nlm.nih.gov/4904688).

1. **[^](#cite_ref-5)** Goldstein P, Stewart G (May 1972). ["Trends in therapeutic abortion in San Francisco"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1530244). *Am J Public Health*. **62** (5): 695–9. [doi](/source/Doi_(identifier)):[10.2105/AJPH.62.5.695](https://doi.org/10.2105%2FAJPH.62.5.695). [PMC](/source/PMC_(identifier)) [1530244](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1530244). [PMID](/source/PMID_(identifier)) [5024298](https://pubmed.ncbi.nlm.nih.gov/5024298).

1. **[^](#cite_ref-6)** Lawson, Herschel W.; Atrash, Hani K.; Saftlas, Audrey F.; Koonin, Lisa M.; Ramick, Merrell; Smith, Jack C. (September 1989). ["Abortion surveillance, United States, 1984-1985"](https://www.cdc.gov/mmwr/preview/mmwrhtml/00001467.htm). *MMWR. CDC Surveillance Summaries*. **38** (2): 11–45. [PMID](/source/PMID_(identifier)) [2506423](https://pubmed.ncbi.nlm.nih.gov/2506423).

1. **[^](#cite_ref-cdc2002_7-0)** Strauss, Lilo T; Herndon, Joy; Chang, Jeani; Parker, Wilda Y; Bowens, Sonya V; Berg, Cynthia J (25 November 2005). ["Abortion surveillance--United States, 2002"](https://www.cdc.gov/mmwr/preview/mmwrhtml/ss5407a1.htm). *Morbidity and Mortality Weekly Report. Surveillance Summaries*. **54** (7): 1–31. [PMID](/source/PMID_(identifier)) [16304556](https://pubmed.ncbi.nlm.nih.gov/16304556).

1. **[^](#cite_ref-cdc2007_8-0)** Pazol, Karen; Zane, Suzanne; Parker, Wilda Y; Hall, Laura R; Gamble, Sonya B; Hamdan, Saeed; Berg, Cynthia; Cook, Douglas A; Centers for Disease Control and Prevention (CDC) (25 February 2011). ["Abortion surveillance - United States, 2007"](https://www.cdc.gov/mmwr/preview/mmwrhtml/ss6001a1.htm). *Morbidity and Mortality Weekly Report. Surveillance Summaries*. **60** (1): 1–42. [PMID](/source/PMID_(identifier)) [21346710](https://pubmed.ncbi.nlm.nih.gov/21346710).

1. **[^](#cite_ref-9)** Ferris LE, McMain-Klein M, Iron K (1998). ["Factors influencing the delivery of abortion services in Ontario: a descriptive study"](http://www.guttmacher.org/pubs/journals/3013498.html). *Fam Plann Perspect*. **30** (3): 134–8. [doi](/source/Doi_(identifier)):[10.2307/2991628](https://doi.org/10.2307%2F2991628). [JSTOR](/source/JSTOR_(identifier)) [2991628](https://www.jstor.org/stable/2991628). [PMID](/source/PMID_(identifier)) [9635262](https://pubmed.ncbi.nlm.nih.gov/9635262).

1. **[^](#cite_ref-10)** Henshaw, Stanley K.; Singh, Susheela; Oye-Adeniran, Boniface A.; Adewole, Isaac F.; Iwere, Ngozi; Cuca, Yvette P. (December 1998). ["The Incidence of Induced Abortion in Nigeria"](http://www.guttmacher.org/pubs/journals/2415698.html). *International Family Planning Perspectives*. **24** (4): 156–164. [doi](/source/Doi_(identifier)):[10.2307/2991973](https://doi.org/10.2307%2F2991973). [JSTOR](/source/JSTOR_(identifier)) [2991973](https://www.jstor.org/stable/2991973).

1. **[^](#cite_ref-11)** *[Elective Abortion](https://emedicine.medscape.com/article/252560-overview)* at [eMedicine](/source/EMedicine)

1. **[^](#cite_ref-12)** Ferris LE, McMain-Klein M, Colodny N, Fellows GF, Lamont J (June 1996). ["Factors associated with immediate abortion complications"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1487918). *CMAJ*. **154** (11): 1677–85. [PMC](/source/PMC_(identifier)) [1487918](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1487918). [PMID](/source/PMID_(identifier)) [8646655](https://pubmed.ncbi.nlm.nih.gov/8646655).

1. ^ [***a***](#cite_ref-grimes_13-0) [***b***](#cite_ref-grimes_13-1) [***c***](#cite_ref-grimes_13-2) Grimes DA, Schulz KF (July 1985). "Morbidity and mortality from second-trimester abortions". *J Reprod Med*. **30** (7): 505–14. [PMID](/source/PMID_(identifier)) [3897528](https://pubmed.ncbi.nlm.nih.gov/3897528).

1. **[^](#cite_ref-14)** Elliott, Jane (6 December 2005). ["I survived an abortion attempt"](https://news.bbc.co.uk/2/hi/health/4500022.stm). *BBC News*.

1. **[^](#cite_ref-15)** P. Clarke; J. Smith; T. Kelly; MJ Robinson (January 2005). "An infant who survived abortion and neonatal intensive care". *Journal of Obstetrics and Gynaecology*. **25** (1): 73–4. [doi](/source/Doi_(identifier)):[10.1080/01443610400025945](https://doi.org/10.1080%2F01443610400025945). [hdl](/source/Hdl_(identifier)):[10019.1/36962](https://hdl.handle.net/10019.1%2F36962). [PMID](/source/PMID_(identifier)) [16147706](https://pubmed.ncbi.nlm.nih.gov/16147706). [S2CID](/source/S2CID_(identifier)) [6094614](https://api.semanticscholar.org/CorpusID:6094614).

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Adapted from the Wikipedia article [Instillation abortion](https://en.wikipedia.org/wiki/Instillation_abortion) by Wikipedia contributors ([contributor history](https://en.wikipedia.org/wiki/Instillation_abortion?action=history)). Available under [Creative Commons Attribution-ShareAlike 4.0 International](https://creativecommons.org/licenses/by-sa/4.0/). Changes may have been made.