Early complications and sequence of pregnancy interruption with hypertonic saline

Abstract

Midtrimester abortions and a number of cases with missed labor were induced by intrauterine instillation of 30% saline solution in 103 women. The instillation-abortion time was relatively short (mean 25.4 h) while oxytocin was not needed for the augmentation of contractions either in elective abortions or missed labor. Eighty-seven women had a curettage after the abortion; this was directly related to fetal weight. The first puncture was unsuccessful in 11 women (10.7%) and a second puncture was made a week later. Ten women had early complications, mainly fever for a few days; there were no instances of uterine perforations or disseminated intravascular coagulopathy (DIC). Postabortal curettage decreased the incidence of early complications. All study patients had a follow-up examination after 2 to 22 yr from the abortion. In 10 women some sequelae were found, but only in three women was the problem possibly related to the saline abortion (hydrosalpinx, incompetent cervix, and intrauterine adhesions). Of 71 women who subsequently wished to become pregnant, 69 succeeded: seven had more than one pregnancy, in three there were recurrent abortions. In 94 patients menstruation was normal, in eight bleeding became heavier, and there was one case of oligomenorrhea. In the authors' experience and contrary to other publications, midtrimester abortion with concentrated saline has been safe and rapid, and late sequelae have been rare and less important than after early induced abortions.

PIP: This study is a longitudinal follow-up of 103 women (mean age, 29.7 years) who had hypertonic saline (30%) induction of midtrimester abortion or of labor with fetal death in utero. Mean instillation-abortion time was relatively short, 25.4 hours. Oxytocin was not needed for augmentation of contractions either in elective abortions or missed labor. 90.3% of the women (93) did not exhibit any early complications. Fever and signs of low-grade infection were observed in 8 patients, and hemorrhage in 2. In 71.9% of patients, menses returned within a month after the operation. All patients had a follow-up exam after 2 to 22 years from date of abortion. In 3 women, sequelae possibly related to the saline abortion (hydrosalpinx, incompetent cervix, and intrauterine adhesions) were observed. 69 out of 71 women who desired to become pregnant succeeded. In 94 patients, menses were found to be normal. In 8, bleeding became heavier, and in 1, oligonomenorrhea occurred. The authors concluded that 30% saline induction of midtrimester abortion is simple and effective, and eliminates need for laminaria, oxytocin, additional prostaglandins, and intrauterine or routine oral antibiotics. Reproductive and gynecological complications are minimal.