Abstract

PIP: In light of the knowledge of the association between oxytocin administration and uterine rupture in late pregnancy, supraphysiologic doses of intravenous oxytocin are used by physicians to augment second trimester saline-induced abortions. According to the Center for Disease Control, this practice causing uterine rupturing is not unique to higher parities and can be fatal if not recognized. 2 case studies are reported. The 1st case, a 23-year-old woman (gravida 3, para 2), underwent saline instilled elective abortion at 18 menstrual weeks' gestation. Following removal of 200 cc of clear amniotic fluid from the uterus, an equal volume of 20% saline was instilled. 2 hours later, intravenous oxytocin was begun and an additional 400 mg of oxytocin was administered in the next 32 hours. 35 hours after instillation the patient had a thready pulse and blood pressure of 88/60, followed by stupor and cardiopulmonary arrest. After resuscitation a laparotomy disclosed an anterior paramedian laceration of the uterus. A hysterectomy was performed, the subsequent course was complicated, and the patient died on the 5th hospital day. In Case 2 a 29-year-old obese women (gravida 4, para 3) had an elective saline-instilled abortion at 20 menstrual weeks' gestation. After saline instillation the patient received intravenous oxytocin in the following amounts: 1) 60 mg; 2) 40 mg, with mild bleeding noted, and 3) 60 mg, followed by profuse vaginal bleeding. The fetus and the placenta were removed, and no detection of uterine rupture was made. The patient was transferred to another hospital, and died 5 hours later following multiple cardiopulmonary arrests. Rupture of the gravida uterus is defined as disruption of the uterine wall, occurring predominantly in the lower uterine segment. Uterine rupture and rupture during a term birth are probably analogous. The death-to-case rate for saline-induced abortions in the U.S. from 1972 to 1975 is .08 deaths/100,000, however, this rate would be higher if only saline-induced abortions receiving oxytocin were considered.