CHAPTER 1 - SUMMARY OF METHODS

This chapter summarises all possible methods to terminate a pregnancy, medical and non-medical.

To read about those techniques you can click on them.

1. Chemicals applied to the Uterus	1.1. Flushing the Uterus	1.2. Prostaglandin applied to the Cervix	2 Chemicals administered systematically.
2.1. Prostaglandin by intravenous drip	2.2 Toxic medicines by mouth	2.3. Toxic fluids into the amniotic sac.	2.4. Anti-progesterone by mouth
3. Surgical evacuation hysterotomy	3.1 Sectio parva	3.2 Vaginal Sectio	4. Mechanical disturbing the pregnancy
4.1 Opening the amniotic sac.	4.2 Balloon methode	4.3 IUD methode	4.4 Laminaria tents
5. Mechanical evacuation of the Uterus	5.1 Classical D&C.	5.2 Finks' Technique	5.3 Manual Aspiration with a Syringe.
5.4 Lewis Apparatus.	5.5 Metothrexate MTX

CHEMICALS APPLIED TO THE UTERUS

1.1 Flushing the uterus with soap water or other fluid. This is one of the oldest methods. Not always effective. Main complications: air embolism in the case of soap water, infection, intoxication if some poisonous fluid is used, in severe cases renal failure due to haemolysis.

When Charles Schlebaum was a general practitioner in the Netherlands in 1970 he sent one of hispatients to the municipal hospital for termination of her unwanted pregnancy. By that time abortion was allowed under certain conditions. In this case the gynecologist flushed the uterus with a solution of cetrimide. Clearly some of this solution entered the circulation. As a result the patient became permanently mentally disabled.

1.2 Application of prostaglandins (dinoprostone) to the cervix in the form of a vaginal suppository or intracervical application of a jelly. This leads in nearly all cases (97%) to a spontaneous abortion. It is a safe and reliable method in the early pregnancy, but there is generally much more blood loss and discomfort than in the case of aspiration. It has been proposed as a means of birth control. By taking every month a vaginal dinoprostone suppository a possible pregnancy would be terminated, if there is no pregnancy there would be no effect. In case of an advanced pregnancy blood loss may be abundant and the patient usually suffers much discomfort, like abdominal pains, vomiting and diarrhea. Little used nowadays, and we do not recommend this method. It is sometimes still used to terminate a pregnancy of over 22 weeks.

Another use is to facilitate the dilation of the cervix.

2. CHEMICALS ADMINISTERED SYSTEMATICALLY

2.1 Sulproston® (16-phenoxy-omega-tetranor PGE2-Me-sulfonamide) is given by intravenous drip has the same effects and limitations as all prostaglandins The side effects are the same but generally stronger than in local application.

Sulprostone infusion I.V. is mostly used in hospitals in eugenic indicated cases.

Nowadays the oral application of Misoprostol (Cytotec ®) 400-800 µg/buccally is more practiced. This technique is practiced "rücksichtlos" is the Rep. of South Africa by medical practitioners and totally uncontrolled in Latin America and the Philippines. The combination of misoprostol with an NSAID (Arthrotec ®) is also used in some country since Cytotec ® was withdrawn from the market.

2.2 Using toxic medicines by mouth, like quinine or ergometrine containing concoctions like extractum secalis cornuti or apiol, are little effective and dangerous because of the toxic side effects. Obsolete.

2.3 Intra-amnionically injection of hypertonic saline was originally used in Japan around 1945 but later abandoned because of the high maternal morbidity and mortality. Despite that it became a popular way to do an abortion in the United States in the late seventies. Some were done in the Netherlands as well, although considered more dangerous than D&E by skilled providers.

Most common complications are DIC, hemorrhage, hyperosmolar crisis if the solution enters circulation, myometrical necrosis and perforation. Since serious complications are reported, and better methods exist, the saline instillation method is abandoned in most hospitals.

Other Fluids used: hypertonic 30% to 40% urea, concentrated glucose and Rivanol®. Glucose is least successful and may lead to serious infections.

revised spring 2010

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