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.
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.
(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
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country since Cytotec ® was withdrawn from the market.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.
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
Other Fluids used: hypertonic 30% to 40% urea, concentrated
glucose and Rivanol®. Glucose is least successful and may lead to
revised spring 2010
worldwide copyright by Dr Joeri van den Bergh.