Experience with intra-amniotic hypertonic saline injections: Aburel's procedure

Abstract

After the twelfth week of pregnancy, intra-amniotic instillation of 20 per cent NaCl solution was performed successfully in 56 of 60 cases. The indications for termination were therapeutic abortion, missed abortion, and fetal death. The average injection-delivery time was 38 hours. This time was dependent upon the amount of saline instilled but independent of the volume of amniotic fluid removed, the patient's age, gestational period, and parity. A sickle cell crisis produced by intra-amniotic injection of hypertonic saline is discussed and the danger of performing Aburel's procedure in patients with hemoglobinopathy or hemolytic disease is stressed. No hemorrhages or lacerations were experienced and the morbidity rate was 5 per cent. The placenta was retained for more than one hour in 27 per cent of the cases. The average hospital confinement was 62 hours if the case of sickle cell crisis is excluded. Physiologic alterations in blood volume, electroencephalogram, serum sodium, hemoglobin, and hematocrit are discussed in relation to the safeguards necessary to maintain minimal morbidity and mortality rates.