Intra-amniotic Injection Of Hypertonic Saline Research Articles

Serotonin, 5-hiaa, total estrogen and pregnanediol excretion in urine during therapeutic saline abortion.

In 24 patients, who underwent therapeutic abortion for various reasons between the 17th and 26th week of pregnancy, urinary excretion of serotonin, 5-HIAA, total estrogens, and pregnanediol were measured before, during and after the intra-amniotic injection of hypertonic saline. 20% hypertonic saline solution (160-500 ml) was given by transabdominal injection over a period of 5 min. The four hormones or metabolites were measured during six periods: I; 12-24 hrs, and II: 0-12 hrs before saline administration, III: 0-12 hrs after saline administration, IV: 0-12 hrs during aborion, V: 0-12 hrs and VI: 12-24 hrs after abortion. The results point to the active participation of serotonin in the process of fetal expulsion, as serotonin was increased by over 100% (from 20-22 to 43-47 mu-g/12 hrs) during periods III-IV, and its metabolite 5-HIAA, too, increased by nearly 60% (from 2.4-2.5 to 3.3-3.9 mg/12 hrs). They decreased during the post-abortive periods V-VI. On the other hand, total estrogens decreased only slowly, but continuously, during all 6 periods (4.9, 4.3, 3.4, 3.1, 1.8 and 1.4 mg/12 hrs). Pregnanediol, beginning with 12 mg/12 hrs showed a slight increase during periods III-IV (14.5 and 15.6 mg/12 hrs) and a decrease during periods V-VI (8.0 and 5.8 mg/12 hrs). These findings are interpreted as indicating the disruption of feto-placental function affecting estrogens during periods III-VI. They might demonstrate an accelerated hydrogenation of progesterone into pregnanediol during periods III-IV, followed by a sharp decreased in progesterone/pregnanediol production during periods V-VI.

Morphologic changes of uterine wall following intra-amniotic injection of hypertonic saline in the rhesus monkey

The morphologic changes in the fetal membranes and uterine wall were studied sequentially in 8 rhesus monkeys at midgestation following replacement of amniotic fluid with 20 per cent sodium chloride. The saline solution caused a rapid stasis of the umbilical and decidual circulations as a result of dense intravascular aggregation or compaction of red blood cells. Later, small-sized blood vessels throughout the uterine wall not protected by the placenta also showed stoppage of flow. The umbilical blood flow stasis caused rapid death of the fetus from asphyxia while stoppage of the decidual circulation caused decidual necrosis. Thromboplastin release from the necrotic decidua caused a superadded intravascular coagulation with blockage of not only the remaining small blood vessels but also the entire uterine venous drainage system. The severe reductions in uterine blood flow with damage to blood vessel walls led to myometrial edema and multiple subserosal and intramural hemorrhages. After 24 to 48 hours, these combined changes led to a Couvelaire-type uterus. Uterine contractions appeared within 15 minutes of instillation of saline, and a laborlike activity evolved despite the progressive impairment of uterine perfusion and myometrial edema.

Body composition studies in the human fetus after intra-amniotic injection of hypertonic saline

Fetal death occurs prior to delivery in the great majority of hypertonic saline-induced mid-trimester abortions. This study on the chemical composition of fetal skin, gut, liver, muscle, fat, brain, and heart in 23 cases indicates a high Na+ concentration in skin and in intestinal contents and a high and constant Na+ concentration in cardiac muscle. Based on these observations, fetal swallowing of hypertonic saline, followed by paralysis of cardiac muscle depolarization when cardiac Na+ concentration reaches a threshold level, is suggested as the mechanism of fetal death.

Disseminated intravascular coagulation resulting in severe hemorrhage, following the intraamniotic injection of hypertonic saline to induce abortion

common ejaculatory ducts. \Ye bvere not able to tilld in the literature any similar case or any description of an attempt to correct surgically this kind of anomaly. In addition, since the patient had a normal libido, erection, and orgasm as I\-et1 as a happy Inaritnl lift, he refused to undergo aiiy operation. Another lvay \\-ould be to try and obtain sterile S~IIICII by treating the patient lvith antiI)iotic\, according to the sensitivity, followed by artificial insemination by the husband. 'I'\vo courses of neomycin, 6 Gm. per day, for 10 days \\.cre given to the patient, but repeated semen cultures were still positive for E. coli. The semen cultures remained positive even after the administration of repeated enemas with neomycin i;olution, 50 per cent. An attempt was made to steritiye the semen “in vitro” by mixing it with neomycin solution, 50 per cent. By this procedurc,, the semen cultures tvere sterile after 20 niinutes. Art’ificial insemination by the husband \\?th the senlr11 after being treated in the abovettlcntioncd \vay seemed to be another logical way of treatment in this case. But since there could be possible teratogenic influence of the neomycin on the semen, we did not choose this way. Th(a couple definitely refused artificial insemination by a donor. The single therapeutic possibility left \vas artificial insemination by the husband with the contaminated senlen. This lvay, of courw, \vould entail some danger of pelvic inflalilrrlatory disease to the ~vomm. Since intercourse is not considered to be a t~acteriologically sterile act, and since the female genital tract has natural defense mechanisnls against ascending infections (closed celvis, cer\.ical mucus, xraginal lactobacitli, etc.), \ve decided to insenkate the v~o1na11 lvith the contamiirated semen \\-hile covering her Ivith a broad\pectrurn antibiotic. The risk involved \c-as cnrefully explained to the couple. After establishing ovulation and patency of the tuber, the \voman leas given I’rnbritin (ampicillill), 2 Gm. per day, for 10 days and 3 artificial inseminations by the husband \cere performed, in the same cycle. The semen \cas oblained after a cleansing enenin. l’he Mife concci\,ed on her first cycle and had an uneventful, Ilorlnnl preglxmcy. AI $0 lvecks, she was adltlittcd I)ecaLIsc of hreectl presentation (high pre\Ixntitig part ) and pr(~tt~ature rupture of n1cmIxanes. A 101~ cemical cesarcan section Tras performed, and a Ilormal fenlale baby xc-eighing 3,500 grams \\-a~ delivered. The postoperative I)eriod \vas Ime~~entful; and the mother with the baby w’ere both discharged on the eighth postoperative day.

Defibrinogenation after intra-amniotic injection of hypertonic saline.

In one patient generalized hemorrhage associated with hypofibrinogenemia and elevated fibrinogen-fibrin degradation products occurred two hours after the intra-amniotic injection of hypertonic saline. Serial coagulation studies were then performed on 12 patients undergoing abortion by intra-amniotic injection of 20 per cent sodium chloride, and six patients during normal labor and delivery. During normal delivery there was only a slight elevation of fibrinogen-fibrin degradation products. After injection of hypertonic saline solution, fibrinogen and platelets decreased significantly, and fibrinogen-fibrin degradation products increased.

Amniotic chloride concentrations in twin-pregnancy after intra-amniotic injection of hypertonic saline.

SummaryDuring termination of a twin‐pregnancy by saline injection, for a psychiatric indication 20 per cent saline was injected into one amniotic sac and the chloriede concentration in both amniotic fluids was recorded by separate cannulation of the amniotic cavities. Changes in chloride concentration of the maternal serum and fetal heart activity were continuously observed. The fetus in the treated sac died and was born macerated, whereas the other showed signs of life at the delivery. The results show that the composition of the amniotic fluid may change significantly by paraplacental transfer.

Hormonal and placental changes after intra-amniotic injection of hypertonic saline.

From the Department of Obstetrics and Gynecology, The New York Hospital-Cornell Medical Center, New York, New York

Termination of pregnancy with intra-amniotic hypertonic saline.

Successful therapeutic abortion was performed consecutively by an intra-amniotic injection of hypertonic saline in 102 out of 110 patients in whom the size of the uterus corresponded with a pregnancy of 16 weeks or more.A spontaneous abortion of the fetus followed the injection alone in 92 of the cases, and the overall injection-delivery interval was 39.75 (range 11-98) hours. In 10 women intravenous oxytocin injection was used as an additional uterine stimulant because contractions were not established after 48 hours. Complete spontaneous expulsion of the placenta occurred in 71 cases, and evacuation of the placenta under general anaesthesia was required in the other 31.No major complication occurred among the 110 patients.

Plasma progesterone in pregnancy interrupted by the intrauterine injection of hypertonic saline.

ABSTRACT Plasma levels of progesterone (pregn-4-ene-3,20-dione) were measured in nineteen pregnant patients following intra-amniotic injection of hypertonic saline between the 13th and 20th week of gestation. A significant decrease in the plasma progesterone was found 5, 10, and 24 hours following the injection. However, the decrease in plasma progesterone was not correlated to the time interval between the saline-injection and the onset of clinical labour (correlation coefficient 0.019).

The Effect of Intra-Amniotic Injection of Hypertonic Saline on the Structure and Endocrine Function of the Human Placenta

The Effect of Intra-Amniotic Injection of Hypertonic Saline on the Structure and Endocrine Function of the Human Placenta

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

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.

Effects of intra-amniotic injection of hypertonic saline on uterine activity, blood and amniotic fluid volumes, and electrolyte concentrations

Intraovular injection of hypertonic saline successfully initiated labor in 16 patients. There was a net increase in amniotic fluid volume associated with a decreased blood volume within 2 to 4 hours following injection. The sodium chloride in the amniotic sac is diluted by the influx of water and is lost into the maternal circulation where increased serum sodium and chloride concentrations were observed. Amniotic fluid pressures were continuously monitored. Uterine activity increases shortly after injection and continues to increase until delivery is accomplished.

The human placenta and membranes: a histological and immunofluorescent study of the effects of intra-amniotic injection of hypertonic saline.

The human placenta and membranes: a histological and immunofluorescent study of the effects of intra-amniotic injection of hypertonic saline.

Progesterone concentrations in uterine venous blood after intra-amniotic injection of hypertonic saline in midpregnancy

Progesterone determinations were carried out on 37 samples of uterine venous blood collected during the second trimester of pregnancy from 23 women, 2 to 21 hours after the intra-amniotic administration of hypertonic saline. Twenty-seven determinations were also carried out on the peripheral blood of these women both before and after the saline treatment. There appeared to be little effect of the saline treatment on the production of progesterone by the placenta, in spite of an increased interine activity and sensitivity to oxytocin.

Fetal death in utero

In 17 patients, with fetal death in utero, abortion or labor was successfully induced by the intra-amniotic injection of hypertonic saline. Although those patients with one exception were “unfavorable” for induction (closed, hard, uneffaced cervix, and little or no spontaneous activity), they were delivered in 2.7 hours on the average after an average induction-onset interval of 13 hours. All patients were delivered uneventfully; there was no need of additional therapy.Six patients were induced by an increase of their uterine volume, using isotonic saline, they were all delivered uneventfully in 9.5 hours, on the average, after a 12.5 hour latent period.In six patients labor was induced by massive prolonged oxytocin therapy, but in only one progressed to successful delivery. The remaining 5 did not progress until labor was induced successfully by saline.Four patients received massive systemic gestagen treatment, there was a marked reduction in uterine activity in all patients, but the saline-induced evolution in uterine activity and clinical progress was only delayed in two.In all the patients the working capacity of the uterus was intact, irrespective of the duration of fetal death or the extent of spontaneous activity. This working capacity was readily displayed when after saline treatment it evolved in a characteristic fashion. Local activity changed through mixed local and partially propagating activity to a terminal phase of propagating activity. Propagating activity preceded the clinical onset of labor.The theoretical and practical significance of these observations are discussed.