These methods involve the injection of drugs or chemicals through the abdomen or cervix into the amniotic sac to cause the death of the child and his or her expulsion from the uterus. Several drugs have been tried, [52] but the most commonly used are hypertonic saline, urea, and prostaglandins.
Otherwise known as "saline amniocentesis," "salting out," or a "hypertonic saline" abortion, this technique is used after 16 weeks of pregnancy, when enough fluid has accumulated in the amniotic fluid sac surrounding the baby.
A needle is inserted through the mother’s abdomen and 50-250 ml (as much as a cup) of amniotic fluid is withdrawn and replaced with a solution of concentrated salt. [53] The baby breathes in, swallowing the salt, and is poisoned.[54] The chemical solution also causes painful burning and deterioration of the baby’s skin. [55] Usually, after about an hour, the child dies. The mother goes into labor about 33 to 35 hours after instillation and delivers a dead, burned, and shriveled baby. [56] About 97% of mothers deliver their dead babies within 72 hours.[57]
Hypertonic saline may initiate a condition in the mother called "consumption coagulopathy" (uncontrolled blood clotting throughout the body) with severe hemorrhage as well as other serious side effects on the central nervous system. [58] Seizures, coma, or death may also result from saline inadvertently injected into the woman’s vascular system.[59]
Because of the dangers associated with saline methods, other instillation methods such as hypersomolar urea are sometimes employed, [60] though these are less effective and usually must be supplemented by oxytocin or a prostaglandin in order to achieve the desired result. [61] Incomplete or failed abortion remains a problem with urea methods, often precipitating the additional risk of surgery.
As with other instillation techniques, gastrointestinal side effects such as nausea or vomiting are frequent, but the most common problem with second trimester techniques is cervical injuries, which range from small lacerations to complete detachments of the anterior or posterior cervix. Between 1% and 2% of patients using urea must be hospitalized for treatment of endometritis, an infection of the lining oft he uterus.[62]
Prostaglandins are naturally produced chemical compounds which normally assist in the birthing process. The injection of concentrations of artificial prostaglandins prematurely into the amniotic sac induces violent labor and the birth of a child usually too young to survive. Often salt or another toxin is first injected to ensure that the baby will be delivered dead, [63] since some babies have survived the trauma of a prostaglandin birth and been born alive. [64] This method is used during the second trimester. [65]
In addition to risks of retained placenta, cervical trauma, infection, hemorrhage, [66] hyperthermia, bronchoconstriction, tachycardia, [67] more serious side effects and complications from the use of artificial prostaglandins, including cardiac arrest and rupture of the uterus, can be unpredictable and very severe. Death is not unheard of. [68]
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