What Is a Hypertonic-Saline-Induced Abortion?

Obstetrician Eugen Aburel developed hypertonic-saline-induced abortion in 1939. It was typically carried out between the 16th and 24th week of pregnancy.

Hypertonic-saline-induced abortion is a type of instillation abortion. An instillation abortion involves injecting a solution into the fetus. Other instillation abortion methods used solutions of urea or prostaglandin.

According to research, saline abortions gained popularity in many parts of the world in the mid-1900s, particularly in the 1960s. A 1972 study found that 28% of legal abortion procedures performed in San Francisco in 1968 were saline abortions.

Currently, instillation abortion procedures of all kinds are rare. In 1972, they accounted for 10.4% of all legal abortions in the United States. This figure dropped to 1.7% in 1985.

According to the Centers for Disease Control, 241 instillation abortions took place in 2020, making up about 0.04% of all abortion procedures.

The hypertonic-saline-induced abortion method took 24–30 hours on average, though it could take longer. The procedure took place in hospitals.

There were two main variations of saline instillation abortions: intra-amniotic and extra-amniotic.

Intra-amniotic instillation was where the saline was injected into the amniotic sac. Extra-amniotic meant that the saline was injected between the fetal membrane and the endometrium.

Intra-amniotic hypertonic-saline-induced abortion procedures typically followed these steps:

1. The pregnant person would empty their bladder and sometimes have an enema.
2. A doctor would sterilize the person’s abdomen and give them a local anesthetic.
3. They would then insert a spinal needle into the amniotic sac.
4. The solution would be instilled into the amniotic sac via the needle.
5. Tissue death would occur.
6. The person would go into labor and deliver the pregnancy tissue.

Extra-amniotic hypertonic-saline-induced abortion procedures typically looked as follows:

1. The pregnant person would empty their bladder and sometimes be given an enema.
2. A doctor would insert a device in the vaginal canal all the way into the cervix.
3. The solution would be instilled via the device.
4. Tissue death would occur.
5. The person would go into labor and deliver the pregnancy tissue.

In either case, the length of the procedure varied depending on how long the labor took. Other factors included:

• the amount of saline solution used
• the concentration of the saline solution
• whether amniotic fluid was withdrawn
• whether other drugs, like oxytocin or prostaglandin, were used
• whether Laminaria tents — devices to increase contractions — were used

When other abortion methods became popular, hypertonic-saline-induced abortion procedures fell out of favor because they were riskier, more complex, and less effective than other methods.

Between 1972 and 1981, the mortality rate of instillation methods was higher than for D&E procedures.

Instillation methods led to 9.6 deaths per 100,000 procedures, while D&E procedures had a mortality rate of 4.9 per 100,000 in the same time period.

In 2019, the mortality rate for all abortion procedures was 4 per 100,000. Nearly all these mortalities were the result of illegal abortion services.

Compared with other methods, saline abortions:

• had a higher risk of causing health complications
• took longer to perform, often requiring overnight hospitalizations
• caused more physical discomfort
• were less effective (the pregnancy was more likely to continue — that is, the abortion did not work)

The health risks of hypertonic-saline-induced abortion include:

• hypernatraemia (too much salt in your body)
• water intoxication
• severe bleeding
• seizures
• coma
• death

As a result, safer methods like vacuum aspiration and D&E replaced saline abortions.

Nowadays, three types of abortion are most common:

• Medication abortion: This method is usually carried out in the first trimester. It involves using misoprostol (and often mifepristone) to terminate a pregnancy.
• Vacuum aspiration: This in-clinic procedure involves removing the pregnancy tissues through the cervix using gentle suction.
• Dilation and curettage (D&C): This is another in-clinic procedure where the cervix is widened, and the pregnancy tissue is removed manually. It’s also called a dilation and evacuation (D&E) or dilation and extraction (D&E).

All of these abortion procedures are considered highly safe and effective. Complications from abortion can occur, but they are rare, affecting less than 2% of people who have abortions.

Modern abortion protocols and procedures are far more safe and effective than hypertonic-saline-induced abortions.

If you want to learn more about your options, these links may be helpful:

• Understanding Abortion Restrictions in Your State
• How to Safely Self-Manage a Medication Abortion at Home
• What to Expect with Later-Term Abortion

You can also find assistance through the following organizations:

• Abortion Finder, National Abortion Federation, and Planned Parenthood can help you find a nearby abortion care facility.
• The Center for Reproductive Rights’ state-by-state abortion laws map contains information about abortion rights and access in each U.S. state.
• The National Network of Abortion Funds has a guide to finding funding for an abortion.

When looking for help related to pregnancy and abortion, it’s important to avoid crisis pregnancy centers.

Although they look like legitimate health clinics, they’re unregulated, unlicensed organizations that are usually backed by anti-abortion groups.

These clinics often share false and misleading information with the intention of discouraging people from abortion. In fact, one study found that 80% of crisis pregnancy centers shared misleading information.

Sian Ferguson is a freelance health and cannabis writer based in Cape Town, South Africa. She’s passionate about empowering readers to take care of their mental and physical health through science-based, empathetically delivered information.