One death and a cluster of febrile complications related to saline abortions.

: Case history of a 17-year-old Arkansas girl who died following a saline abortion performed in a New York City hospital in September, 1971, and a report of the subsequent investigation revealing possible contaminating techniques by the attending physician are given. The young woman was single, nulliparous, and at 16 weeks gestation when the abortion was performed by exchange of hypertonic saline and amniotic fluid. The procedure was uneventful, but febrile conditions developed 8 hours after delivery. Despite antibiotic treatment the fever continued and blood cultures later revealed an infection of Staphylococcus aureus. The patient died 12 days after the abortion. An epidemiologic investigation was conducted at the hospital that the girl had attended. Records of 911 patients receiving saline abortions between July 1971 and February 1972 were examined, revealing the development of fever in 44 cases. 57% of these febrile cases occurred in a 3-week period and were associated with 2 physicians whose patients' postinstillation fever rates were 17% compared with 2.5% for all other physicians in the hospital. There was no correlation between the incidence of fever and the patients' age, race, duration of retained placenta or operative removal of the placenta. It is concluded from epidemiologic evidence and direct observation of the physician's procedure that the infection was probably introduced through breaks in sterile technique at the time of fluid exchange. Rigorous aseptic procedures should be followed carefully in all saline abortion procedures.