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Abortion

Types of abortion: the description, the timing, preparation, complications

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Author: Tselmer NE, obstetrician, practical experience since 2007, the first qualification category.
March, 2019.

Called abortion an abortion when the child's gestation period of less than 22 weeks. If the gestational age greater than 22 weeks, then abortion is classified as miscarriage.

On a week may have an abortion

In the early stages

Domestic legislation allows us to take a decision on abortion up to 12 weeks (abortion in early pregnancy) any pregnant woman. Early abortion can be assigned a doctor and by virtue of any circumstances impeding the normal course of pregnancy.

In the early stages and 12 weeks permitted the following methods of abortion:

  • medical method - pills, provoking miscarriage (the safest method)
  • Vacuum aspiration uterine cavity (vacuum abortion) - sucking membranes of eggs uterus via vacuum apparatus;
  • Method of surgical curettage (curettage) of the uterus (the method is allowed, but not recommended at the present time to the wide use).

Do not forget that every abortion entails

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complicationsWhich may occur immediately after the procedure, but may be delayed for a period of up to several years.

The later stages

When gestational age is between 12 and 22 weeks, the abortion can be carried out only in a hospital, and only because of the emerging medical or social reasons. This is due to the fact that at such late pregnancy it can interrupt an extremely negative impact on women's health.

Medical indications for abortion on late term (12 to 22 weeks) may occur on the part of the mother and of the fetus:

  • Mother's side it can be a disease in which the future child bearing will cause a threat to a woman's life. For example, the case of cancer, the treatment of women requiring urgent chemotherapy, are not permissible during pregnancy.
  • identified in the course of pregnancy, fetal abnormality (genetic abnormalities, malformations incompatible with life, missed abortion in the later stages).

The list of medical indications (diseases) is strictly determined by the order of the Health Ministry of the Russian Federation from 03.12.2007 N 736 (ed. dated 27.12.2011) "On approval of the list of medical indications for the artificial termination of pregnancy".

The decision to terminate pregnancy in the longer term is accepted by medical commission (in the commission attending obstetrician-gynecologist, chief doctor or his assistant, consultant - for example, a physician-geneticist in identifying chromosomal abnormalities or fetal cardiologist in cardiac pathology women).

The decision to hold a late abortion for social indicators from 12 to 22 weeks will only be accepted if the pregnancy came as a result of the rape of women. rape fact should be documented (recorded patient seeking care and to the police after the incident).

Abortion occurs in late term medication method (dose and method of administration of the preparations differ from medical termination of early pregnancy).

After 12 weeks, cervical dilatation and curettage sharp surgical instruments not held due to the large size of the fetus and the pregnant uterus. the uterus becomes soft and stretched, they are easy to perforate (accidentally punctured) tools for the expansion of the cervix and uterine evacuation. In this case, the risk of surgery is too high for a pregnant woman.

Curettage of the uterus in the longer term is already possible only after the fact when abortion to reduce the uterus (it is sometimes necessary to do in the case of residues of the ovum in the uterus and signs bleeding).

Methods of abortion

medical abortion

Medical Abortion is performed using a drug called mifepristone (mifegin), which reduces the effect of progesterone, Which is the main hormone of pregnancy, and is used in conjunction with prostaglandins - those drugs that can strengthen uterine contractions and helping to deprive the ovum.

Medical abortion is performed on an outpatient basis at a stage of pregnancy up to and including 8 weeks (63 days of menstruation), and provided that the pregnancy is without complications.

In pregnancy, during the period from 9 to 12 weeks and above medical abortion has been held only in a hospital. In preparations in this term is somewhat reduced efficiency (the smaller the time, the more effective drugs).

With the ineffectiveness of medical abortion and pregnancy progresses the patient is proposed to terminate the pregnancy by vacuum aspiration.

More about the nature of medical abortion, consequences and contra - in our a separate article.

vacuum abortion

For abortion using vacuum aspiration method, ie the applied vacuum apparatus with which breaks down and sucked the fertilized egg from the uterus. Abortion by vacuum aspiration is gentler as compared with scraping (curettage), as does not involve use of acute obstetric curette not traumatize the uterine wall.

  • Vacuum called abortion mini abortionIf it is carried out at a stage of pregnancy less than 5 weeks. At this stage of pregnancy is not required to expand the cervix with special metal expanders, because the suction tool for small gestational sac has a narrow diameter.
  • Vacuum abortion during a period of 6 to 12 weeks is carried out with the extension uterine cervical canal. Here, the size of the gestational sac require use nozzle for vacuum suction of larger diameter.

More about methods and effects described in a separate article.

Scraping or curettage of the uterus (surgical abortion)

Curettage performed for pregnancies of 6 to 12 weeks and is performed only in a hospital setting. Before carrying out scraping the cervix also requires mechanical expansion, then the fertilized egg destroyed and scraped from the uterine cavity with a sharp surgical instrument - obstetric curette.

Currently abortion by scraping using a curette is allowed, but it is slowly becoming obsolete technology. The broad use is not recommended.

curettage method of abortion is permitted in rare cases:

  • when there is no possibility to use more sparing techniques (vacuum aspiration of the ovum and medical abortion);
  • scraping is performed in the case of residues ovum after previous abortion, in order to completely empty the uterus;
  • curettage curette is necessary in the case of dense tissue attachment of the ovum and bleeding. This often happens after a miscarriage in later periods (from 12 to 22 weeks) after the termination of pregnancy in the later stages. In these situations, it is impossible to securely fasten the fabric to remove the end of the vacuum suction. One has to resort to using a curette.

Contraindications to abortion

Main obstacles to the holding of the vacuum abortion and curettage:

  • inflammatory diseases of the genital organs;
  • the presence of foci of purulent infection, regardless of their location in the body of a woman;
  • acute infectious diseases.
  • in less than six months after the previous pregnancy was terminated.

Analyzes and surveys algorithm women before abortion

  1. Menstrual delay and suspected pregnancy is reasonable to start with a test for the presence in the body of the woman human chorionic gonadotropin (hCG). At home, the women are using for this purpose an ordinary pregnancy test "two bars", and in the preparation of abortion in the laboratory investigated blood test for hCG. The patient refers to a gynecologist, specifies the duration of pregnancy.

  2. Then, the ultrasound (US), which measures the presence of fertilized eggs in the uterus. Confirmation of intrauterine pregnancy in the US is a prerequisite before performing an abortion (excludes ectopic pregnancy).

  3. The reception was at the gynecologist to inspect the uterus and evaluation of discharge from the genital tract. carried fence smear the degree of vaginal purity and onkotsitologiyu. In the presence of inflammation in inflammatory exudates or smear when viewed on a gynecological chair assigned readjustment genital tract. Perform an abortion in the presence of an infection can not - with tools for performing abortion and dilatation microorganisms from the vagina will extend above the uterus and fallopian tubes.

  4. Also appointed general clinical examination: overall analysis blood and urine, Blood type and Rh factor, blood analysis for syphilis, HIV, hepatitis B and C.

  5. The result of examination and electrocardiogram are necessary physician before using intravenous anesthesia (usually at term abortion more than 5 weeks requires full anesthesia).

  6. In the presence of concomitant diseases in women volume of inspection can be expanded. For example, blood disorders, severe anemia, bleeding in surgical procedures before further studies are appointed blood coagulation.

  7. The first time a patient with an unwanted pregnancy gynecologist should send her to a psychologist if any specialist domiciliary pregnant. In the major cities in antenatal clinics are special medical and social support offices for pregnant women who find themselves in difficult situations.

complications of abortion

More the early and delayed consequences of abortion can be read in our separate article.

Complications of Medical Abortion

  • uterine bleeding, requiring tool emptying of the uterus in a hospital (Vakoumé aspiration uterus) and application means reduces the uterus;
  • incomplete abortion (residues ovum also removed via vacuum aspiration of the uterine cavity in a hospital);
  • infectious complications (risk of less than 1% of cases);
  • the progression of the pregnancy in a situation where there was no rejection of the ovum.

Complications of vacuum and surgical techniques

Complications can be divided into:

Early arise directly during the procedure or during the first day after interruption -

  • bleeding;
  • cervical injury;
  • Allergic reactions to anesthetic drugs.

Later, observed during the period from one week to several months:

  • hemometra (accumulation of blood because of the fact that the cervical canal was closed too early);
  • incomplete abortion;
  • depression;
  • inflammatory processes (endometritis, adnexitis)

The long-term consequences of abortion may occur years after the procedure:

  • hormonal disorders - one of the causes of infertility;
  • adhesions, fallopian tubes;
  • difficulties in carrying a pregnancy.

It is necessary to clearly realize that no matter how malotravmatichen was not a vacuum abortion, he still is the intervention in the female body and can not be considered totally safe. Surgical abortion (scraping) is an aggressive method of termination of pregnancy, and the risk of complications for women's reproductive health is clearly increasing.


sources:

  • Clinical guidelines MoH (treatment protocol) "medical abortion", Moscow, 2015, a group of authors.
  • "National leadership in gynecology", ed. IN AND. Kulakov, GM Savelyev, IB Manukhina 2009.
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