Surgical abortion (curettage).

This is a common but rather traumatic method of abortion. It is prescribed for up to12 weeks, and the operation is performed only under general anesthesia, as it causes pain. In the process, the doctor dilates the cervix and, using a curette, scrapes the uterine cavity.

 Surgical abortion lasts only 15-20 minutes, after which the patient needs to stay in the hospital for another 2-4 hours to prevent possible complications.

After surgery, the following complications may develop:

• damage to the endometrial layer;

• cervical injury;

• extensive bleeding;

• development of inflammation;

• an extensive wound of the tissues of the uterine cavity with an inaccurate procedure;

• subsequent infertility.

Doctors prefer not to use this procedure if medical or vacuum abortion is possible.

Vacuum aspiration (mini-abortion).

This abortion surgery is used early. The method consists in the fact that the doctor uses a special apparatus to cleanse the uterus. Under the action of vacuum, the attached fetal egg breaks off and is excreted from the body. The procedure is recommended for periods of 4 to 12 weeks. Late is unsafe, earlier the egg is too small to suck.

During the procedure, the doctor inserts a thin tube connected to a pump into the uterine cavity. Sometimes patients are given general anesthesia, but more often they get by with local anesthesia. Among the advantages of vacuum aspiration are:

• the procedure lasts 10 minutes, rarely longer than 20-25 minutes;

• guaranteed complete abortion, no re-procedure required;

• minimal trauma in comparison with the instrumental technique.

However, this method of abortion has its drawbacks. So, the risk of damage to the uterus remains, some women have a hard time with abortion from a psychological point of view.

Methodology.

In order for the abortion to be successful, and the woman not to face dangerous consequences, the procedure must be impeccably followed:

1. 2 days before the abortion, the woman takes "Mifepristone" as prescribed by the doctor, this is necessary to soften the cervix.

2. An antibiotic is given 2 hours before the procedure to protect against infection.

3. Next, the patient sits on a gynecological chair, and the doctor treats the vagina and cervix with an antiseptic.

4. They give an injection of local anesthesia and proceed to the procedure.

5. In some cases, additional preparation is required - the expansion of the cervical canal.

6. A plastic cannula connected to an aspiration syringe is inserted into the uterus.

7. The pump is turned on, the doctor cleans the uterine cavity well, then the instrument is removed.

For another 2-3 hours, the woman remains in the hospital, after which she can go home. It is important that the obtained tissue from the uterus be sent for a thorough examination to confirm a complete abortion.

When can an abortion be denied?

There are some restrictions on the procedure:

• inflammation of the genital organs - colpitis, endometritis, salpingo-ophritis;

• purulent diseases in the body, including chronic tonsillitis;

• SARS, acute respiratory infections;

• ectopic pregnancy or suspicion of it;

• less than 6 months have passed since the last abortion.

Restrictions are associated with the severe consequences of the intervention, including medication.

Possible indications for abortion.

A woman can have an abortion of her own free will, regardless of the indications. Doctors strongly recommend the procedure in the following situations:

• failed miscarriage - the operation is shown without fail;

• serious diseases that will not allow to bear the fetus, including: HIV, heart failure, hypertension, malignant tumors, syphilis, tuberculosis, sepsis and other conditions requiring long-term antibiotic therapy;

• a recent course of radiation or chemotherapy;

• severe epilepsy and other neurological disorders;

• heart, kidney or liver failure;

• congenital diseases associated with metabolic disorders;

• early detection of fetal pathologies.

But physical indicators are not the only ones. Termination of pregnancy is necessary if the woman is in prison. Abortion is also recommended in case of deprivation of parental rights. If a woman's husband suddenly died or became disabled, then abortion can also be considered a reasonable choice.

What abortion is considered early?

Artificial termination of pregnancy in the early stages is a procedure in the 1st trimester, no later than 12 weeks. From week 13, abortion will be considered late. It is important to remember that medical interruption of gestation is possible only up to 9 weeks.

Termination of pregnancy in the early stages.

The decision to terminate an early pregnancy is made by a woman for various reasons. And regardless of them, she needs a competent, qualified procedure and, of course, subsequent rehabilitation. Even an emergency medical abortion in the first 3-4 weeks after conception can lead to unpleasant consequences if you do not follow the doctor's recommendations.

How to prevent dangerous manipulations?

In order not to have to resort to abortion, it is necessary to take a reasonable approach to pregnancy planning and contraception. At present, for any couple, you can choose the best way of prevention.

These could be the following:

• barrier - condoms, special vaginal caps;

• oral contraceptives;

• spermicidal preparations that are inserted into the vagina before each sexual intercourse;

• intrauterine devices (they can be used in women with contraindications to hormonal contraception, and some spirals have a therapeutic effect on fibroids and endometriosis).

For women over 30 who already have children and no longer plan to give birth, voluntary sterilization can be performed - tubal ligation, which is guaranteed to protect against fertilization and will not disturb the general condition.

If unprotected intercourse occurs, use emergency contraception, for example, Postinor. It is drunk during the day after sexual intercourse to cause hormonal changes that will not allow pregnancy to develop. But this tool knocks down the hormonal rhythm, so you can not resort to it more than 1 time per year.

Special attention deserves folk methods of abortion at 1 week and at a later date. Some women use them in the hope of hiding their situation from others or from a desire to save money on going to the doctor. This approach can backfire in the form of incomplete abortion, massive bleeding, or infection. In most cases, such manipulations are accompanied by the development of infertility.

Women should remember that abortion is not a way to plan a pregnancy. This is an emergency method that is used in exceptional cases. It is better to approach the choice of a method of prevention wisely already at a young age than to regret later on your mistakes.

Termination of pregnancy in the 2nd trimester.

At 11 weeks of pregnancy, a screening ultrasound is performed, which allows you to identify severe malformations of the child, calculate the risk of Down syndrome and other pathologies. Some congenital malformations can be corrected after childbirth, and some of them are incompatible with life. Even Down syndrome, in addition to mental retardation, causes disorders in the formation of the heart, which lead to congenital heart failure. Therefore, if developmental anomalies are suspected, an additional ultrasound is performed at 17 weeks, after which a decision can be made on the need to terminate the pregnancy.

In the second trimester, the following methods are used:

• administration of prostaglandins;

• replacement of amniotic fluid with 20% sodium chloride solution;

• hysterotomy;

• a combination of several methods.

Artificial abortion in the late period is accompanied by a high risk of complications, and also severely traumatizes the psyche. After it, a long recovery period is necessary, during which it is impossible to become pregnant. It is optimal to wait 1-2 years, undergo an examination and prepare for subsequent conception in order to exclude the causes that led to the pathology of pregnancy for the first time.

Medical interruption.

Methods of artificial termination of pregnancy with the help of medications have been developed. They are used with a gestation period of up to 49 days, or 7 weeks, if counted from the day of the last menstruation. This method is safer than surgical, complications develop in only 3% of cases. It can be:

The best results can be achieved at a period of 3-4 weeks, when the fertilized egg is not yet firmly attached to the uterine wall. Medical abortion has a less traumatic effect, does not create a risk of infection. It is recommended for use in Rh-negative women to avoid immunization with fetal antibodies.

The drugs used have a range of contraindications, so the pharmaceutical method is not used under the following conditions:

• more than 8 weeks of pregnancy;

• ectopic pregnancy;

• acute infections of the genital organs;

• after long-term treatment with corticosteroids or in case of insufficiency of the adrenal cortex;

• severe form of bronchial asthma;

• tendency to thrombosis.

Women who smoke, especially over 35 years of age and with heart disease, have a high risk of blood clotting disorders and the development of thrombosis. Therefore, they use this method of abortion with caution.

Before the procedure, a woman undergoes a standard examination, consults a psychologist. Medical abortion is performed in a gynecologist's office, hospital or private clinic. He does not require hospitalization. But after taking the medicine, it is recommended to observe a doctor for 2 hours.

In the presence of a doctor, the patient drinks 200 mg of mifepristone. This is a hormonal drug that binds to progesterone receptors and blocks its action. The endometrium stops growing, the fetus dies. At the same time, the sensitivity of the myometrium to oxytocin is restored, the uterus begins to contract and reject the embryo. After 48 hours, you need to take misoprostol orally or gemeprost vaginally. These are analogues of prostaglandins, which increase uterine contractions and expel the rejected fetal egg. The endometrium is not injured.

Normally, after taking the drug, bleeding begins. It doesn't have to be very strong. If a woman has to change the pad every 30 minutes, this is an occasion to urgently consult a doctor. The absence of discharge within 2 days indicates an unsuccessful interruption attempt.

The following conditions are pathological:

• rise in temperature above 38 degrees;

• intense pain in the abdomen, sometimes extending to the lower back;

• foul-smelling discharge.

After 2 days, the result is evaluated by ultrasound. With the preservation of the fetal egg and incomplete interruption, vacuum aspiration or scraping is done. If everything went well, then after 10-14 days the woman needs to come for an examination to her doctor.

Menstruation should begin 5-6 weeks after taking the pills. But you should worry about contraception after a medical abortion, you can get pregnant again a few days after the end of bleeding. To normalize the hormonal background, it is optimal to use combined oral contraceptives during this period. They will reliably protect against conception and help establish a cycle.

Vacuum aspiration.

Methods for terminating a pregnancy at a short time are safer in terms of the development of complications after them. In a antenatal clinic without hospitalization, vacuum aspiration can be performed. It is carried out for up to 5 weeks of gestation, which is determined by the date of the last menstruation and according to ultrasound data.

If we take the days of delay as a count, then you can perform a mini-abott up to 21 days with a regular cycle. The optimal period is 14 days. Before this time, the vacuum is not performed: the fetal egg is very small and may not fall into the catheter. If you delay the aspiration, then this threatens with complications.

Manipulation is carried out without anesthesia. On the gynecological chair, the vulva and the vestibule of the vagina are treated with an antiseptic, mirrors are inserted. The cervix is grasped with bullet forceps, the uterine cavity is probed with a metal probe. The cervical canal is not expanded, but a plastic catheter is immediately inserted - a tube connected to an aspirator. Within 3-5 minutes, the contents of the uterine cavity are aspirated. This is accompanied by unpleasant pulling pains in the lower abdomen.

After the manipulation, the patient is placed on the lower abdomen with a heating pad with ice, they are offered to lie down on the couch for an hour. After that she can go home.

At home, it is recommended to take antibiotics for 3-5 days, for example, Macropen, Doxycycline. This is especially true for women with a low degree of purity of the vagina. To restore hormonal levels the next day, you can start taking combined oral contraceptives. It is not advisable to install an intrauterine device immediately after an abortion: under the influence of uterine contraction, it may fall out.

During the month, observe sexual rest, visits to the bath, sauna, solarium, weight lifting are contraindicated. The menstrual cycle is restored within 3-4 months.

If, after vacuum aspiration, after a few days, the temperature rises, abdominal pain appears, and you are worried about increasing bloody discharge, then you need to urgently consult a doctor.

Complications can be:

• inflammatory diseases of the uterus and appendages;

• hematometer;

• placental polyp;

• unsuccessful abortion attempt;

• hormonal disorders.

For control in a few days, you need to perform an ultrasound of the pelvis. Compliance with the recommendations of the doctor increases the chances of a successful outcome.

This method is approved for use up to 12 weeks of pregnancy. Previously, a woman is examined in a antenatal clinic, after which she is hospitalized in a hospital.

Abortion is the curettage of the uterine cavity with a curette and the removal of the endometrium along with the embryo. This manipulation is performed under anesthesia. Therefore, before the operation, the anesthesiologist talks with the patient in order to exclude contraindications for the administration of narcotic painkillers.

On the morning of the day, you can not eat. Before the operation, you need to empty the intestines and bladder, take a shower and shave off the hair in the perineum.

The woman lies down in the gynecological chair. After giving anesthesia, the doctor inserts mirrors into the vagina, captures the cervix and probes its cavity. With the help of Hegar dilators, the cervical canal is gradually dilated. Then start scraping. Curettes of various sizes are used, the endometrium is gradually exfoliated, which flows down the spoon of the lower mirror. Start with the walls of the uterus and end with the corners. Gradually, when scraping, a crunch appears, which indicates the complete separation of the ovum and membrane. Bleeding should decrease, the uterus should contract.

Blood loss during curettage is up to 150 ml. Some clinics perform manipulation under ultrasound control to avoid complications.

The patient is awakened from anesthesia and transported to the ward. Those with Rh-negative blood are immunized with anti-Rhesus D immunoglobulin in the postoperative period. This is necessary to avoid conflict between the blood systems of the mother and child in subsequent pregnancies.

An intravenous drip of Oxytocin is also prescribed to improve uterine contractions, antibiotics to prevent inflammatory processes. The length of stay in the hospital is individual and depends on the condition.

After surgical interruption, sexual rest, limitation of physical activity and overheating for a month are also necessary. From the next day, you can start taking hormonal contraceptives to help restore the menstrual cycle.

Bloody discharge lasts for several days, gradually brightens, becomes mucosaic. If red blood develops or appears, you should consult a doctor.