Abortion in early pregnancy is the safest. It minimizes possible complications and consequences. Therefore, you should not hesitate to make a decision, otherwise it is fraught with serious consequences.
The main types of abortions in the early stages up to 5 weeks are only medical termination of pregnancy. It includes surgical, medical and vacuum methods of abortion, which are carried out under the supervision of qualified specialists. The most optimal of them is medical or pharmacological abortion.
It is considered a gentle method of abortion. However, this does not mean that you can carry out the procedure yourself. Many people ask how to terminate an early pregnancy on their own. Studying the instructions for a special drug purchased at a pharmacy is not enough! This can cause a lot of complications, which will certainly lead the patient to the surgical table. Pharmaboration is a serious procedure. It should be carried out only after a full examination and under the careful supervision of a gynecologist.
Almost every woman is interested in: 1. Until how many weeks do they have an abortion, when is it possible and when is it not? Early dates for interruption are up to 5 weeks using vacuum and tablet methods, later up to 12 weeks - only by surgical intervention. 2. At what time is it safe to have an abortion? Of course, for up to 5 weeks. During this period, the fetus is just beginning to form, which makes the procedure easier. 3. When is an abortion performed? It depends on how to terminate the pregnancy, which method to choose. For example, pharmabortion can be performed even on the day of treatment in the absence of contraindications.
Attention! Carrying out procedures on your own is dangerous for a woman’s health and life. “At ON Clinic” you can get professional help to terminate a pregnancy without consequences or complications.
Deadlines
Medical abortion (up to 22 weeks) is performed using medications (mifepristone, pencrofton) that provoke a miscarriage.
- Up to 9 weeks (63 days of delay in menstruation), it is possible to carry out medical interruption on an outpatient basis;
- From 9 weeks - only in the hospital.
At the request of the woman, abortion is carried out only up to 12 weeks.
In the late period from 12 to 22 weeks, termination of pregnancy is carried out strictly if there are medical or social indications.
Medical abortion is performed on an outpatient basis for up to 9 weeks of pregnancy and provided that the pregnancy proceeds without complications.
During pregnancy from 9 to 12 weeks and above, medical termination of pregnancy is carried out only in a hospital. The effectiveness of drugs during this period is slightly reduced (the shorter the period, the more effective the drugs).
The procedure 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 - these are drugs that can increase uterine contractions and help reject the fertilized egg.
What you should know
For the success of surgical intervention, a general rule applies. The more time has passed, and the longer the period in weeks, the more difficult it is to perform the operation, the higher the likelihood of various complications occurring in the future.
During pregnancy, a woman undergoes a restructuring of her entire body and hormonal levels. Even the most gentle early abortion is an intervention that inevitably has a negative impact on the functioning of the entire body.
Women who have had an abortion are automatically at risk in the future. Such women are most at risk of ectopic pregnancy and miscarriage.
Intervention in the pregnancy process must be carried out under the supervision of a specialist. Attempting to get rid of an unwanted child on your own is unacceptable, as this can lead to serious consequences, including death. After an abortion, it is necessary to carry out all prescribed procedures, and if your health worsens, you should immediately contact a medical facility.
Contraindications
- Large uterine fibroids (many nodes or a node larger than 4 cm and deforms the uterine cavity, there is a possible risk of bleeding);
- Allergic reaction to drugs included in the abortion regimen;
- Suspicion of ectopic pregnancy;
- Anemia, in which the hemoglobin level is less than 100 g/l;
- Hormone-dependent tumors;
- Hepatic, renal, adrenal insufficiency and some severe extragenital diseases (hereditary porphyria, severe bronchial asthma, glaucoma);
- Smoking over the age of 35 years + long-term use of COCs and pregnancy arising from COCs (the risk of thrombosis increases, drug interruption can be used only after an additional study of the coagulating properties of the blood).
If pregnancy occurs due to an intrauterine device, the IUD should first be removed, and then it is also possible to use medical termination of pregnancy.
When using a medication regimen, you cannot breastfeed, so this method of abortion is not suitable for a nursing mother.
An alternative to medical abortion is vacuum aspiration.
How is a medical abortion performed?
The medical abortion procedure includes four visits to the gynecologist.
The abortion itself occurs in two stages: the first dose of the drug and a day or two later - the second dose. Bleeding occurs in the second stage and begins within 3-4 hours after taking the tablet.
After two weeks, a follow-up appointment with a gynecologist is required.
Visits to the gynecologist:
- 1 visit: consultation and referral for tests;
- Visit 2: taking the drug;
- 3rd visit, after 1-2 days: re-administration of the drug;
- 4 visit, no earlier than 14 days later: control visit
Standard tests before abortion
- general blood and urine analysis,
- blood group and rhesus,
- smears for purity and oncocytology,
- testing for HIV infection,
- hepatitis B and C and syphilis.
First appointment with a gynecologist
At the first appointment with a gynecologist regarding an unwanted pregnancy, a woman receives advice about available methods of termination, receives referrals for examination and psychological consultation.
Before the procedure begins, an ultrasound examination is mandatory, which serves as the basis for prescribing an abortion and as a method for excluding ectopic pregnancy.
If an ectopic pregnancy is suspected, the patient is prescribed a blood test for hCG twice with an interval of several days (the increase in the pregnancy hormone over several days differs in the normal course of pregnancy and in an ectopic or frozen pregnancy).
If the examination reveals an inflammatory type of smear or bakvaginosis, then medical abortion is carried out in the usual way with the simultaneous administration of antibacterial drugs as prescribed by the doctor.
Carrying out an abortion requires the prescription of antibacterial drugs:
- In patients without risk factors for infection, examined for the presence of chlamydia: to prevent inflammatory complications, once a day of the procedure.
- In patients with identified chlamydial or other infection, as well as in the presence of risk factors for the addition of inflammatory complications (with bakvaginosis earlier in the smear): a course of 7-10 days.
Second appointment
At the second appointment with the gynecologist, the patient comes with a decision to have an abortion and signs an informed consent for medical termination.
The patient is given 1 dose of drugs: first, the drug mifepristone, which has an antiprogesterone effect, is used. Progesterone is a pregnancy hormone, and when it is blocked by the drug, a signal for termination occurs and the cervix prepares for miscarriage.
When using 1 tablet for 1 day, there are no significant changes in the woman’s well-being. There may be a slight nagging pain in the lower abdomen, scanty bleeding, and sometimes nausea.
Important! If the mother is Rh-negative and the partner is Rh-positive, it is also recommended to use an injection of a dose of anti-Rhesus immunoglobulin to prevent Rh incompatibility with the child during the next desired pregnancy.
Third visit to the gynecologist
At the third appointment with the gynecologist, after 24-48 hours, the patient is given the second part of the tablets, which directly cause uterine contractions and miscarriage through the prepared dilated cervix. At different times, the dosage of drugs and the method of administration differ (tablets can be taken orally, placed under the tongue, or inserted vaginally).
In 95% of patients, bleeding begins within three to four hours after taking the drugs.
Women almost always develop symptoms that the doctor warns about in advance:
- Cramping pain in the lower abdomen, which each woman experiences differently, depending on her pain threshold. For pain relief, the patient can take a tablet of no-shpa, baralgin or ibuprofen. A miscarriage will occur a few hours after the contractions begin.
- Heavy bleeding during a miscarriage (more and heavier than normal menstruation). True bleeding occurs rarely, in 0.2-1% of cases. A woman should be alerted to such a volume of blood loss that two sanitary pads of the maximum size are thoroughly saturated with blood within an hour, and this is repeated for the second hour. In this case, the patient must call an ambulance, which will take her to the gynecological hospital. In the hospital, if bleeding develops, vacuum aspiration of the uterine cavity is performed.
- An increase in temperature to 38.5 (common and a common side reaction to the interruption pill). You should go to the hospital if the temperature rises for more than 4 hours, with chills.
- Diarrhea (observed in more than half of cases, also a side effect of drugs).
Usually bleeding stops completely after 7-9 days. The longer the pregnancy, the heavier the bleeding. In some cases, brown spotting persists until the next menstruation, which can be considered normal.
Fourth technique
4th appointment with the gynecologist - control. The patient is examined on a gynecological chair, and a control ultrasound of the pelvic organs is assessed. An ultrasound is recommended to be performed 2 weeks after a miscarriage. By this time, the cavity and size of the uterus are reduced. Within 2 weeks after the abortion, the patient can take herbal preparations to contract the uterus: royal collection, infusion of water pepper.
Third trimester (28 weeks before birth)
Studies have shown that even if a woman travels to a state with liberal laws (such as Nevada or New York), it will usually be very difficult to terminate a pregnancy after 24 weeks.
Despite the fact that in the third trimester of pregnancy, of course, abortions occur much less frequently, a woman can have it if she has a reason that suggests the need for abortion.
“For example, if she discovered that the fetus has a serious anomaly,” doctors say.
Another thing is if a woman has a health problem, which may include heart problems, uncontrolled diabetes or uncontrolled hypertension.
After a medical abortion
After medical termination of pregnancy, the patient is prohibited from sex for 3 weeks. A ban on sexual activity is associated with an increased risk of infection due to the increased vulnerability of the inner surface of the uterus.
If you want to protect yourself in the future with oral contraceptives, a woman should take 1 tablet from the package on the first day after a miscarriage.
Menstruation usually begins 3-4 weeks after the procedure and is no different from normal. Slightly more abundant or scanty discharge is allowed, as well as less intense nagging pain during the first menstruation after medical abortion. Typically, such disorders occur after a procedure performed over a period of more than 6 weeks.
If the patient decides to take oral contraceptives, the cycle will be set in accordance with their dosage regimen.
It is recommended to optimally plan a new pregnancy 6 months after an abortion. However, every woman’s body is individual, so it is strongly recommended to discuss this issue with a gynecologist.
Abortion mortality statistics
The Centers for Disease Control and Prevention reports that there were more than 600,000 abortions in the United States in 2013, the latest year for which data is available.
Mortality rates for women undergoing legal abortions are extremely low. However, the CDC calculates a mortality rate of only 0.65 deaths per 100,000 legal abortions between 2008 and 2012.
By comparison, the CDC reports that there were 17.8 U.S. pregnancy deaths per 100,000 births between 2009 and 2011. According to research from the Guttmacher Institute, abortion in the first trimester carries less than a 0.05% risk of serious complications requiring hospital treatment.
But with many state laws limiting when a woman can have an abortion, it's difficult to know how later abortions might actually affect a woman's health.
Is abortion after 22 weeks as safe as abortion after 14 weeks? It depends on various factors.
Possible consequences
- uterine bleeding requiring instrumental evacuation of the uterus in a hospital (vacuum aspiration of the uterine cavity) and the use of uterine contractions;
- incomplete abortion (remnants of the fertilized egg are also removed using vacuum aspiration of the uterine cavity in a hospital);
- infectious complications (the risk of their development is less than 1% of cases);
- progression of pregnancy in a situation where rejection of the fertilized egg has not occurred.
If medical abortion is ineffective and pregnancy progresses, the patient is offered to terminate the pregnancy using vacuum aspiration.
There have been no large-scale studies on the teratogenic effect of drugs for medical abortion on the fetus, but 14 cases of fetal defects developing after using this regimen are known. If the patient suddenly changes her mind and decides to carry an advanced pregnancy, she should be warned about these known cases.
Late pregnancy termination
Abortion in the 2nd trimester (long term) of pregnancy is possible only for medical reasons:
- late detection of pathology by the midwife;
- severe malformations of the physical development of the fetus;
- identified genetic abnormalities of the embryo;
- serious conditions that threaten a woman’s health;
- oncological diseases detected during pregnancy;
- tuberculosis in the active stage;
- HIV infection;
- Treponema pallidum infection.
All types of late-term abortions are performed only in a hospital. The decision to terminate the pregnancy is made at a consultation. The presence of a local gynecologist and the head of the antenatal clinic is required. The results of ultrasound, various screenings, and tests are reviewed.
The commission may take into account the social factors for termination of pregnancy indicated by the woman. But they do not influence the decision of the council.
If a woman does not want to terminate her pregnancy if indicated, then doctors do not have the right to carry out any actions regarding the mother and child.
According to WHO recommendations, during this period the following is carried out:
- Abdominal caesarean section - in emergency conditions, the purpose of which is to save the woman’s life. Spend 2 or 3 trimesters in any month.
- Transvaginal cesarean section - with dissection of the cervix and extraction of the fetus with forceps is used extremely rarely. The intervention is extremely traumatic, there is a high risk of postoperative complications and bleeding.
- Introduction of saline solutions into the uterine cavity, medications to kill the fetus. The drugs are administered transcervically or transabdominally.
- The use of gels and oxytocin preparations to stimulate contractile activity of the uterus.
After birth and expulsion of the placenta, the doctor performs surgical curettage of the uterus.
Advantages of the method
- high efficiency of the method (95-98%);
- eliminates surgical intervention, injury to the uterine mucosa and damage to myometrial vessels;
- with medication interruption, a gentle, non-traumatic dilation of the cervix occurs;
- Medical abortion makes it possible to avoid general anesthesia;
- Medical termination is not a surgical procedure, so the risk of ascending infectious complications is very low (less than 1%);
- the risk of long-term consequences for the patient’s reproductive health is reduced, which is especially important for first-time pregnant women;
- Psychologically, it is easier for a woman to endure a medical interruption than a surgical operation under anesthesia.
Sources:
- Medical termination of pregnancy. Clinical recommendations (treatment protocol). — Ministry of Health of the Russian Federation, 2015.
