How to survive an abortion for medical reasons: advice from a psychologist

The course of pregnancy in a woman’s body is a complex physiological process that requires tension in all organs and systems. If the pregnant woman's body was healthy before the conception process, this will not cause excessive physical stress. However, if there are concomitant diseases or pathological abnormalities that were not identified before pregnancy, this can become a threat to both the health and life of the woman herself and her unborn child.

There are a number of situations in which abortion is performed for medical reasons. This procedure can be carried out at different times. The timing of the abortion affects the choice of method of its implementation.

How does abortion happen?

The fertilized female reproductive cell in the uterine cavity attaches to its wall within a week. This process is called implantation. And it means the formation of a relationship between the body of mother and child. But at the implantation stage and subsequent weeks, this connection is not yet very strong.

Subsequently, under the influence of female sex hormones, tissue proliferation occurs and the formation of a baby place or placenta occurs. Vessels grow through the placenta, and there is an active exchange of waste products between the fetus and the maternal body. This organ is formed 12-16 weeks from the moment of conception. And the destruction of the placenta is a much more difficult task. Therefore, early abortion is considered to be termination of pregnancy carried out before 12 weeks, and in late stages - after 12.

In the early stages

During the attachment of the embryo to the lining of the uterus, constant hormonal interactions occur. The growth of the endometrium in the area of ​​attachment is stimulated, the growth of other follicles is blocked, blood circulation is increased, etc. All these stages are influenced by biologically active substances, and at this moment the connection between the fertilized egg and the uterus is easy to destroy, since there are still no obvious anatomical structures that ensure this connection . In other words, embryo rejection is possible. In some cases, this occurs for natural reasons associated with the pathology of the mother’s reproductive system. Then it's called a miscarriage.

However, this process can be caused externally by taking medications. This method of early abortion is called medication.

Its essence is to take drugs that block the interaction of progesterone—the key hormone in the development and maintenance of pregnancy—with its receptors in the uterus. The lack of influence of progesterone activates the contractile activity of the uterus, reduces the strength of embryo attachment, resulting in its rejection.

In order to enhance the activity of fetal expulsion, another drug is taken every other day, which contains analogues of natural prostaglandins. They affect the production of oxytocin and increase muscle activity. Therefore, after 24-48 hours, you can expect the appearance of bloody discharge and the onset of abortion.

Another early termination option is called a mini-abortion. Its implementation is dictated by a stronger interaction between the fetus and the mother, because the further it goes, the more epithelial structures are formed at the site of attachment of the fertilized egg. A mini-abortion involves vacuum aspiration of the fetus.

Under the influence of the negative pressure of the device, the embryo and surrounding tissues are destroyed and products are removed through an aspirator. This method already involves the penetration of special instruments into the uterine cavity - probes, a vacuum aspirator, and therefore is carried out only in gynecological offices. However, it is not particularly difficult and rarely causes adverse reactions in the body.

In the later stages

After three months of fetal development, the process of removing it is no longer so simple. At this time, the placenta is actively forming or has already been formed - this is an entire organ, with all its vessels, nerves and a large number of tissues. Therefore, to remove the embryo it is necessary to use more radical methods.

Curettage of the uterine cavity in this situation is an effective method of ending pregnancy.

This method is otherwise called curettage, because a special tool is used to remove the fertilized egg - a curette.

Using it, the doctor removes elements of the child’s body, destroying it with the sharp edges of the curette. The procedure is carried out blindly, so there is a risk of damage to the organ wall, in particular through perforation. But this method of surgical termination of pregnancy rarely leads to incomplete abortion, that is, leaving elements of the fetus in the uterine cavity, which reduces the likelihood of repeated interventions.

Curettage can be carried out until the 22nd week of pregnancy, but you need to remember - the later curettage is done, the more complicated the procedure itself and possible complications will be.

When is it contraindicated?

Contraindications to abortion are determined by the results of examinations and tests. If a woman refuses artificial childbirth, not a single doctor will be able to convince her. Then expectant mothers take full responsibility for their lives and the life of the child.

There are a number of reasons when such manipulation will lead to irreversible consequences. If such an outcome is suspected, doctors recommend abandoning it.

Main contraindications.

1. The period is more than 12 weeks. Removal of the fetus is possible only in the first trimester. After twelve weeks, such manipulations are carried out only with the permission of specialists.
2. Carrying a child with Rhesus conflict. If partners have different Rhesus values, then only the first pregnancy can be successful. Therefore, doctors recommend saving it.
3. An inflammatory disease that manifests itself in acute form. Full treatment is prescribed.
4. Disease of the genitourinary system. At such moments, there is a high risk of the disease spreading to the uterus. Therefore, treatment is carried out initially.
5. Ectopic pregnancy. In this case, stopping the baby’s development cannot be avoided. But for this, surgery is used to remove the fertilized egg.

Indications

There are reasonable restrictions on abortion. Up to 12 weeks, a woman can terminate at her own request, but after this period this possibility is no longer possible and can only be guided by special indications.

This distinction is dictated by several reasons. Firstly, as pregnancy progresses, the process of terminating it becomes more complicated—this has already been discussed above. Secondly, the ethical and moral aspects of the issue play a role: the fetus develops, grows, and after 22 weeks of development it begins to manifest its vital functions independently. Therefore, it is necessary to remember the indications for abortion.

Medical

The mutual influence of the fetus and the mother's body on each other leads to changes in the vital functions of the pregnant woman's body. Often a number of situations arise or exist initially in which pregnancy is not only undesirable, but also unsafe for both. In this case, its termination can be carried out at any time, because it directly threatens the life of the mother or the fetus has developmental defects that limit its normal independent existence after birth. Medical indications are divided into maternal restrictions and fetal restrictions.

On the part of the mother's body, termination of pregnancy can be caused by:

• severe cardiovascular diseases and heart defects;
• decompensation of lung pathology;
• severe diabetes mellitus complicated by kidney pathology;
• some mental pathologies;
• infectious diseases (such as HIV, rubella, syphilis, active forms of tuberculosis);
• severe pathologies of the endocrine system;
• diseases of the hematopoietic organs, hemoblastosis;
• hereditary and degenerative diseases of the nervous system;
• malignant tumors;
• vascular diseases of the brain and spinal cord;
• diseases of the digestive system (with frequent exacerbations or in the terminal stage);
• complications of previous pregnancies and childbirth, etc.

These indications must be determined by the obstetrician-gynecologist together with specialists in the relevant fields, and the decision to terminate the pregnancy will be made by a council of doctors.

On the part of the fetus, abortion can be caused by congenital genetic diseases and death in the womb.

Social

The only social indication for abortion today is pregnancy as a result of rape. Moreover, this fact must be verified. Previously existing indications (disability or death of a spouse) became invalid in 2012.

Abortion for medical reasons

31.08.2017

Alexey Novikov

Want to see a spherical conversation about abortion in a vacuum? The SPAS TV channel managed to put together a talk show that contained absolutely all the normative components of such a “discussion.” They say that good chess players can calculate their opponent's moves almost until the end of the game. So here it is: I directly heard the following remark from my opponents. This is not because I am a good chess player or a great demagogue. This is simply how absolutely all the conversations about abortion that I have seen over the past ten years look like. It doesn’t matter where – in comments, on forums, in talk shows. And what I want to draw your attention to: the program lasts one hour and thirteen minutes - and forty minutes, no less, is occupied by the discussion, which began immediately, in the fifth minute. “What if there are medical conditions?”

Oh, those “medical indications.” Killer trump card. And it’s really lethal – the transmission was actually leaked. And why? Because, unlike some “I can’t pay off a mortgage” or “I don’t want a child,” the question of diagnosis is objective and substantive. But this is not the most important thing. The main thing is that by this phrase everyone means what they want, and therefore using this argument is a quick, easy and effective way to talk. Watch the dialogue between the doctors from the end of the seventh minute. One talks about thromboembolism in the mother, which can carry a child, and the other talks about the absence of an abdominal wall in the fetus. There is elderberry in the garden, and there is a guy in Kyiv, yes.

So what to do? How to respond and discuss this topic? Now I’ll tell you everything.

PART ONE. INTRODUCTION

First.

You cannot cram in the inconceivable and embrace the immensity. It is by definition impossible to discuss the topic of specific diagnoses for specific people, so in general terms only attitudes to types of situations can be formulated: 1) the development of pregnancy threatens the life of the mother; 2) the child is not viable; 3) the child has developmental defects; 4) ectopic pregnancy; 5) rape.

Second.

When discussing “medical indications,” we must take into account statistics that show that no more than 3% of the total number of abortions are carried out under this article. According to TsNIIOIZ, in 2012 the share of abortions performed for medical reasons amounted to 2.63% of the total. Since 1992, their share has fluctuated from 1.4% to 4.2%. At the same time, the share of abortions performed at will amounted to almost 69% in 2012, and in 1992 – 87.7%. Obviously, abortions based on indications do not have a strong impact on the overall picture, actually occupying last place, because the number of criminal abortions and abortions for social reasons is generally vanishingly small. This seems to tell us that the problem is not primary. But in conversations it’s the other way around – 90% is about it.

Third.

What makes the situation especially complicated is the fact that there is a conflict of interests of at least two equal individuals (this does not count the woman’s existing children). You can, of course, gracefully neutralize the problem by declaring that “the life of one person (a child) is of greater value than the health of another person (a woman),” as some activists do, but, in my opinion, this is not the best solution.

Fourth.

Political moment. If we talk about any restriction or even ban on abortion, the question of whether there are exceptions arises. Plus the classic problem of “the life of one against the life of many.” Let's say the people agree to limit abortions at will, but demand that they remain for medical reasons. And since the opportunity to have an abortion remains, unborn children still die, and a corruption loophole appears. In a number of countries, abortion is prohibited for medical reasons, too, and that’s okay - they live somehow. In Poland, again, there was a recent scandal when the authorities decided to ban abortion completely. And this is taking into account the fact that, according to official statistics, there were about a thousand abortions a year.

Fifth.

Just as in a car the most broken part is the gasket between the steering wheel and the seat, so it is here. 99% of people discussing this problem are not even approximately familiar with the subject of discussion.

PART TWO. ESSENCE

Necessary note.

Two words: “overdiagnosis” and “reinsurance.” And not at the level of specific doctors, but set by the standards of pregnancy support. The number of analyzes and studies that a pregnant woman undergoes, although it has not reached infinity, is confidently striving for it, and sooner or later it is possible to find something in them that does not meet the standards. And then referrals to specialized ones begin, and so on. Additional stress. Well, plus the personality factor. You may encounter such an uzist that he will even find brain cancer for you. But this is a topic for another discussion. The most interesting thing is that no one bears any responsibility for the diagnostic results. They will say “sick child”, they will perform an abortion, but there will be no pathological examination of the fetus. Whether there was conditional Down syndrome or not is not important. Here, if a wart is removed, you will receive a certificate from a pathologist, but here, no. Whether such a volume of research is needed or not, what problems there are, is a topic for a separate professional discussion. But the fact remains: there are a lot of examinations, and almost everyone can find something suspicious.

First. Threat to mother's life

In order to develop an attitude towards this problem, it is necessary to determine the object of protection. If we choose only the child in the womb as its quality, then we can declare any interests of the mother secondary or insignificant and, accordingly, do not take them into account. If we believe that the mother is also a defendant, then there is a clear conflict of interest that must be resolved taking into account all the various possible factors.

The attitude to this situation from the point of view of the Orthodox Church is quite clearly expressed in the Fundamentals of the Social Concept of the Russian Orthodox Church:

XII.2. <…> In cases where there is a direct threat to the life of the mother during the continuation of pregnancy, especially if she has other children, it is recommended to show leniency in pastoral practice. A woman who terminates a pregnancy in such circumstances is not excommunicated from Eucharistic communion with the Church, but this communion is conditioned by her fulfillment of her personal penitential prayer rule, which is determined by the priest receiving confession.

Although there is a fairly widespread opinion that in a given situation one must accept everything as it is (“rely on the will of God”), I cannot unequivocally agree with this. When it comes to human life, only the owner of this very life can decide. You can't force anyone to be a hero. Of course, there are many cases when a woman with cancer, for example, refused chemotherapy in order to maintain her pregnancy. But I cannot take the liberty of drawing any categorical conclusions based on such cases, much less insisting that there is only one solution to this problem.

Second. Non-viability of the child

Let us assume that the development of pregnancy does not directly threaten the life of the mother, but the fetus has a confirmed fatal pathology. On the one hand, the decision is clear. On the other hand, one must understand that forced delivery is a risk for the mother, and perhaps it is worth allowing the child to be born naturally. Again: in the event of an artificial termination of pregnancy, the body will not be given to the parents, but will be disposed of as medical waste. Although for some people, especially believers, it would be important to bury the child humanely. And if we take the religious aspect, then baptize, if there is such an opportunity. I repeat, each such situation must be considered individually, and there are not and cannot be any solutions common to all. But some options in our medicine are currently completely missing.

Third. Child's disability

Obviously, from the point of view of a healthy person, disability seems to be something beyond terrible. No one would want to lose their legs, arms, sight or mind. And even more so, he would not want such a child to be born to him. This is a completely understandable emotional position. But, as always, reality is different from what people usually imagine. Here, first of all, it is worth saying that there are different developmental deviations. For the purposes of this article, they can be divided into those that are treatable, such as hydrocephalus, those that require supportive care and special care, such as Down syndrome, and the most severe cases. This division is very, very relative, but it allows, at least to a first approximation, to introduce some certainty, because usually we are talking about some completely conditional disease.

As for cases that can be treated, it is worth noting that not all parents of special children regret having such children. It's also worth thinking about the following points:

1. Taking into account the fact that abortions are actually freely performed in our country, disabled people continue to be born. And not all diseases, including those that make Down syndrome look like a mild illness, are diagnosed prenatally. In addition, a person can become disabled after birth. (More on this later.)

2. Diagnostics aimed solely at identifying a disabled person at any cost will interpret doubts for the worse. This is, in fact, what is happening now. In the absence of control over the results, this leads to the fact that for every one truly sick person, there are another one or two or three (there’s nowhere to get statistics from) healthy people who are aborted on suspicion. And not just because doctors cannot diagnose something correctly. There is always a certain proportion of women who have not made the final decision. And a small impact is enough for them to tip the scales in one direction or another.

3. You can turn a blind eye to people with disabilities as much as you like, but they were, are and will be. Obviously, the only way to really get rid of them is to kill them after birth. I hope that we will not reach such progress in humanistic thought. This means that we must learn to live in such a way that any person has the opportunity to realize their potential. We are not the first to encounter such a problem, and we have already gained quite a lot of experience in this area. It remains to apply it in practice. Moreover, such a change in the environment will also benefit healthy people, because it is convenient to get into a low-floor bus not only with a wheelchair, but also with a child, a grandmother who has difficulty climbing steps can also get on the ramp, and they thank the local administration for the presence of descents from the sidewalk and cyclists. It is also worth remembering that anyone, even the healthiest, can become disabled at any time. And it will be much easier for him if his life and social activity are not interrupted.

4. The most interesting thing. In this case, social support should be an integral part of the fight against this type of abortion. We must be prepared to say: your child is not like everyone else, but we value absolutely every human life, so we are ready to help you raise this child by any means, including placing it under our care. Church shelters for such children do exist, and often they are absolutely unique, such as, for example, a shelter for deaf-blind children in Sergiev Posad. But more systematic work is needed.

Fourth. Ectopic pregnancy

There will be some special information here, but it is necessary. A pregnancy in which a fertilized egg is implanted outside the uterine cavity is called ectopic ( graviditas extrauterina

, while implantation of the egg occurs outside the decidually changed endometrium. Ectopic pregnancy occurs in approximately 2% of cases. Decidual changes in endometrial cells are a special condition, in fact, the preparation of the uterus to accept the fertilized egg, if it is fertilized, and to the development of pregnancy. Decidual tissue plays an important role in the implantation of the fertilized egg, and also serves as a protective layer from damage to the walls of the uterus by the aggressively invading chorion - the villi of the fertilized egg.

For those who don't know. There is an ovary where the eggs mature, there is a uterus where the fertilized eggs develop, and there is a fallopian tube that connects the ovaries and the uterus. And now the mature egg crawls and crawls along this pipe and stumbles upon a swarm of sperm. (Or it doesn’t, but that’s another story.) After a short casting, fertilization occurs and the egg begins to divide. And, of course, crawl further into the uterus, which is preparing in every possible way for landing and the further development of pregnancy. But trouble may occur, and the egg will try to implant where it is not necessary: ​​in the tube (most often - 98% of cases), the ovary or the cervix. Sometimes it can go into the abdominal cavity and try to implant there. I'll tell you more about this below.

So: anywhere except the uterus, the embryo cannot develop. No other organ has the necessary elasticity and cannot resist the penetration of the “root system” of the embryo. The development of pregnancy will result in organ damage, internal bleeding and possibly death of the mother. Almost no chance. But every rule has exceptions. According to statistics, 98% of ectopic pregnancies are tubal, 0.1% are cervical and, according to various sources, from 0.0003% to 1.4% are abdominal (abdominal)[1]. It is in the case of the development of an abdominal ectopic pregnancy that the fetus has some chances (about 20%) of developing to the point at which its life can be saved after being removed from the mother’s body.

Let me explain with a specific calculation. Let's take 100 million pregnancies. 2% of the total number of pregnancies are ectopic (that's 2 million). Of these, abdominal 0.003% - 1.4% (from 60 pieces to 28 thousand). They have a 20% chance of successful delivery, that is, from 12 to 5.5 thousand. Naturalistic studies show a number close to the minimum estimate: “Live births from abdominal pregnancy are extremely rare. For example, with the number of births in the world about 130 million children per year, it was possible to identify only 38 cases of living children born from such pregnancies over five years (2008 – 2013), and the material was collected in 16 countries, on different continents”[2].

It is interesting to note that even in Ireland, a country with one of the strictest anti-abortion laws, the approach to ectopic pregnancy is close to the Russian one: the thematic website states, in general terms, the following: ectopic pregnancy is a life-threatening condition. Unfortunately, it is impossible to save it. The following are the methods that medicine offers to help women in this situation. Moreover, “observation” is also mentioned. But it is emphasized that this is only possible if such a pregnancy is at a very early stage and is “frozen” (the level of marker hormones decreases, etc.). And this is done in order to avoid traumatic operations to remove the tube, etc., and not for reasons of the possibility of prolonging such a pregnancy. The expectation is that it will disappear on its own. On the contrary, if signs of its development appear, then the question is raised about its prompt removal in order to avoid a life-threatening pipe rupture, etc. The fact that in very rare cases, at the level of a miracle, such pregnancies can lead to the birth of a living child are exceptions that cannot refute the currently available data on this pathological process, but, on the contrary, only confirm them. And they cannot determine medical methods of helping women in such situations.

A similar point of view is shared by the Australian Department of Health and the UK Department of Health.

Cases of carrying such a pregnancy are casuistry. In addition, delivery in this case is a difficult abdominal operation, threatening serious complications. And the child will receive certain damage during the growth process, which will lead to the development of various pathologies.

But the ideas of activists do not stand still, so there are a number of figures who equate an operation to terminate an ectopic pregnancy with an abortion. Some simply say that since God sent such a test to a woman, it means she must accept it and humbly end it. By the way, it was after such statements that I realized that working with an Orthodox audience requires no less than with a non-Orthodox one, and I decided to do the appropriate training. Others are more inventive, therefore they argue that an ectopic pregnancy should develop under supervision in order to allow delivery if something happens or even transfer the embryo from the tube to the uterus.

As for “transplanting”: this cannot be done, because the finest mechanisms of implantation have already been disrupted; they are implemented using the endometrial tube and cannot be repeated when bringing the fertilized egg to the uterine mucosa. And the endometrium of the uterus in a situation with an ectopic one is in a dual state: on the one hand, it undergoes gravid changes (that is, those that occur during pregnancy), on the other hand, without “seeing” the embryo, it tries to be rejected. In 90% of cases, patients bleed. “Replanting” is just a provocation of an ascending infection, but not a chance for survival. Regarding “observe”: in our country, as soon as the diagnosis of suspicio graviditas extrauterina

, i.e. suspicion of an ectopic pregnancy, the patient does not belong to herself: only emergency hospitalization and observation in a 24-hour hospital or immediate surgery. It happened that unlucky mothers were rescued from the other world after IVF, sitting at home and “saving” until the tube ruptured with internal bleeding and coma against the background of a blood loss of 2.5 liters. That is, there will be observation, but only until the ectopic pregnancy is finally confirmed.

Let me summarize. Ectopic pregnancy is an acute, life-threatening condition for the mother that requires immediate surgical intervention. The child has virtually no chance of survival (for bores - one in three and a half million), and often he is already dead at the time of the operation.

End of article:
Abortion as a result of rape .
—————

1 Barto R.A. “What is an ectopic pregnancy”; K. McIntyre-Zeltman, L. Andrews-Dietrich “Obstetrics” (Chapter 17 “Ectopic Pregnancy”); Mayorov M.V., Zhuchenko S.I., Chernyak O.L. “Ectopic pregnancy: modern methods of diagnosis and treatment.”

2 Live births resulting from advanced abdominal extrauterine pregnancy, a review of cases reported from 2008 to 2013 (https://www.webmedcentral.com/article_view/4510).


Legislation

The Constitution of the Russian Federation guarantees women's rights and freedoms, in particular, according to Article 36 of the Law on the Protection of Health of Citizens of the Russian Federation, every woman has the right to independently decide the issue of motherhood. But with a caveat: until a certain date. For medical reasons, pregnancy can be terminated at any time.

These indications are regulated by the Instructions on the procedure for authorizing artificial termination of pregnancy for medical reasons and the List of medical indications for termination of pregnancy. The list is contained in Order No. 736 of the Ministry of Health of the Russian Federation dated December 3, 2007, as amended and supplemented in 2011.

The order of the Ministry of Health and Social Development is the fundamental document in determining medical reasons.

Social indications are regulated by Decree of the Government of the Russian Federation dated 02/06/2012 No. 98. In this case, the presence of the head of the medical institution, an obstetrician-gynecologist, a lawyer and a social work specialist is required.

Social indications for abortion

According to social indications, an abortion operation can be undertaken only in those cases in which there are no issues that could complicate the course of the operation itself, especially its consequences.

From this point of view, contraindications to performing an abortion operation for social reasons are, first of all,:

1. Pregnancy over 12 weeks for recurrent pregnant women and 10 weeks for first-time pregnant women, or in the absence of offspring at all.
2. Genital infantilism and hypoplasia.
3. Inflammatory diseases of the appendages, pelvic peritoneum and tissue, as well as signs of open gonorrhea.
4. Purulent erosions and endocervicitis are of nongonorrheal origin.
5. Malignant and ulcerative processes on the external genitalia of the vagina and cervix.
6. Inflammation of the appendix in acute and subacute forms with increased temperature.
7. So-called focal infections: sore throat, flu, flux, purulent otitis media, wounds and ulcers with suppuration, furunculosis.
8. Suspicion of ectopic pregnancy.

Diagnostics

In order to terminate a pregnancy, it is necessary to document the fact of pregnancy. To do this, a blood and urine test for chorionic hormone and an ultrasound examination are performed, during which the fetal heartbeat can be determined as early as the 5th week of development. This will be a reliable sign of pregnancy.

Before performing an abortion in the early stages, it is necessary to diagnose inflammatory and infectious diseases:

• take a smear of vaginal flora;
• do a general blood test;
• carry out an inspection.

If an abortion is performed for medical reasons, then consultation with a specialist in the profile of the disease is necessary to certify it.

As for fetal developmental anomalies, screening examinations of the pregnant woman in a timely manner at the antenatal clinic will help. 90% of congenital pathologies are detected already in the first trimester at the 11th week using ultrasound and determination of biochemical markers of chromosomal disorders. These tests do not require invasive procedures, such as amniotic fluid sampling, and are inexpensive. Every pregnant woman is subject to this screening upon registration at the antenatal clinic.

Preparation for the procedure

To have a successful and safe abortion, you need to prepare for it. If a woman uses pills, then no special preparation is required; it is enough not to eat a large and heavy meal the day before and follow the regime on the eve of the procedure to reduce stress on the body. Psychological preparation is of primary importance: a woman must be confident in her decision if this happens at her request.

If you have a mini-abortion or curettage, you need to limit physical activity, exclude sexual activity 4-5 days before the procedure, and the night before take a light dinner and eliminate bad habits. It is also necessary to carry out hygienic treatment of the external genitalia, but without the use of chemical intimate hygiene products. It is also not advisable to use panty liners and tampons the day before.

Regardless of the type of abortion, a pregnant woman must undergo a number of examinations:

• general blood and urine analysis;
• determination of blood group and Rh factor;
• blood chemistry;
• determination of some coagulogram indicators;
• smear on flora.

In some cases, hospitalization is necessary.

In this case, the woman must:

• take a biochemical blood test;
• do an ECG;
• take a chest x-ray;
• and also give blood tests for HIV and hepatitis.

Execution method

Medical abortion is not difficult to perform. Under the supervision of a doctor, the woman takes 3 tablets of Mifepristone, is under the supervision of a doctor for several hours and can go home. A day later, another medicine is taken to enhance contractions of the smooth muscles of the genital organs. At this time, the embryo separates and characteristic bloody discharge appears, accompanied by slight pain in the lower abdomen.

When performing a mini-abortion, a woman is placed on a gynecological chair, a thin catheter is inserted into the genital tract and reaches the uterine cavity, where the device creates negative pressure and destroys the fertilized egg, which is then removed using aspiration. Sometimes the manipulation requires local anesthesia and widening of the entrance to the uterus with special instruments - bougies. After vacuum aspiration, the patient is asked to lie down for several hours, and after 5-7 days she is invited for an ultrasound.

Curettage is a more complex intervention. It is also carried out on a gynecological chair. First, the site of action is anesthetized, and the entrance to the vagina and uterus is certainly widened with Hegar dilators. Then the uterine cavity is probed and a curette is inserted. Using this instrument, the embryo and contents are removed from the uterus with careful movements. After the procedure, ultrasound control is performed.

Often, curettage is performed under general anesthesia, then more complex preparation and administration of anesthetic drugs is carried out.

Recovery

After an abortion, a woman is in a vulnerable state to all adverse factors. At this time, it is important to adhere to special recommendations, especially immediately after an abortion.

First day

On the day of the abortion, nagging pain in the lower abdomen may appear. This is normal and indicates that the uterus is contracting and removing the remaining destroyed tissue and blood clots. Therefore, another normal occurrence will be a small amount of spotting. They can last up to 5-7 days, depending on the radicalness of the procedure and individual characteristics. You will also be concerned about weakness and general malaise. This is due to powerful hormonal changes and the body’s reaction to abortion as stress.

It is recommended to follow a gentle regime for the first day, sometimes even bed rest. Neither physical nor psychological stress is advisable. It is recommended to take anti-inflammatory drugs and other medications as prescribed by a doctor. Meals should be balanced and nutritious, but you should not overeat or drink alcohol. You should also avoid tonic drinks: strong coffee or tea. It is necessary to monitor changes in the nature and volume of discharge and monitor body temperature.

In what cases should you not have an abortion?

There is no clear list of contraindications for artificial termination of pregnancy. If the risk to the mother's health is high, abortion is performed to save the woman's life.

It is extremely undesirable to artificially remove the fetus from the uterine cavity in the following conditions:

• acute inflammatory processes in the pelvic organs;
• ulcers in the urinary canal area;
• subacute stage of appendicitis, with increased body temperature;
• severe conditions due to an acute infectious process (temperature above 37.5);
• ectopic pregnancy;
• abortions more often than 2 times a year.

The final decision to continue or terminate the pregnancy should be made jointly with a gynecologist and related specialists. Doctors from a modern medical center for abortion and contraception will help you get professional advice and identify indications and contraindications for abortion.

MAKE AN APPOINTMENT

Abortion and contraception clinic in St. Petersburg - department of the medical gynecological association "Diana"

Make an appointment, tests or ultrasound via the contact form or by calling +8 (812) 62-962-77. We work seven days a week from 09:00 to 21:00.

We are located in the Krasnogvardeisky district, next to the Novocherkasskaya, Ploshchad Alexander Nevsky and Ladozhskaya metro stations.

The cost of a medical abortion in our clinic is 3,300 rubles. The price includes all pills, an examination by a gynecologist and an ultrasound to determine the timing of pregnancy.

Rehabilitation

Further management of the post-abortion period is aimed at restoring reproductive function and the functioning of other organs and systems. In this case, the main recommendations will concern both lifestyle and drug effects on the body.

Mandatory treatment

The prescription of some medications is necessary after termination of pregnancy. This is due to the body’s pronounced response to aggressive actions during abortion. A local inflammatory reaction develops in the organs of the reproductive system, which can be expressed in weakness, fatigue, and fever.

To reduce the severity of this peculiar defense mechanism, medications with anti-inflammatory activity are prescribed.

They need to be taken for a week or even two.

Since there is a risk of infectious complications, broad-spectrum drugs can be prescribed: protected penicillins, cephalosporins. And in case of extensive trauma or reduced immunity, women are prescribed them for preventive purposes. Antibiotics are taken for 5-7 days.

If an infectious process develops directly, then a determination of the pathogen and its antibiotic sensitivity is indicated. Pending the results of these tests, antibiotics are selected based on the expected spectrum of microorganisms.

Hormonal changes in the reproductive system can disrupt its functioning for a long time, so obstetricians and gynecologists often resort to prescribing oral contraceptives. These drugs regulate the cyclic release of hormones, so it is preferable to use bi- or triphasic drugs rather than monophasic ones.

Combined oral contraceptives, or COCs in other words, are medications that require medical supervision. Therefore, they are selected strictly according to the doctor’s indications.

Additional

Restoring other body functions is an equally important task. To compensate for decreased immune resistance, you can take dietary supplements and vitamin preparations. It is important to include vitamin E and vitamin C in your diet, as they affect the female reproductive system.

Antioxidants and herbal remedies that enhance immunity will also be useful. These include various tinctures: ginseng, eleutherococcus. Among other herbal remedies, you can use anti-inflammatory herbal infusions, for example, linden with chamomile in the form of tea or decoction.

If a woman’s emotional background is disturbed, it is necessary to correct the resulting deviations. The use of sedatives, even tranquilizers and antidepressants as prescribed by a doctor is indicated.

For very severe pain that does not go away for a long time even after the discharge has stopped, you can use antispasmodics. However, such a situation will be an absolute reason to consult a doctor.

Depending on the diagnosis

Concomitant pathology requires careful adherence to the regimen of taking appropriate medications.

Let's look at the most common diseases.

For diabetes mellitus, it is necessary to monitor blood glucose and take oral glucose-lowering drugs or insulin, depending on the type and severity of diabetes.

It is also necessary to remember that surgical interventions and inflammatory processes require an increase in the amount of insulin compared to the usual regimen.

Such common pathologies of the thyroid gland as hyper or hypothyroidism require correction of hormone levels to the so-called euthyroidism - a state in which hormones are within normal limits. To do this, in case of hypofunction, thyroxine preparations are taken, and in case of hyperfunction, on the contrary, their formation in the thyroid gland is suppressed. In this case, endocrinologists often use a “block-replace” scheme, that is, they prescribe both thyroid hormone blockers themselves and thyroid hormones in order to reduce the adverse effects of reduced levels of T3 and T4.

Cardiovascular disease can worsen the condition as the impact of stress and the nervous system increases.

If a woman suffers from hypertension, beta-blockers are indicated as drugs that reduce these effects. If there are contraindications to them, other groups of drugs can be used.

If there is pain in the heart, it is necessary to use medications containing nitroglycerin, as well as medications that reduce the heart's need for oxygen, for example the same beta blockers. It is also important to remember the effect of oral contraceptive treatment on the state of the cardiovascular and coagulation systems.

Problems with the digestive tract are common diseases. In this case, it is necessary to take gastroprotectors if there is a history of gastritis or an ulcer.

If breakdown and absorption are impaired, or for pancreatic pathologies, enzyme preparations are prescribed. Gastric ulcer requires complex treatment taking into account the presence of Helicobacter pylori.

A frequent complication of invasive procedures on the genitals is the development of vaginosis or even the addition of pathological microorganisms. To diagnose this condition, you should do a smear on the flora, based on the results of which antibiotics will be prescribed. In this case, drugs of the penicillin group, as well as Metronidazole, are most often used.

Psychological help

After an abortion, women may need the help of a psychologist to cope with what happened, since they are often unable to cope with this situation on their own. According to statistics, a woman more often makes the decision to have a medical abortion at her own request under the pressure of such circumstances as the partner’s reluctance to have children or the inability to raise a child on her own due to financial difficulties.

Thus, a strong feeling of guilt and dissatisfaction arises, a major role in this is played by a sharp change in hormonal levels, which worsens the psychological state.

When an abortion is performed for medical or social reasons, the psychological burden doubles. Difficult experiences sometimes force women to commit rash and even dangerous actions, so they require specialized help.

To support women, special groups are created, and hospitals have a psychotherapist or psychologist. A big role is also played by the reactions of loved ones and their observation in order to identify possible signs of depression in time.

Cognitive behavioral therapy in small groups is especially effective in this situation, where women can exchange experiences and restructure their attitude towards this problem.

It is also useful to provide medical support with sedatives and antidepressants as decided by the attending physician.

How to survive an abortion: practical advice

Severe mental suffering can occur immediately after an abortion or some time later, but it also happens that it occurs several years later. Most often, the critical moment occurs 2-5 years after the abortion. Sometimes a woman cannot forget her grief until the end of her days. It is not easy to survive such a tragedy, but life goes on, and it must be done.

1. Stay in reality. The hardest thing is to face the truth and understand that this happened to you and your child. You had a medical abortion. Accept this fact. Your suffering is a healthy sign that you are aware of what happened. To heal emotional wounds, you need to acknowledge their existence and the reason for their occurrence.
2. Don't hide your feelings. Cry. This is much better than hiding grief deep inside. The pain will not go away on its own, and unshed tears will sooner or later find a way out in illness and nervous disorders, just as a deep splinter festeres.
3. Seek support. If you want to hide from everyone and be alone with your grief, you have every right to do so, but do not turn it into a way of life. Man is a social being and it is easier for him to recover from loss when he feels supported. Share your feelings with loved ones who can respect your loss and share your grief. Seek help from a psychologist. Join a support group or chat on forums with women who have experienced similar misfortunes.
4. Sorry. This is the most difficult thing. Anger towards yourself and others who were involved in the abortion is normal. To forgive yourself, you first need to forgive others, forgive fate for taking away this short-lived happiness. Once you get through this, it will be easier for you to forgive yourself.
5. Don't let anyone invalidate your feelings or make light of your grief. You have the right to suffer. You have lost a child.

At the very beginning of your recovery journey, you need to realize that you can only help someone who wants help and is looking for it.

Possible consequences

In any case, termination of pregnancy is not an absolutely safe procedure and can be fraught with the development of complications.

In the early stages there is a risk:

• bleeding;
• infections;
• inflammation.

If curettage is performed, there is a possibility of perforation of the uterine wall and traumatization of neighboring organs, the development of peritonitis, which certainly poses a threat to life.

Late-term abortion may result in other undesirable consequences:

• chronic inflammatory diseases;
• endometriosis;
• neoplasms, including malignant ones.

Frequent abortions and multiple scars on the uterus will contribute to miscarriage and infertility.

Methods and terms

The choice of method for termination, taking into account medical indications, is directly related to the duration of the pregnancy being terminated.

• An abortion performed before 12 weeks is called early.
• Interruption starting from the 12th week until the 22nd week is late.

Correct determination of the period when deciding whether to perform an abortion is important for choosing the most appropriate method of termination.

Termination of pregnancy is possible at any stage if there are medical indications.

If the period exceeds 22 weeks, termination is achieved by artificially induced labor.

The following methods are widely used by specialized medical institutions to terminate pregnancy:

1. Use of oral medications for a period not exceeding six weeks.
2. Vacuum aspiration - used for up to 12 weeks.
3. Curettage and dilatation are used until the 12th week if the first two methods are unproductive, and as an independent method at a later date.
4. Artificial birth is the method of choice after the 22nd week and when the fetus weighs more than 500 g.

The choice of method is influenced by: the current clinical situation, the duration of pregnancy, the woman’s condition, the equipment of the medical institution, the qualifications and preparedness of the medical personnel.