Medical interruption of pregnancy in early terms: in priority safety. Artificial abortion of pregnancy

Medical abortion - Artificial abortion of pregnancy, performed by trained medical personnel in compliance with all the requirements of the method. Medical abortion is carried out in a medical institution with an informed consent of the woman and the mandatory design of the relevant medical records. Artificial abortion of pregnancy is carried out at the request of a woman up to 12 weeks; According to social testimony - up to 22 weeks, and in the presence of medical testimony and the consent of the woman - regardless of the term of pregnancy.

Indications for medical abortion

At your own accord, a woman's pregnancy is interrupted for a period of up to 12 under the presentation of the direction from female consultation, passports and policy in the institution operating under the Mandatory Medical Insurance Program.

According to medical reasons, the interruption of pregnancy is carried out regardless of its term if pregnancy and childbirth are able to worsen the state of the health of the woman and threaten her life, or if the anomalies of the development of the fetus are discovered. The testimony establishes an obstetrician-gynecologist together with the specialists of the appropriate profile (therapist, surgeon, oncologist, psychiatrist, etc.) and the head of the medical institution after examining the patient under the hospital. At the same time, the woman writes a statement that the Medical Commission considers.

According to social indications, the interruption of pregnancy is carried out for a period of up to 22 weeks. Decree of the Government of the Russian Federation of August 11, 2003 compiled a list of social testimonies to the artificial abortion: the court decision on deprivation or the restriction of parental rights; pregnancy as a result of rape; Woman stay in prison; The disability of the I-II group of her husband or death of a husband during pregnancy. The question of the interruption of pregnancy on the following testimony solves the Commission after the conclusion of the obscehnecologist of the women's consultation on the period of pregnancy and upon presentation of relevant legal documents. If there are other grounds for interrupting the pregnancy of non-medical nature, the issue of this interruption solves the Commission individually. The Commission includes the chief physician or his deputy for therapeutic work, the head of the department, the attending physician, as well as specialists: a lawyer, psychiatrist, etc.

Contraindications of medical abortion

• Inflammatory processes of genital organs.
• The presence of purulent foci is regardless of their location.
• Acute infectious diseases.
• Late term of pregnancy. In the later dates, abortion is contraindicated, if the abortion of pregnancy during this period is more dangerous for health and life than the continuation of pregnancy and childbirth.
• Term less than 6 months after preceding pregnancy interrupt.

Preparation for artificial interruption of pregnancy

Before interrupting pregnancy, a preliminary outpatient examination is carried out: collection of anamnestic data; Bimanual study with the inspection of the cervix in the mirrors; determining the degree of purity of the vagina; clinical blood test; general urine analysis; Definition of blood group and resfactor; study of blood for vicinfection, syphilis, hepatitis B and C; Analysis of the resulting blood system (according to indications); Uzi small pelvis organs; Inspection therapist. If necessary, we assign consultations from other specialists.

Medical abortion

One of the safe methods of artificial interruption of the pregnancy of early terms as an alternative to surgical intervention is a drug abortion. In the Russian Federation, the use of this method is permitted within 6 weeks of pregnancy (duration of amenorrhea 42 days). For this purpose, antiprogestins are used (mifepristone ©) in combination with prostaglandins (misoprostol). A single patient takes 600 mg of mifepristone © inside (3 tablets), and after 36-48 hours, Mizoprostol 400-800 μg is prescribed inside. The effectiveness of the method, according to WHO and Russian studies, is 95-98%. After interrupting pregnancy, ultrasound control is required.

Mini abortion

In the first trimester, a mini abortion (vacuum-aspiration) is performed to remove a fruit egg from the uterine cavity. Used electric pump and cannulas with a diameter of 5 to 12 mm from flexible rigid plastic or metal. The effectiveness of the method is 99.8%. After interrupting pregnancy, ultrasonic control is carried out.

Medical abortion

The removal of the fetal egg in terms of 6-12 weeks produced by scraping the walls of the uterus (dilatation of the cervix and the curethip) in the conditions of the gynecological hospital.

Preparation for the operation

On the eve of the planned operation, a woman takes a shower, she put a cleansing enema, swear their hair from outdoor genitals. On the day of the operation and on the eve of the evening they forbid food. If an abortion is supposed to be carried out under anesthesia, a woman examines anesthesiologist. Before the operation, it is necessary to empty the bladder and intestines. To prevent possible complications in the early postoperative period, preventive reception of doxycycline is recommended: 100 mg per 1 hour to operation and 200 mg after surgery.

Methods anesthesia

Anesthesia intravenous, master.

Technique operation

Medical abortion is performed in a small operating room in the position of a woman on a gynecological chair. The toolkit includes vaginal mirrors, bulletin tongs, uterine probe, a set of extends hegareric No. 4-12, Cureti No. 6, 4, 2, tongs to remove the fetal egg (ABortsang), tweezers (or Corncang), sterile material.

Sequence of actions during operation.

1. Conduct a two-handed vaginal andabdominal study to determine the magnitude of the uterus, its position in the small pelvis and to eliminate contraindications to the operation.

2. Process the external genitals, the vagina and the cervix with a solution of iodonate or another antiseptic.

3. Mirrors are introduced into the vagina.

4. Take the cervix with bullet tongs for the front lip. The front mirror is removed, the rear is transmitted by an assistant sitting on the left. To straighten the cervical canal, the neck is tightened down the book and the stop (when the uterus is position in AnteFlexio) or the shock (when the uterus is positioned in RetroFlexio).

5. The uterine probe is introduced into the uterine cavity to clarify the position of the uterus and measure the length of its cavity. The curvature of the uterine probe and the depth of its administration determine the direction of administration of GEGAR expanders to No. 11-12.

6. Enters hegare expansion sequentially somewhat further than the inner domestic language. The introduction of expansion contributes to the stretching of the muscles of the cervix. An attempt to fix the introduction of expansion can lead to the breaks and perforation of the cervix and body of the uterus. Each expander is held in three fingers so that with great care to pass internal ZEV and stop the expander movement immediately after overcoming the resistance of the language. If there is a difficulty when entering the expander of the subsequent number, return to the previous one, is captured by bullet tongs the rear lip of the cervix and hold the extender in the cervix for some time.

7. Remove the fruit egg with curetles and abortsang. ABortsang remove parts of a fetal egg. The scraping begin with a stupid Curette number 6, then as the uterus reduces and reduce its size uses more sharp curetles of a smaller size. The curette is gently administered to the bottom of the uterus and movements towards the inner yawn in front of the front, right, rear and left walls separated the fruit egg from its bed. Simultaneously separate and remove shells. After checking the area of \u200b\u200bpipe angles with an acute curette, the operation finish.

In the case of a complete removal of a fetal egg, a crunch is felt, the uterus is well reduced, the bleeding stops. The average blood loss during the interruption of pregnancy under 6-9 weeks is about 150 ml.

The completeness of the emptying of the uterus from the elements of the fetal egg is advisable to monitor with the help of an ultrasound (especially in unborn).

After the artificial interruption of pregnancy of women with resound-negative blood is immunized by immunoglobulin antveosus Rho (D).

The duration of stay in the medical institution after an abortion is determined individually depending on the state of the health of the woman.

Pregnancy Interruption in the II Trimester

There are various methods of interrupting pregnancy in the II trimester (for medical and social indications):

• The use of prostaglandins (intraamnional, eclaimnional, parenteral, vaginal).
• Amnioinfusion of hyperosmolar solutions (20% sodium chloride solution).
• Hysterotomy.
• Combined methods.

COMPLICATIONS

Complications of abortion

• Hypotension uterus with bleeding.
• Incomplete removal of a fetal egg after scraping.
• Perforation of the uterus.
• Tarve the cervix.

Complications in the postoperative period

• Hematometer.
• The aggravation of inflammatory diseases of the internal genital organs.
• Placental polyp.

Remote complications of artificial abortion

• Inflammatory diseases of the uterus and appendages (14.6 and 19.2%).
• Menstrual cycle violation (8-42.4%).
• Iso immunization during rescovism.
• Violation of patency of uterine pipes with the development of infertility or ectopic pregnancy.
• Damage and degeneration of endometrial, the formation of synechs in the uterus, leading to implantation impaired and the emergence of anomalies for the development of the fetus.
• Damage and scar changes in the inner zoom and cervical canal, leading to exhauscocervical insufficiency and non-obscure pregnancy.
• Psychoic disorders.
• The adverse effect of artificial abortion on the functional state of the cardiovascular, endocrine, nervous and other systems of the female organism.
• Complicated month of subsequent pregnancy: increasing the frequency of the threat of interrupt and non-leaving pregnancy, the development of late toxicosis, the risk of bleeding in childbirth, the weakness of generic activity, an increase in the birth rate of children with a small body weight.
• Repeated artificial abortions - the cause of the pathological flow of the menopausal period.
• An increase in the risk of development of dormriconal diseases and breast cancer in women with three artificial abortions and more in history.

Features of the postoperative period

In the postoperative period, it is necessary to monitor the body temperature, the pulse rate, separation from the genital organs. Outdoor genitals twice a day are harvested with antiseptic solutions. After extracting from the hospital, it is recommended to observe women's advice. Patients with high infectious risk are shown peri or postoperative antibiotic effect of infectious complications. In order to normalize the pituitary and prevention of endometriosis, they are prescribed COC for 3 months.

Information for the patient

• After an abortion, a physician consultation is desirable about the selection of contraceptive means.
• It is necessary to abandon the reception of the bath (better shower), swimming in pools and open water bodies during the first 14 days.
• Carefully observe the hygiene of the genital organs, daily waved.
• Poland must be compliance within 21 days to prevent possible driving infection in the uterus, which after an abortion is a big open wound. Health should be started after the first menstruation, which will come after an abortion.
• The bladder and intestines should be emptied regularly to better reduce the uterus.
• During the week after an abortion, daily measure the body temperature, avoid hypoints, severe physical exertion.
• It is necessary to urgently turn to the gynecologist in the event of a temperature lift, the appearance of pain over the Lone or in the lower sections of the abdomen, bleeding from the genital tract.
• It is necessary to urgently turn to the gynecologist if menstruation came earlier or did not come at the expected period. The deadlines for menstruation before and after the abortion are the same.

Abortion, or interruption of pregnancy up to 22 weeks, is spontaneous or artificial. According to existing statistics, in the world, about each second pregnancy ends with an abortion.

Spontaneous abortion is differently called miscarriage. Artificial abortion is medical or criminal. Conducting the last illegal and is a criminal offense.

Definition of concept

Medical abortion is an interruption of pregnancy by artificially, corresponding to several criteria:

• Performed by specially trained medical personnel.
• Venue is a specialized medical institution.
• The patient's informed consent is necessary for manipulation.
• Filling in special medical records.

If the abortion is carried out without compliance with these requirements, then it is called "Criminal".

Indications

Medical abortion is always made by testimony. In most countries for this manipulation in the first three months of pregnancy, just the desires of a woman.

To commit artificial interruption of pregnancy at the later dates (from 13 to 22 weeks), it is necessary to have strictly regulated testimony: medical or social. Their list is approved by the Ministry of Health. Examples of such indications may be:

1. Rough malformations of fetal development.
2. Interene fetal death.
3. Serious threat to the health or life of the mother (active stage of tuberculosis, decompensated heart defects, terminal stage of cirrhosis, HIV (AIDS) and other diseases and pathological conditions).
4. Heavy mental illness, drug addiction.
5. Oncological pathology (cancer) of any localization.

Also, a medical abortion can also be made according to social indications. For example, when pregnancy is a consequence of rape.

In some countries (Chile, Nicaragua, Salvador, etc.), an abortion is classified as a crime equal to the murder. That is, in the territory of these countries there is no testimony to an abortion. In other states, a medical abortion can be produced only in exceptional cases, for example, in order to save the life of a pregnant woman.

Contraindications

For the procedure of artificial interruption of pregnancy, there are contraindications. Common of them for all types of abortion are:

• Acute infectious pathology.
• Inflammatory processes of genitals.
• The term of pregnancy is 22 weeks or more.

There are also their contraindications for a particular method of medical abortion.

Separate discussion requires pregnancy in women with negative blood factor. It should be known that an abortion in this case can significantly increase the risk of rhesus conflict in the future. Therefore, such women should be very weighted to approach the decision to interrupt pregnancy, especially if she is the first.

Survey

Before conducting a medical abortion procedure, a certain preparation is performed. The list of the necessary surveys is determined by the term of pregnancy, as well as indications of honey. abortion.

The mandatory list of surveys before conducting manipulation includes:

1. Gynecological examination.
2. Analysis of separated from the genital tract (smear per microflora).
3. Determination of the presence of syphilis (RW), the virus of human immunodeficiency and the pathogens of viral hepatitis B, C.
4. ONKOCITOLOGICAL STUDY OF MAZKOV (Sometimes Kolposcopy is also required).
5. Establishing a blood group and a rhesus factor.
6. Coagulogram.
7. Fluorography and others.

Methods of holding

Medical abortion can be produced in two ways: surgical or drug. The choice of a particular method depends on very many factors, however, the decisive role plays the term of pregnancy at the time of its interrupt.

The medication method is based on the specific effects of certain pharmaceuticals during pregnancy.

Surgical methods involve embryo or fetus extraction using special devices and manipulations. These include:

• Vacuum excavation of the fetal egg ("mini abortion").
• Cyuptage (instrumental).
• Interventions in late dates: dilantation and evacuation, hysterotomy.

In addition to the term of pregnancy, other existing factors affect the choice of a specific methodology for performing artificial abortion. For example, hysterotomy is made by a malignant tumor of the reproductive system or pronounced stenosis of the cervical canal. The identification of testimony and contraindications to a specific method of medical abortion is carried out by a doctor who conducts this procedure.

Drug

This is the most relatively gentle way of artificial abortion.

It is carried out under the careful control of the doctor. The term of pregnancy for abortion with the help of drugs should be no more than six full weeks or up to 42 days of amenorrhea (lack of regular menstruation). A woman takes a tablet drug group antiprogestins, and after 36-48 hours - Prostaglandin. These drugs provoke the amplification of the motor activity of the uterine wall and the detachment of the fetal egg, followed by its exile from the uterine cavity. This process is accompanied by bleeding of various intensity.

After completion of bleeding, an ultrasound examination of the uterus is carried out in order to control its full emptying.

The effectiveness of this technique is more than 90%. If a fruit egg is delayed in the uterine cavity or an abortion is accompanied by abundant bleeding, its surgical emptying is carried out.

Contraindications to carry out such an abortion are:

1. Disorders of the chopping system.
2. The presence of tumors in the uterus (Leiomioma and others), scar changes after operational interventions - cesarean cross-section, organ-powder operations, etc.
3. Renal failure.
4. Bronchial asthma.
5. Breast-feeding.
6. Individual intolerance to the medicines used to carry out this procedure.

Mini abortion

The removal of the fruit egg by the method of vacuum excavation (aspiration) is shown on the period of pregnancy up to five weeks or up to 21 days of delay. Expansion (dialing) of the cervical channel In this case, the method of interrupting pregnancy is most often not required, so it is considered less traumatic than the instrumental.

It is usually necessary to the anesthesia - local or general. A special plastic or metal cannula is introduced into the uterine cavity, connected to electrical circuit (the apparatus creating a vacuum - negative atmospheric pressure). A fetal egg with shells is thus removed. Over the next few days, moderate bleeding is noted.

Contraindications for conducting vacuum excavation of the fetal eggs are the same as for other surgical methods.

Using the method of vacuum aspiration, diagnostic procedures can be carried out, for example, with suspected endometrial hyperplasia. In these cases, it is called Pipel biopsy or aspiration biopsy.

Instrumental

It is performed on the period of up to 12 weeks of pregnancy and is carried out in stationary conditions prepared by the specialist. In early terms, preference should be given to a vacuum or medication method.

The operation is carried out under general anesthesia. First, with the help of special expander (hegare or laminari sticks), the cervical canal is dialing (expansion). The procedure is quite painful and sometimes traumatic. Then special tools (curettes and abortiongom) are removed by a fruit egg and its shell.

For several days after the intervention, the woman can feel moderate pulling pain in the lower abdomen. Blood sections are marked approximately for the first week.

Late

Abortion of pregnancy in terms of 13 to 22 weeks is made in strict indications. In other cases, such an abortion is classified as criminal.

In these timing, during the interruption of pregnancy, there is the greatest risk of complications, so it is carried out only by an experienced doctor in specialized medical hospitals.

Depending on the gestational period, several pregnancy interruption methods are used, which can be combined into two groups:

• Dilatation and evacuation.
• Stimulation of generic activities ("artificial" childbirth).

In the first case, first produces the cervical cervix in various ways, which can take several hours. Then, with the help of the abortion, curetles and / or vacuum aspirate, the fetus and placental tissue is removed.

For a period of pregnancy, more than 20 weeks is more often used to stimulate generic activities by various methods, leading to independent expulsion of the fetus. However, at the end of the expulsion procedure, an instrumental revision of the uterine cavity is always carried out for the absence of delayed fetus residues, placenta or shells.

What to do after abortion?

There are some rules that are important for all women who have suffered a procedure for artificial interruption of pregnancy, regardless of the method of its implementation. These include:

1. Measurement of body temperature every day for a week after manipulation.
2. Careful daily hygiene genitals.
3. Avoid hypothermia, physical overload, weight lifting.
4. It is recommended to be sexual peace, at least three weeks after the abortion procedure. Most experts advise to resume sexual life not earlier than at the end of the first normal menstruation, which comes after an abortion.
5. Regular emptying of the bladder and intestines to improve the contractile activity of the uterus.
6. Over the course of two or three weeks, you need to abandon the adoption of the bath (only shower), swimming in pools or open water bodies.
7. Indications for immediate treatment for medical assistance are: an increase in body temperature, the appearance or enhancement of pain in the lower abdomen, bleeding or abundant isolation of a purulent nature.
8. The beginning of the next menstruation ahead of time or its delay also serves as a reason for the immediate consultation of the doctor of the gynecologist.

And, of course, before the abortion procedure should be discussed with a doctor and choose the optimal method of protection from unwanted pregnancy in the future.

Complications

Abortion is a manipulation that practically always does not pass without a trace. Even in the case when the technical side of the procedure occurs without visible complications, the disadvantage of the abortion procedure affects almost all organs and systems of the female organism. "Tuping" to raise pregnancy, the body is experiencing a kind of shock from what she was interrupted. This occurs a serious hormonal imbalance, violation of the functions of nervous, immune, cardiovascular and other systems. And taking into account the fact that the decision on abortion for most women is a rather painful step, as a result, disorders occur in the psycho-emotional sphere: a dream is disturbed, irritability, depression, and so paragraph.

So what are the complications of the medical abortion? They are divided into early and remote.

Early

Early consequences of abortion include those that arise directly during or in the first days after the procedure of artificial interruption of pregnancy. Typical examples of such complications are:

• Incomplete extraction of a fetal egg or its shells. It is fraught with the development of bleeding and / or inflammatory damage to the genital tract. In these cases, compulsory conducting a surgical audit of the uterine cavity with its full emptying is required.
• Hypotonic uterine bleeding, as the cause of the violation of its contractile ability.
• Perforation (bodybag) of the uterine wall.
• Traumatic damage to the cervix.
• The hematometome is the accumulation of blood and bunches in the uterine cavity. Very often at the same time an infection is joined, which leads to serious inflammatory violations.

It should be remembered that the abortion procedure is performed by the doctor almost "blindly". Therefore, no one can guarantee the absence of consequences with any methodology for the implementation of medical abortion.

Remote

Remote complications are manifested after some time after an abortion: days, months or even years. These include:

• Inflammatory pathology of small pelvis organs (more often - uterine pipes and endometrial).
• Menstrual cycle disorders.
• The obstruction of phallopy pipes, leading to infertility or an increase in the risk of ectopic pregnancy.
• Disruption of the structure and functions of the endometrium. In the uterus, connective tissues (synechia) can appear, which violate the processes of implantation and intrauterine development of the fetus. And extensive scar changes endometrial after surgical abortion can make an implantation at all impossible.
• Scar deformation of the cervix. Leads to the formation of exhaustic-cervical insufficiency, which is manifested by non-obscure pregnancy.
• Pathology of pregnancy: an increase in the risk of non-obscuration and premature births, bleeding, anomalous attachment of the placenta, weakness of labor activity, etc.
• The risk of the emergence of the dormantic pathology of the breast (mastopathy).
• Psychogenic violations and other complications.

There is also information that repeated abortions increase the risk of the pathological course of the climacterial period.

In conclusion, it is worth noting that the abortion is not a means of tafeability. And his consequences are sometimes very serious and carry a threat not only to health, but sometimes women's life.

Nowadays, there are a wide variety of ways to prevent unwanted pregnancy (contraceptive means). In their correct selection and application, the probability of pregnancy is practically absent.

Despite the fact that the drug interruption has become popular in modern medicine, a number of consecutive actions must be made for a successful conduct of the procedure. This will minimize possible consequences and bring the effectiveness of the method to the maximum. It is important to remember that the abortion of myphen needs to be performed as soon as possible, ideally in the first days of menstruation delay, after confirmation of the fact of pregnancy. The diagram of reception of drugs is calculated by a gynecologist, individually for each woman.

Stage 1:EXPLORATORY SURVEY

You call the contact phone to our medical center and write down at a convenient time for you to receive to the gynecologist, calling the administrator the reason for the appeal: "I want to make a medical abortion." It is advisable not to take food for about 2-3 hours before the visit.

Having come to the medical center, you go to ultrasound to clarify the term of pregnancy and the exception of the main contraindication - ectopic pregnancy. The latter circumstance is fundamentally important, so the results of the ultrasound made in another medical institution are not accepted.

Next, with the results of the ultrasound (pregnancy and its localization), you go to the gynecologist. After instructions on the presence of undesirable pregnancy and desire to interrupt it, the consultation is discussed possible solutions to the problem. In the event of a choice of the method of drug abortion, information on the essence of the method, contraindications, probable side effects, complications, symptoms and possible variants of the flow of this procedure are provided.

Also on prior consultation, you choose options:

• preparation of Mifegin (France)
• by the drug Mithferibon (Russia)

For pre-travelers and testimony, a list of analyzes may be recommended to clarify the health of the health and exclusion of contraindications. Further provides time 2-3 days to make a final decision.

Stage 2:Reception of the drug Mifegin (Mithferibon)

You confirm the desire to interrupt the pregnancy by this method. Filling the "Sheet of informed consent of the patient" to conduct medication abortion with pills. Reception of the drug Mifegin (MiPepristone) in the presence of a doctor. After that, you get all the recommendations, a schedule for receiving the drug support and turning on control ultrasound. If your VIP program has been selected, appropriate appointments are given, recommendations.

If a vomiting occurs within 1 hour after administration (which is extremely rare), then the desired result will not be achieved and the abortion of pregnancy will be necessary to perform in another way. After taking a mefinet for 36 - 48 hours, the appearance of spastic pains and bleeding from sex tract is expected and possible. In the event of these symptoms, it is necessary to consult with the attending physician.

3 Stage:Reception of support

After 36 - 48 hours after the reception of myphepin (mifepristone), preparations of support are prescribed - prostaglandins. In most cases, after that, the drug abortion passes during the first 12-48 hours. The pain and degree of bleeding can be different in intensity and duration, and with a larger time they are more pronounced. After 1 - 3 days to confirm the fact of the exit of the fruit egg, it is necessary to make the first ultrasonic control. If a fetal egg did not come out to this deadlines, additional support preparations are issued and the date of the next Uz-control is assigned.

Women with negative blood rhesus must pass immunization with a special anti-conversion immunoglobulin in order to prevent the reshus-conflict with future pregnancies. It is held in case there are no antibodies in the blood to the factor.

4 Stage:Control examination

Bleeding and pain are not evidence that the abortion has occurred completely. Therefore, it is necessary to carry out a test study with the relevant methods (ultrasound) after 5 and 15 days after the admission of myphen (mifepristone). According to this Uz-research, the final result is determined. In case of pregnancy, appropriate intervention can be recommended. In case of incomplete interruption of pregnancy, it is possible to try to solve the problem through a complex of conservative measures with subsequent ultrasound control. With a negative result of conservative therapy, appropriate instrumental interference should be proposed in one of therapeutic institutions.

Sometimes it happens that a woman cannot be to enter the child for certain reasons, and the conception has already happened. For such situations, a drug abortion is often used (pharmacological abortion, artificial interruption) - a procedure that is customary to do in the early deadlines using special tablets. This abortion variant is characterized by a minimum number of complications, compared with surgical methods. The effectiveness of the pharmacological interrupt is 98 percent, but only if it is carried out in a timely manner.

What is a drug abortion

Conducting an abortion without surgery is called the medical interruption of gestation, a pharmacist, non-operation abortion. Such a procedure causes artificial miscarriage. It differs significantly from the surgical option, because special pills are applied to its implementation. The process does not require the use of anesthesia and the invasion of the uterine cavity, which prevents a number of unwanted complications. Medical abortion is considered one of the safest ways to interrupt pregnancy.

Indications

As a rule, a drug abortion interruption is appointed in such cases:

1. A woman independently refuses to maintain a mother-in-law pregnancy (gestation).
2. A condition that can threaten the patient's health and even life.
3. The location of the fetal egg in the uterine cavity, the exclusion of the ectopic gestation.
4. The procedure may occur with the improper development of the fetus, the risk of the appearance of genetic pathologies.
5. A woman suffers from overweight, misa, erosion, endometriosis, has the pathology of the development of the uterus.
6. Pregnancy term is more than 22 weeks. During this period, a pharmacological interrupt is considered one of the safest methods of artificial abortion.

Advantages and disadvantages

The non-operative way of interrupting gestation in a woman with a tablet has a number of positive qualities. Unlike operational intervention, the drug termination of gestation has the following advantages:

• minimal soreness of the procedure (aborted tablets without anesthesia);
• abortion proceeds naturally like menstruation;
• after the tablet abortion, the risk of complications is reduced;
• in contrast to other interrupt methods, the chance of contact with infections, which are transmitted through blood (for example, hepatitis, HIV);
• if a drug abortion is used, then in contrast to a surgical or vacuum abortion, a negative effect on the reproduction function is excluded (that is, the patient does not threaten infertility).

With all the pluses of abortion, which is carried out by means of tablets, the procedure has several drawbacks:

• in rare cases, not all the fruit egg comes from the uterus, some part of it can remain (the residue is removed by the operational way);
• tablets from pregnancy in early time sometimes cause uterine bleeding, periodically need to use blood transfusion, scraping;
• in some patients, allergies are allergic to certain tablets for the non-operational breakdown of pregnancy;
• since drugs for interrupting gestation belong to hormonal medicines, their impact on the patient's body is difficult to predict;
• sometimes pains, discomfort in the abdomen, intestinal disorder, nausea, temperature rise, general malaise, severe weakness are fixed;
• another minus is a high cost of drug interruption of pregnancy compared to a surgical abortion, but the price is justified by the result.

Contraindications

There are a number of prohibitions for the medical method of interrupting gestation. Absolute contraindications:

• infectious diseases of chronic form at the time of exacerbation;
• ectopic pregnancy;
• it is prohibited to interrupt the pregnancy in the presence of gynecological acute diseases;
• allergic reaction to the composition of medicines for non-operation abortion;
• the formation of a malignant oncological tumor;
• unconfirmed gestration (without a gynecologist and ultrasound examination);
• blood disease in the patient;
• severe somatic pathology of chronic type (renal, liver failure);
• bronchial asthma.

Relative contraindications of drugless non-operation abortion:

• arterial hypertension;
• uterine mioma, endometriosis;
• lactation period (you need to stop breastfeeding just before the drug);
• scars on the uterus (cesarean section);
• smoking in patients over 35 years old;
• the occurrence of pregnancy in the process of receiving hormonal means for the prevention or use of intrauterine methods of contraception.

Timing

A pharmacet is usually appointed with a latency of menstruation from a woman not more than six weeks (or 42 days from the first day of last periods). This procedure is performed using special preparations in the form of tablets. The scheme of using medicines is as efficient as possible with a period of gestation in six weeks. It is quite realistic to interrupt pregnancy in the early periods of tablets, but in the late stages of the tooling, the positive performance of the tablets is reduced to a minimum.

Tablets for abortion

The following tablets are considered popular medication for non-operational interruption of pregnancy:

1. The main preparation for the pharmacological abortion is a mifepristone. This name is international, the drug belongs to the AntiproTagenne Group. The drug of the mifepristone block the activity of the hormone of progesterone, which is needed to preserve gestation. Tablets are manufactured by a large number of pharmaceutical enterprises, therefore there are many of its derivatives (they are described below).
2. Pencrofton - tablets, which are considered an excellent substitute for a classic surgical abortion. The drug brings the embryo from the uterus due to the opening of the neck. Pharmacological interruption of pregnancy by this drug is carried out until the term of 7 weeks. Pencrofton tablets practically do not cause side effects, in some cases weakness and nausea is observed.
3. To carry out a drug abortion, Mizoprostol tablets still use. They provoke the pushing of the fetal egg using the uterine muscles stimulation. This drug is often appointed by young patients who have not yet been giving birth. The effectiveness of pregnancy interrupting Tablets Mizoprostol is 70-85%.
4. Pharmacological abortion by the drug Mifegin is carried out in many countries of the world. Tablets have a blocking effect on uterine receptors, which causes the rejection of the fetus. The uterus softens, its musculature is reduced, and the neck opens, pushing the fruit egg. Means for medication interruption of gestation Mifegin is as efficiently as possible up to 6 weeks. After taking tablets, side effects may occur (probability 5-10%).
5. The analogue of the mifepristone - mytholian is an anti-betegenic steroid drug. It blocks the synthesis of the main hormone of pregnancy - progesterone, increases the contracting functions of myometrium. Tablets are used to interrupt pregnancy at the first time (up to 42 days amenorrhea). Sometimes the effect of the tablets is accompanied by side effects: pain at the bottom of the abdomen, headache, weakness, nausea.
6. Another drug for artificial abortion is Mifeprex. Apply tablets for a period of up to 42 days. The main advantages of the drug are considered very good tolerability and a high level of efficiency. In some patients, bloody discharges can go for 2-3 days after receiving tablets.

Preparation

Before the procedure is carried out, the patient needs to be prepared. The doctor pre-talking with it, reports in advance about contraindications to the procedure, talks about the probability of complications after it, on the essence of the non-operation technique. Then a woman is sent to such surveys:

• general blood test, urine;
• full inspection at the gynecologist;
• Uzi small pelvis organs;
• smears to identify vaginal infections;
• delivery of blood per group, Rh, factor, hepatitis, syphilis, HIV.

How is a drug interruption

Before the pharmacological abortion is forbidden to eat smoked, fatty, salty food, and after the procedure it is impossible to take a bathroom, to visit the pool. It is also not recommended to eat 3 hours before interrupting pregnancy. Disposal abortion is carried out outpatient. Stages of holding:

1. The patient is re-examined. The doctor then gives the woman three tablets of the selected drug (with a content of myfepristone). After that, the patient is under the supervision of specialists for 2-4 hours. Some pregnant women, the yield of the Fetal Egg occurs during the stay in the hospital, if this did not happen, then the patient is sent home.
2. At home, it takes tablets - prostaglandins for 36-48 hours to secure a positive result. The interruption must come no more than for three days. The patient then comes to the doctor again and the control ultrasonic study passes.
3. The patient is spent repeated ultrasound after a couple of weeks. If it is found that in the uterus there are residues of a fetal egg or unwanted pregnancy continues to develop, then a surgical abortion (scraping of the uterine cavity) is appointed.

What happens after medical interruption of pregnancy

If the woman everything went without complications, then after passing the last ultrasound and consultation, they are prescribed contraceptives. They allow you to avoid the onset of pregnancy, and also contributes to the active restoration of the hormonal background. If the interruption of gestation with pills has passed without consequences, after six months you can conceive a child. If the situation arose, because of which the uterus cavity had to scrape, the doctor discharges anti-inflammatory drugs and physiotherapy. After successful treatment, a woman will usually re-pregnant.

Determining performance

The last visit of the patient to the doctor is carried out 2 weeks after receiving medicines. The state of the uterus is estimated at the ultrasound, because the effectiveness of the event can be revealed exclusively to such a method. The study helps to find out how effectively an abortion has passed, there is no residue of the fetal egg in the uterine cavity, as it looks like. The effectiveness of the procedure will be maximum if all the instructions of the gynecologist are clearly performed.

Rehabilitation

Two or three weeks after a pharmacological abortion, a woman should relate to his well-being very carefully. If the body temperature increases, there are abundant discharge with blood and severe pain at the bottom of the abdomen, then you need to urgently visit the doctor. When rehabilitation proceeds without the consequences described above, it is worth avoiding supercooling, colds, stressful situations, to a minimum limit physical activity. You can't take a bath, do script, swim in the pool, river, sea. Exclude sexual proximity until the next menstruation.

Life circumstances often evolve not as we want, and dictate our own conditions. Sometimes pregnancy is undesirable or contraindicated for health. In such a situation, one way out of the situation is an abortion.

In the early period of pregnancy, doctors often use a drug abortion, which is considered the safest to the health of a woman. In the article we will talk about how this truthful information is and what consequences can have the use of tablets for interrupting pregnancy.

And now we will focus on this.

Preparations used for abortion in early time

The first drugs for drug abortion were invented in France at the beginning of the last century, today the country remains one of the main leaders in the production of drug interrupting. Medical abortion is always carried out under the careful observation of the attending physician, the independent use of drugs can be dangerous to the health of a woman and lead to infertility. Please note that the drug abortion is allowed to do in the earliest periods - up to 41 days from the beginning of the last menstruation. After that, other methods of pregnancy interrupt are applied.

The main advantages of drug abortion are considered:

• Minimum risk of infertility. Preparations, in contrast to the scraping, do not injure the mucous membrane of the uterus, so the risk of infertility is significantly reduced.
• Lack of complications. Surgical methods of pregnancy interrupt are often fraught with the development of inflammatory processes, cervies of the uterus, and with medication abortion, the probability of the development of complications is minimal.
• Outpatient mode. With a medication method, the hospitalization of the patient to the hospital is not required. The reception of hormonal drugs leads to the fact that the embryo dies, the uterus is reduced and the fruit is displayed out. The body after such a procedure is restored quickly, the next day the woman can return to the usual way of life.

Medicines that are used for drug interrupting pregnancy are not received in the free sale, you can only buy them for the appointment of a doctor. The drugs are based on anti-subsogenes, they are also called antiprogestins - this is a group of biologically active substances that suppress the effect of natural gestagenis at the receptor level. We are necessary for and to ensure its livelihoods, suppressing it with special pills, a woman stimulates the rejection and death of the embryo.

The most popular antiprogestin is currently considered to be a mefin or a mifprovon, which is used in the dosage of 600 mg. Modified (3 tablets), the drug is operating for three days. 36-48 hours after taking antiprogestions, prostaglandins are prescribed, for example, in a dosage of 400 mg. (2 tablets). During drug intake, the woman should be under the supervision of a doctor.

The list of drugs for medication abortion looks like this:

• Mifepristone
• Mifeprex
• Mytholian
• Pencrofton
• Mifhegin
• Mizoprostol.

The active ingredient in all tablets is a mifepristone, they differ in each other by the manufacturer, and according to quality and efficiency.

Spontaneous miscarriage occurs within a week after taking tablets. The completeness of the miscarriage is controlled by an ultrasound. The cost of abortion drugs depends on the manufacturer, for example, the Russian drug Mifepristone is cheaper than French Mifgyna or Chinese MiFepRistone 72. On average, the price of these drugs ranges from 1,000 to 5,000 rubles. Each woman, deciding to the drug abortion, should understand that the unauthorized use of drugs can cause serious side effects, so self-medication in this case is inefficient.

Conducting scheme

Medical interruption of pregnancy is not such a simple process as many may seem. In fact, it is carried out in several stages and requires careful preparation.

1. Survey. First of all, the doctor must conduct a survey, including a gynecological examination and an ultrasound, to establish an exact period of pregnancy. Before carrying out the procedure, the doctor must make sure that the woman has no contraindications to the use of tablets. The patient is introduced with the principle of the work of medication and the technique of an abortion, it should clearly understand the features and side effects of the procedure. After that, a written agreement is signed for manipulation.
2. The main stage. First, the woman under the supervision of the doctor takes the pills causing the embryo rejection and preparing the uterus to his exile. Within a few hours after the procedure, the woman is at day hospital and in the absence of side effects is released home.
3. Completion. After 1.5-2 days, the next drug is taken, which launches the process of expulsion of the fruit egg. Within two hours after taking tablets, a woman is under the supervision of a doctor.

Determining performance

After 36-48 hours after the procedure, the doctor makes the control ultrasound, looks so that there is no stagnation of blood in the uterus. Two weeks, it is necessary to repeat the gynecologist and make an ultrasound again to make sure the success of the procedure and eliminate the incomplete expulsion of the fruit egg from the uterus. In this case, a woman is prescribed a manual scraping.

The possibility of non-efficiency of the procedure

Each country establishes its dates for the allowed drug abortion, while you should understand that the higher the time on which the abortion is made, the higher the likelihood that it will have to re-clean. In the US, medicinal abortion is allowed to do up to 7 weeks, there are no such clear restrictions in Britain, there are different rules, in some cases you can do up to 8 weeks, sometimes up to 9-13 and even up to 24 weeks.

In Russia, it is believed that the drug abortion is optimally done up to 6 weeks, sometimes allowed to 9 weeks, but most doctors do not want to take such responsibility. In their opinion, the late medication abortion may cause serious side effects, such as bleeding or inflammatory process in the uterus caused by the remnants of the placenta. Therefore, in the later dates, additional cleaning is performed necessarily. It turns out that the sooner the woman turns to the gynecologist, the higher the effectiveness of the drug abortion, and the more period, the lower the efficiency of the procedure and the probability of complications.

With the first abortion, the risk of incomplete interruption of pregnancy is higher. You can see it on the test ultrasound. With an increase in the period of pregnancy, the possibility of preservation of pregnancy increases, it can be traced on a control examination after 1.5 - 2 weeks after an abortion. In general, studies show that the partial removal of the fetal egg occurs in 3% -5% of cases, and pregnancy pregnancy is not more than 1% of cases from the total number of drug abortions.

Contraindications and side effects

As with any medical manipulation, complications may occur during drug abortion. They are rare enough, but every woman should know consequences of the procedure:

• Continuation of pregnancy. In 1% -2% of cases, pregnancy interruption may not occur.
• Strong.
• Abundant uterine bleeding. It may develop because of the incomplete removal of the fetal egg.
• Increase body temperature, chills, weakness.
• Nausea,. In such cases, the doctor may decide on reuse drug.
• The aggravation of chronic diseases of the urogenital system.
• Hormonal disbalance.
• Inflammation of the uterus and appendages. Sometimes arises due to the spread of infection from the urinary tract. At the same time, the temperature rises, the stomach hurts, allocations appear.
• Problems with uterus restoration, for example, a hematometer (blood in the uterus) or sub-monitor in the uterus (slowing down the recovery of the body). There are problems with a cycle, abdominal pain.
• Long bleedingwhich can last up to 2 weeks, is associated with a violation of the hormonal background. Approximately 3% -5% of women after tableted abortion there is a cycle disruption, with a conventional abortion the percentage increases to 12% -15%. The cause of such a phenomenon is the neuroendocrine disorders due to the impairment of the endometrium ability to recover. In giving birth women, the cycle is restored for 4 months, at the annoying - six months.

There are certain contraindications for conducting a drug abortion, so a pre-woman should be examined by a gynecologist. Doctors celebrate situations when a woman independently takes pills, after which there are complications, life threatening. For example, it passes, as well as normal, but in this case, the drug abortion is contraindicated. Receiving tablets are fraught with a rupture of the fallopian tube and a fatal outcome or, at best, infertility. Below we highlight the main contraindications To the drug abortion you need to know:

• or suspicion of it.
• Renal and adrenal failure.
• Diseases associated with blood clotting disorders.
• Inflammatory processes of the urogenital system.
• Myoma uterus.
• Durable corticosteroids.

Failure to complicit contraindications often leads to unpredictable consequences and can end with fatal outcome, so before the start of the procedure, passes a complete examination from a qualified gynecologist and read the information about the drug abortion.

Negative consequences

At such an early term, the decision to interrupt pregnancy, a woman accepts independently. As experience shows, most often the bases for abortion serve:

Before making the decision, think about the consequences and about the life of the future baby. Pregnancy launches in the body of a woman certain mechanisms and completely changes the hormonal background. Artificial interruption of pregnancy does not pass unnoticed, for the body this is a serious stress, so the backrest of all processes can slow down or pass with complications that will have to be treated.

Most women after an abortion gets a cycle, monthly go is irregular and painful. This is usually the first Bulletin of what more serious problems begin. Another common complication is uterine bleeding. If you do not stop it on time, then this can lead to a fatal outcome. Often, women fail in work, the load on the adrenal glands is enhanced, and this disrupts the metabolism. Development decreases, the amount of male hormone increases, which stimulates the development of infertility and affects the appearance of a woman.

The breast almost immediately reacts to the occurrence of pregnancy, so after an abortion it suffers first - the appearance of tumors and neoplasms is possible. Basic women after abortion are doubly risky in infertility. Studies have shown that three out of ten women who have made an abortion will subsequently cannot have children.

Medical consequences of the procedure may be irreversible, so later, when the desire to have children appears, not everyone will get pregnant - there is always a risk of developing secondary infertility. Any medical intervention, even at first glance, innocuous, may have side effects, up to death. Therefore, do not joke with your health - it is preferable to carry out the competent prevention of unwanted pregnancy so that then it should not be solved by the question of cardinal methods.

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