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Abortion – abortion for up to 22 weeks followed by destruction of a germ or death of a fruit incapable of independent existence. Distinguish misbirths and artificial interruptions which share on early, for up to 12 weeks, and late, more than 12 weeks. In the world 40-60 million abortions a year are made, and very many such interventions can illegally be carried out in conditions not to the corresponding favorable medical indicators. Such actions often lead to complications, in certain cases with loss of working capacity or lethal effects.
Early abortions — artificial abortion on early terms is carried out according to the decision of the woman. Often abortion is method of planning of a family, instead of safer methods using contraceptives. Anyway the woman has to understand that safe abortions do not happen. The doctor convincing the patient is that early abortions are safe in comparison with late interruptions, it is impossible to call competent, each professional doctor knows that it not so.
Pregnancy even on small terms causes changes in the woman's organism. There is a reorganization of many systems, the first changes happen in nervous and endocrine systems. From the moment of fertilization the organism begins to produce more hormones, emitting such substances as estrogen, progesterona, prostaglandins which cause changes in ovaries, a uterus, mammary glands. Abortion provokes sharp hormonal failure in an organism owing to which all suffer hormonal dependent bodies. Normal work of closed glands, ovaries, adrenal glands and a thyroid gland is broken. Therefore disturbances of vegetative dysfunction, nervous breakdowns, depressions, nervoza and other deviations become the first frustration after abortion.
Before carrying out procedure of abortion it is necessary to pass some laboratory researches. And only after that the woman is allowed to abortion. It is important to make it as each method has the contraindications, non-compliance whom can lead to complications after abortion. The general blood test, a smear, the analysis on HGCh, on syphilis – RW, a viral hepatitis In is surely carried out and With, HIV, becomes a koagulogramma of blood. On later terms the list can be supplemented at the discretion of the doctor, additional analyses are done also in a case by pathologists.
Quite widespread method of abortion from 2 to 8 weeks. In fact, such method is medicamentous provocation of an organism on a misbirth or an abortion. Today it becomes the best alternative of operational interruption. Use of this method till 4 weeks as fetal egg still poorly attached to a uterus and efficiency of a method is higher is recommended. Besides the hormonal reorganization of an organism which still is poorly expressed that gives the chance to avoid many effects of abortion.
In fact medicamentous abortion consists in reception of steroid drug of Mifepristone. This means provokes death of a fruit and blocking of effect of progesterone. Drug is accepted strictly under supervision of the doctor and his control in the next two hours. The dose of mifepristone makes 600 ml. That it is enough for death of a germ, increase in sensitivity of a myometrium to oxytocin causing reductions of a uterus. 36-48 hours later after reception of the first drug the patient has to accept analog of prostaglandins, it can be oral 400 mkg of Mizoprostol or 1 mg of a giperprost vaginalno. These means provoke an expulsion of the fetus from a cavity of the uterus.
Before reception of mifepristone it is necessary to pass without fail ultrasonic research for confirmation of normal pregnancy and its terms. Examination is conducted because of contraindications to drug. Reception of mifepristone is contraindicated at term more than 49 days from the first day of the last periods – amenorrheas. Drug at an extrauterine pregnancy, chronic diseases of adrenal glands, a severe form of bronchial asthma, problems with coagulability of blood is contraindicated. Do not accept it also and at infectious and inflammatory processes of a reproductive system as it promotes distribution of an infection. Refer the expressed exhaustion, a renal and liver failure and allergies to drug components to the general contraindications.
Ultrasonic research repeats after abortion and in 8-14 days in order that it will be convinced of a full expulsion of the fetus. In case of incomplete abortion vacuum aspiration or tool abortion is carried out. But there is not a lot of such cases as only 2% of women are unreceptive to drug.
Complications after abortion by means of mifepristone can be different character. In 5% of cases of complications there is plentiful bleeding which proceeds more than the put term. In 10-45% very frequent reductions of a uterus are observed. In rare instances the women who transferred earlier Cesarean section can have a hysterorrhesis.
Side effects of mifepristone from a digestive tract are shown by moderate or slight pains in a stomach, nausea and vomiting. There is an increase of arterial pressure, emergence of allergic rashes, small tortoiseshells, an erythema and an epidermichesky necrosis less often. Vegetative frustration, heat, a fever, dizziness, or a hyperemia can sometimes be shown.
Vacuum aspiration or mini-abortion
The method is widely applied at abortion from 3 to 6 weeks. Its popularity is caused by use an outage of technology, asepsises, in usual out-patient conditions. Anesthesia is applied to not giving birth patients, and consists in a local anesthesia, some cases the full anesthesia lasting several minutes becomes. The period of return to normal life activity of the patient 1 hour that is connected with painlessness of procedure and absence of an operational injury.
Mini-abortion is often carried out without expansion of a neck of uterus at the giving birth patients and with insignificant expansion at not giving birth. In the second case metal dilators which open a neck of uterus only so are used, it is how necessary for input of abortal tools. It gives the chance to avoid traumatizing a neck. For definition of need for dilators use a probe if its introduction is complicated use anesthetics and dilators. Then the aspiration catheter attached to the syringe or an electroaspirator is entered into a cavity of the uterus. After that the catheter makes disturbance of integrity of fetal egg and its aspiration.
After procedure it is reasonable to conduct ultrasonic research in 7-10 days as there are cases of incomplete abortion, and the oosperm remains in a cavity of the uterus. Tool abortion is in that case applied.
The principle of vacuum aspiration consists in a suction by means of the abortal tool of an ovum without breaking a mucous membrane of a uterus, it gives the chance to avoid such complications as istmiko-cervical insufficiency and neurodystrophic processes of a mucous membrane of a uterus. But complexity makes diagnosing of exact duration of gestation and an exception of an extrauterine pregnancy. Complications after abortion are limited to pains in the bottom of a stomach which are very similar to menstrual pains, disturbances of a menstrual cycle, inflammatory diseases and hormonal disturbances.
Heavier complications after abortion it is, for example, a pnevmoeboliya, it arises owing to air hit, in circulatory system forming air blood clot which corks a large vessel. Such complication extremely rare as modern vacuum aspirators do not allow a possibility of hit of air in a cavity of the uterus. But at illegal abortion with use of outdated tools this complication often leads to a lethality. One more complication is a perforation of a uterus and wound of adjacent bodies. It can arise at insufficient qualification of the specialist who is carrying out abortion. Perforation of a uterus happens during sounding of her cavity by a metal uterine probe.
Abrasion or tool abortion
In the recent past the most frequent procedure of abortion. Today it will be out less often as it has more serious complications, than other methods of abortion of small term. Abortion is carried out on the term of 6-12 weeks and only in the conditions of a hospital. When carrying out abrasion the neck of uterus is opened by means of metal dilators then the doctor scrapes out fetal egg together with a placenta and a mucous membrane of a uterus. The special tool – the curette therefore often such procedure carries the name a curettage is used to a scraping.
Procedure is carried out under the general anesthesia which is selected depending on specific features of the woman. It can be as an intravenous anesthesia, so epidural anesthesia or an endobronchial anesthesia. In the second case inhalation drug is entered into a trachea by means of a special tube. But any of these types of anesthesia has to be carried out by the anesthesiologist after necessary analyses.
At tool abortion carry out ultrasonic control by the vulval sensor, and after procedure inspection of a cavity of the uterus gistereskopy is performed. But enough often such surveys are at a loss in connection with introduction of an anesthesia and completely it is almost impossible to exclude complication. Therefore treatment after abortion, for prevention of complications, such as bleeding and an infection is appointed.
Bleedings become the most frequent complications after a scraping, a spasm of a neck of uterus because of what in a cavity of the uterus blood clots which provoke inflammatory process are formed. At such complication the repeated scraping and further treatment is required. There is much less often such complication as break of a wall of a uterus at which there is severe bleeding, peritonitis, injuries of abdominal organs. At illegal tool abortion practically all complications are life-threatening women as often there is no opportunity in time to give help or the doctor tries to suppress the fact of illegal abortion.
Unlike early abortions, abortion after 12 weeks of fetation cannot be the decision only of the woman. Such interventions have to have permission from the special commission where the pregnant woman submits the corresponding application. On late terms abortions carry out or on medical indications, or for the social reasons. In the first case abortion is carried out at heavy fetation, its frailty, to a serious illness of the pregnant woman which is not compatible to pregnancy when life of mother is put above life still of the narozhdenny child. Pregnancy owing to rape, the status of the refugee, death or disability 1-2 groups of the husband, lack of housing, a possession of many children or the status of single mother can be the social reasons which allow carry out abortion.
It should be noted that abortion on late terms very often leads to complications. Such procedures have to be carried out in the conditions of a specialized hospital. But, as it is known the choice of a method of abortion often is based not on medical indications, and depending on material resources of the woman. In the world many illegal abortions on late terms are carried out that practically in all countries is considered a crime from outside, both the patient, and the doctor.
On the term of 6-14 weeks procedure of abortion at which two other methods – vacuum aspiration and abrasion are combined is carried out. Abortion happens by the principle of the first technique, but difference is that the thin tube to which the vacuum suction is attached is entered into a cavity of the uterus. With its help the body of a fruit is shattered and removed from a cavity of the uterus then carry out a control scraping for avoiding of complications. At this operation the general anesthesia and intravenous solutions of Oxacillinum is applied. This drug promotes sokratitelny ability of a uterus.
The vacuum curettage on term 13-22 weeks of pregnancy is carried out a little in a different way as the sizes of a fruit do not give the chance to use a vacuum suction. In this case the neck of uterus reveals much more widely, than at abortions on early terms, large parts of a body of a fruit are removed nippers and only after that use a suction which deletes small parts of a body of a fruit, a placenta and a water cover of a fruit. Then carry out a control scraping.
After such abortion refer inflammatory processes of generative organs, infectious diseases, severe uterine bleedings to complications. Often there are injuries of a neck of uterus which lead afterwards to erosion and tumoral diseases. There are strong hormonal disturbances, commissures, failure of a menstrual cycle. All this leads to infertility and not incubation of the subsequent pregnancies. The last complication most often arises at interruption of the first pregnancy.
Gisteromiya — analog of Cesarean section which includes carrying out the general anesthesia, the long postoperative period and all complications connected with operation of Cesarean section. This way is applied seldom or never according to special indications, so as its use is limited to a high rate of mortality and incidence. Gisteromiya is full operation which demands inspection and training of the patient.
From 13 to 22 weeks, and are more often 21-22 weeks, abortion which is called by artificial childbirth is applied. This method is based on stimulation of patrimonial activity at which within 24-36 hours there is an abortion. On medical indications from mother artificial childbirth is appointed in a case of the central nervous system, a renal failure, at a diabetes mellitus and diseases of blood. From the child indications are chromosomal anomalies, fruit malformations, death of a fruit in a womb.
Salt abortion consists in filling of sodium chloride in a bag with amniotic waters. Previously from a bag of waters 200 ml of amniotic liquid instead of which 20% saline solution are entered are pumped out. Under the influence of solution the fruit perishes and in 24-48 hours prostaglandins for calling of labor pains are used. In certain cases prostaglandins and oxytocin enter together with saline solution. What increases efficiency of reductions, but at such method often during interruption viable children are born. For this reason salt abortion is carried out considerably less than tool.
Late medicamentous abortion
Medicamentous abortion on late duration of gestation is considered quite outdated method. It consists in reception by the patient of hormone of prostaglandin which provokes slow disclosure of a neck of uterus and causes pains. Such procedure very painful is also quite long. Therefore today at such abortions use a combination of prostaglandin and mifepristone. But such combination leads to the birth of the living child with heavy pathologies. In this regard such method considerably concedes to salt abortion on the humanity.
If artificial childbirth is contraindicated to the patient, interruption is carried out by other alternative methods. In case of contraindications to all ways the gisteromiya is appointed. Some disturbances of cardiovascular system, the central nervous system, placental presentation, existence of a hem owing to the previous Cesarean section can be such contraindications. Complications arise on smaller term more often, than on 21-22 week of pregnancy, it can be both bleedings, and inflammations of pelvic bodies, and in 2,5% of cases incomplete abortion.
Complications after abortion
The most frequent complication after abortion is bleeding. Such complication develops with insufficient hormonal support of an endometria. In certain cases it can be caused by an injury of a vagina, neck or cavity of the uterus. Sometimes such damages by tools or chemicals cause plentiful bleeding. For example, such complication happens at use of some anestetichesky drugs which influence sokratitelny function of a uterus.
Bleeding can arise in the presence of residual fetal fabric in a cavity of the uterus. There is uterine bleeding less often at disturbance of coagulability of blood which development can be caused by a heavy infection, administration of giperosmolyarny solutions, a scraping on late terms. The cancelled misbirth also causes severe bleeding.
Injuries of a neck and uterus complication which most often happens at illegal abortion or attempt to conduct abortion independently. Damages at abortion, and especially perforation of a wall of a uterus in an abdominal cavity can cause severe bleedings. Damage of large vessels is fraught with a lethal outcome. Vaginal injuries in attempt to independently cause an abortion. Often are complicated by infections as women use national methods of an expulsion of the fetus, enter foreign bodys into a vagina, use the caustic substances.
Vacuum aspiration the safest procedure, but also at this method there can be damages. More often it is ruptures of a neck of uterus from the holder. Perforation happens very seldom and if it happened during sounding, then usually the wound quickly heals without additional treatment. Damage of a wall of a uterus by the curette demands careful supervision within a day and urgent surgical intervention at suspicion on internal bleeding or injury of intestines.
Residual fetal fabrics after abortion can be the cause of bleeding and distribution of an infection as is the fine environment for growth of bacteria. Often fabric remains at incomplete abortion or if the misbirth took place. The first signs of existence in a cavity of the uterus of residual fabric it is pains in a stomach or pelvic pains. Pains in a back, severe bleedings which can lead to shock, an unconscious state, fast pulse perspiration join them. At a palpation the uterus painful, is increased, soft.
After abortion the woman should watch closely the state and in case of symptoms of an infection will see a doctor for the help. Pains in the field of a basin, a stomach and spins, fever, a fever, long bleeding or bloody allocations can be symptoms of infections. The general weakness, drowsiness, muscular pains is observed. At inspection it is possible to find morbidity of a uterus, appendages, fetid vulval allocations. Symptoms of an infection after abortion are shown 2-3 days later, but can develop and much later or right after procedure.
After abortion refer disturbances of reproductive function to late complications. From all cases of late complications of 60-68% occupies secondary infertility and another 20-30% other disturbances of sexual function. After artificial abortion, there are chronic inflammatory processes of bodies of a basin which lead to infertility, the risk of extrauterine pregnancies strongly increases.
Medicamentous abortion can sometimes cause allergic reactions, but they are insignificant in comparison with toxic reactions in attempts to carry out such procedure independently. In the majority a case of independent abortion of the patient get to a hospital with symptoms of toxic poisonings with the herbs provoking an abortion a catharsis or other drugs. Depending on the used drug symptoms of poisoning change.
In attempt to interrupt pregnancy by means of the caustic substances, such as potassium permanganate, there are severe bleedings, ulcers and erosion of a neck of uterus. At poisoning with vegetable drugs can lead to a renal failure, a liver. Toxic doses of quinine make stomach aches sick, vomiting, diarrhea, a ring in ears, dizziness and a vision disorder. Drug strikes the central nervous system, there are opacification of consciousness, fever, the suppressed breath, a coma. The lethal dose makes 8 grams inside. Quite often trying will get rid of pregnancy of the woman accept quinine in doses which considerably exceed critical. Ergot drugs also lead to poisoning, pulse increase, a loss of consciousness and a lethal outcome. These substances really have abortal effect, but to apply them very risky as side effects considerably exceed their efficiency. Not one of these drugs does not provide safe and reliable abortion.
Treatment after abortion
In case of complication after abortion the patient needs the help of the specialist. It is not necessary to rely on the fact that bleeding or pain will pass independently. If there is a suspicion on incomplete abortion, abrasion of a cavity of the uterus, for removal of residual fabric after which drug treatment is appointed is required. In case of a serious condition immediate hospitalization and surgical intervention at suspicion on peritonitis is required. In the presence of an infection appoint an intravenous or intramuscular antibioticotherapia which is continued before improvement of a condition of the patient, lack of temperature within a day then drugs are appointed orally. Use oxytocin drugs for the termination of bleeding, after repeated abrasion or a vacuum curettage, for removal of residual fabric.
In the presence of complications from a nervous system, hormonal failure, appoint the corresponding drugs. Quite often after abortion deterioration in the general state, exhaustion, nervousness is observed, in such cases it is necessary to appoint the vitamin therapy and drugs supporting immune system.
The woman has to realize that abortion is not a contraception method. For the correct planning of a family it is necessary to choose more suitable method what, not to allow undesirable pregnancy. Abortion is intended for those cases when pregnancy can really threaten life of mother or at a fruit irreversible pathologies, incompatible with life. The specialist the gynecologist will always help to pick up optimal variants of contraception, whether it be intrauterine contraceptives (Naval Forces) or a combination oral contraceptives.