Types of abortion

What week is it possible to have an abortion

Ways of abortion

Contraindications for abortion

Analyzes and algorithm of examination of a woman before an abortion

Complications of abortion

What week is it possible to have an abortion

In the early stages

Domestic legislation allows you to make a decision on the artificial termination of pregnancy up to 12 weeks (abortion in the early period) to any pregnant woman. An early abortion can also be prescribed by a doctor due to some circumstances that prevent the normal course of pregnancy.

In the early stages of up to 12 weeks, the following methods of abortion are allowed: 

  • Drug method – taking pills that cause miscarriage (is the safest method) 
  • Vacuum aspiration of the uterus (vacuum abortion) – sucking the ovum from the uterus using a vacuum apparatus; 
  • The method of surgical curettage (curettage) of the uterus (the method is allowed, but is not currently recommended for widespread use).

Do not forget that any artificial abortion entails complications that can occur immediately after the manipulation, and can be delayed for up to several years. 

On late terms

When the gestation period is from 12 to 22 weeks, abortion can be performed only in the hospital and only because of medical or social indications that have appeared. This is explained by the fact that at such late stages of pregnancy her interruption can have a very negative effect on the health of the woman.

Medical indications for late pregnancy (from 12 to 22 weeks) can occur on the mother’s side and on the side of the fetus:

  • On the mother’s side, these can be diseases in which further pregnancy will threaten the life of a woman. For example, a case of cancer that requires urgent treatment of a woman with chemotherapy drugs that are not permissible during pregnancy.
  • fetal pathologies identified during pregnancy (genetic abnormalities, malformations incompatible with life, missed abortion).

The decision on the need for termination of pregnancy in a long term is taken by the medical commission (as part of the commission, the attending physician is an obstetrician-gynecologist, the chief doctor or his deputy, a consultant — for example, a genetic doctor with a chromosomal fetus or cardiologist who has a heart disease in a woman).

The decision to conduct a late abortion on social indicators from 12 to 22 weeks is made only when the pregnancy arose as a result of the rape of a woman. The fact of rape must be documented (the patient’s treatment for medical assistance and to the police after the incident was recorded).

Termination of pregnancy in the later period occurs by the drug method (the dose and method of administration of drugs differ from the drug interruption in the early stages).

After 12 weeks, the dilation of the cervix and the scraping with sharp surgical instruments are not carried out due to the large size of the fetus and the pregnant uterus. The walls of the uterus become soft and stretched, they are easy to perforate (accidentally poke) tools for expanding the cervix and the evacuation of the ovum. In this case, the risk of surgery is too high for a pregnant woman.

Scraping of the uterus in a large period is possible only after a miscarriage with a reduced uterus (this sometimes has to be done in the case of residues of the ovum in the uterus and signs of bleeding).

Ways of abortion

Medical abortion

Medical abortion is performed using a drug called mifepristone ( mifegin ), which reduces the effect of progesterone, which is the main hormone of pregnancy, and is used in conjunction with prostaglandins – these are drugs that can enhance the contraction of the uterus and help reject the fertilized egg. 

Medical abortion is performed on an outpatient basis with a gestation period of up to 8 weeks inclusive (63 days of delayed menstruation) and provided that the pregnancy proceeds without complications.

In pregnancy between 9 and 12 weeks or more, medical termination of pregnancy is carried out only in the hospital. For drugs in this period, efficiency is somewhat reduced (the shorter the period, the more effective the drugs).

With the ineffectiveness of medical abortion and the progression of pregnancy, the patient is asked to terminate the pregnancy by vacuum aspiration.

Vacuum abortion

To terminate a pregnancy, the vacuum aspiration method is used, that is, a vacuum apparatus is used, with the help of which the fertilized egg is destroyed and sucked out of the uterus. Abortion by the vacuum aspiration method is more gentle in comparison with curettage (curettage), since it does not involve the use of an acute obstetric curette and does not injure the uterine wall.

  • Vacuum abortion is called a mini-abortion if it is carried out with a gestation period of not more than 5 weeks. At this gestational age, it is not necessary to dilate the cervix with special metal dilators, because the tool for sucking a small gestational sac has a narrow diameter. 
  • Vacuum abortion with a period of 6 to 12 weeks is carried out with the expansion of the cervical canal of the uterus. Here, the size of the ovum requires the use of a nozzle for a vacuum suction of a larger diameter.

Scraping or curettage of the uterus (surgical abortion)

Scraping is carried out with a gestation period of 6 to 12 weeks and is performed only in a hospital setting. Before curettage, the cervix also requires mechanical expansion, then the fetal egg is destroyed and scraped out of the uterus with a sharp surgical instrument – an obstetric curette.

Currently, abortion by the method of curettage using a curette is allowed, but is considered gradually obsolete technology. Not recommended for widespread use.

The abortion curettage method is allowed in rare cases:

  • when it is not possible to apply more benign methods (vacuum aspiration of the ovum and medical abortion);
  • curettage is carried out in the case of residual ovum after a previous abortion, in order to completely empty the uterus;
  • curette curettage is necessary in case of tight attachment of the tissues of the ovum and bleeding. This often happens after a spontaneous abortion in a late period (from 12 to 22 weeks), after abortion in a late period. In these situations, tightly adhered tissues cannot be completely removed by vacuum suction. We have to resort to the use of curettes.

Contraindications for abortion

The main reasons that prevent the conduct of vacuum abortion and curettage:

  • inflammatory diseases of the genital organs;
  • the presence of foci of purulent infection, regardless of their location in the woman’s body;
  • acute infectious diseases.
  • six months after the previous pregnancy was interrupted.

Analyzes and algorithm of examination of a woman before an abortion

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  1. In case of delayed menstruation and suspicion of pregnancy, it is reasonable to start with a test for the presence in the woman’s body of human chorionic gonadotropic hormone ( hCG ). At home, women use for this purpose the usual pregnancy test “two strips”, and when preparing for an abortion in the laboratory, a blood sample for hCG is examined. The patient turns to a gynecologist, the duration of pregnancy is specified.
  2. Then, an ultrasound (US) is performed, which is used to determine the presence of a fertilized egg in the uterus. Confirmation of uterine pregnancy on ultrasound is a prerequisite before abortion (ectopic pregnancy is excluded).
  3. At the reception at the gynecologist, the uterus is examined and the discharge from the genital tract is evaluated. A smear is taken for vaginal purity and oncocytology . In the presence of inflammation in a smear or inflammatory secretions when viewed on a gynecological chair, sanation of the genital tract is prescribed. It is impossible to perform an abortion in the presence of an infection – with the tools for abortion and cervical dilatation, microorganisms from the vagina will spread higher into the uterus and fallopian tubes.  
  4. A general clinical examination is also appointed: complete blood and urine analysis , determination of blood group and Rh factor, blood test for syphilis, HIV infection, hepatitis B and C.   
  5. The result of the ECG and the examination of the therapist are needed before the use of intravenous anesthesia (usually abortion with a period of more than 5 weeks requires full pain relief).
  6. In the presence of concomitant diseases in women, the scope of the survey can be expanded. For example, in case of blood diseases, severe anemia, bleeding, surgical procedures have previously been prescribed additional studies of the blood coagulation system . 
  7. At the first treatment of a patient with an unwanted pregnancy, the gynecologist should refer her for a consultation with a psychologist if there is such a specialist in the place of residence of the pregnant woman. In large cities, special medical and social offices are created in women’s clinics to support pregnant women who find themselves in difficult situations.

Complications of abortion

Complications of Medical Abortion

  • uterine bleeding, requiring instrumental emptying of the uterus in the hospital ( vacuum – aspiration of the uterus) and the use of uterus-reducing means;
  • incomplete abortion (remnants of the ovum are also removed using vacuum aspiration of the uterus in the hospital);
  • infectious complications (the risk of their development is less than 1% of cases);
  • the progression of pregnancy in a situation where there was no rejection of the ovum.

Complications of the vacuum and surgical methods

Complications can be divided into:

Early, occur directly during the procedure or on the first day after the interruption – 

  • bleeding;
  • cervical injury;
  • allergic reactions to narcosis drugs.

Late, observed in the period from a week to several months:

  • a hematometer (accumulation of blood due to the fact that the cervical canal was closed too early);
  • incomplete abortion;
  • depression;
  • inflammatory processes ( endometritis, adnexitis ) 

The long-term effects of abortion can be observed years after the procedure:

  • hormonal disorders – one of the causes of infertility;
  • adhesions, obstruction of the fallopian tubes;
  • Difficulties in carrying a pregnancy.

It is necessary to clearly realize that as though a vacuum abortion was not low-impact, it is still an intervention in the female body and cannot be considered absolutely safe. Surgical abortion (curettage) is an aggressive method of abortion, and the risk of developing complications for the reproductive health of women is clearly increasing.

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