Medical abortion (up to 22 weeks) – made with the help of drugs ( mifepristone, pencrofton ), which provoke a miscarriage.
- Up to 9 weeks (63 days of delayed menstruation) it is possible to conduct a medical interruption on an outpatient basis;
- From 9 weeks – only in the hospital.
At the request of a woman, an abortion is performed only up to 12 weeks.
In the later period from 12 to 22 weeks, abortion is carried out strictly in the presence of medical or social indications.
Medical abortion is performed on an outpatient basis, with a gestation period of up to 9 weeks and provided that the pregnancy is uneventful.
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).
The procedure is performed using a drug called mifepristone ( mifegin ), which reduces the effect of progesterone, which is the main hormone of pregnancy, and is used in conjunction with prostaglandins – these are drugs that can enhance the contraction of the uterus and help reject the fertilized egg.
- Large uterus fibroids (many nodes or a node more than 4 cm and deforms the uterus, there may be a risk of bleeding);
- Allergic reaction to drugs included in the scheme of abortion;
- Suspected ectopic pregnancy;
- Anemia, in which the hemoglobin level is less than 100 g / l;
- Hormone-dependent tumors;
- Hepatic, renal, adrenal insufficiency and some severe extragenital diseases (hereditary porphyria, severe asthma, glaucoma);
- Smoking over the age of 35 years + long-term use of COC and pregnancy arising on the background of COC (the risk of thrombosis increases, drug interruption can be applied only after further investigation of the coagulating properties of blood).
If a pregnancy occurs on the background of an intrauterine device, you should first remove the IUD, and then it is also possible to use a drug-induced abortion.
When using a drug regimen, you cannot breastfeed, so this method of abortion will not work for a nursing mother.
An alternative to medical abortion is vacuum aspiration.
The medical abortion procedure includes four visits to the gynecologist.
Abortion itself takes place in two stages: the first dose of the drug and in a day or two – the second dose. Bleeding occurs in the second stage and begins within 3-4 hours after taking the pill.
Two weeks later, a follow-up gynecologist’s appointment is required.
Visits to the gynecologist:
- 1 visit: consultation and referral for analysis;
- 2 visit: taking the drug;
- 3 visit, after 1-2 days: re-taking the drug;
- 4 visit, not earlier than in 14 days: control
Standard tests before abortion
- general blood and urine analysis
- blood group and rhesus
- smears on the degree of purity and oncocytology ,
- screening for HIV infection
- hepatitis B and C and syphilis.
The first reception of the gynecologist
At the first visit to the gynecologist about the unwanted pregnancy, the woman receives advice on the available methods of interruption, receives referrals for examination and psychological counseling.
Prior to the procedure, an ultrasound examination is required, which serves as the basis for the appointment of an abortion and the method of excluding ectopic pregnancy.
If an ectopic pregnancy is suspected, the patient is prescribed a blood test for hCG twice with an interval of several days (the growth of the pregnancy hormone over several days varies during the normal course of pregnancy and during ectopic or frozen pregnancy).
If the examination revealed an inflammatory type of smear or bacterial vaginosis , then medical abortion is performed in the usual way with the simultaneous use of antibacterial drugs as prescribed by a doctor.
Abortion requires the appointment of antibacterial drugs:
- In patients without risk factors for accession of the infection, examined for the presence of chlamydia: for the prevention of inflammatory complications once a day of the procedure.
- In patients with an identified chlamydial or other infection, as well as in the presence of risk factors for the addition of inflammatory complications (with saccharinosis previously in a smear): a course for 7-10 days.
At the second visit to the gynecologist, the patient comes with the decision made to conduct an abortion and signs an informed consent to the medical interruption.
The patient is given a dose of drugs: first, use the drug mifepristone , which has anti – progesterone action. Progesterone is a pregnancy hormone, and when it is blocked by the drug, there is a signal for interruption and preparation of the cervix for a miscarriage.
On the background of the use of 1 tablet for 1 day, there are no significant changes in the woman’s well-being. There may be a weak pulling pain in the lower abdomen, scanty hemorrhage, sometimes nausea.
Important! In the case of the Rh-negative mother and the Rh-positive partner, it is also recommended to inject a dose of anti-Rh immunoglobulin to prevent Rh incompatibility with the child during the next desired pregnancy.
Third visit to the gynecologist
At the third reception at the gynecologist in 24-48 hours, the patient is allowed to take the second part of the tablets, which directly cause uterine contractions and miscarriage through the prepared opened cervix. At different times, the dosages of the drugs and the method of administration vary (tablets can be prescribed to drink inside, put under the tongue, enter vaginally).
In 95% of patients, bleeding begins within three to four hours after taking the drugs.
Almost always women have symptoms, which the doctor warns in advance:
- Cramping pain in the lower abdomen, which each woman suffers differently, depending on the pain threshold. For the purpose of pain relief, the patient can take a pill of no-shpa, baralgin or ibuprofen. A few hours from the start of labor there will be a miscarriage.
- Copious bloody discharge during miscarriage (larger and stronger than normal menstruation). True bleeding occurs rarely, in 0.2-1% of cases. A woman should be alerted to such a volume of blood loss, in which two hygienic pads of maximum size are soaked through with blood for an hour, and this is repeated during the second hour. In this case, the patient must call an ambulance, which will take her to the gynecological hospital. In the hospital with the development of bleeding is carried out vacuum aspiration of the uterus.
- Increasing the temperature to 38.5 (occurs frequently, is a common adverse reaction to an interruption pill). Contact the hospital should, if the temperature rises more than 4 hours, with chills.
- Diarrhea (observed in more than half of cases, is also a side effect of drugs).
Usually, bleeding stops completely after 7-9 days. The longer the gestation period, the more profuse the bleeding. In some cases, until the next menstruation brown spotting is preserved, which can be considered the norm.
4 reception at the gynecologist – control. The patient is examined on the gynecological chair, the control ultrasound examination of the pelvic organs is evaluated. Ultrasound is recommended to perform 2 weeks after miscarriage. By this time, the cavity and the size of the uterus are reduced. Within 2 weeks after the abortion, the patient can take herbal preparations to reduce the uterus: uterine collection, infusion of water pepper.
After a medical termination of pregnancy, the patient is forbidden sex for 3 weeks. The prohibition of sexuality is associated with an increased risk of attaching an infection due to the increased vulnerability of the inner surface of the uterus.
In case of desire to be protected further with the help of oral contraceptives, a woman should take 1 tablet out of the package in the first day after the miscarriage.
Menstruation usually starts 3-4 weeks after the procedure and is no different from normal. Slightly more abundant or more meager discharge, as well as not intense pulling pain in the first menstrual period after medical abortion are allowed. Usually such violations occur after a procedure carried out for periods longer than 6 weeks.
If the patient has decided to take oral contraceptives, then the cycle will be set in accordance with the scheme of their admission.
Optimal planning of a new pregnancy is recommended 6 months after the abortion. However, the body of each woman is individual, so it is strongly recommended to discuss this issue with the gynecologist.
- 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.
With the ineffectiveness of medical abortion and the progression of pregnancy, the patient is asked to terminate the pregnancy by vacuum aspiration .
There have been no large studies on the teratogenic effects of drugs for medical abortion on the fetus, but 14 cases of the development of fetal malformations after the application of this scheme are known. If the patient suddenly changes her mind and decides to carry on a progressive pregnancy, she should be warned about these known cases.
- high efficiency of the method (95-98%);
- allows you to exclude surgery, injury to the uterine lining and vascular damage myometrium;
- with medical interruption, a careful non-traumatic cervical dilatation occurs;
- medical abortion makes it possible to refuse general anesthesia;
- medical interruption is not a surgical procedure, therefore the risk of ascending infectious complications is very low (less than 1%);
- the risk of late consequences for the reproductive health of the patient is reduced, which is especially important for first-pregnant women;
- psychologically, it is easier to transfer a drug interruption to a woman than a surgical operation under anesthesia.