Abortion is an artificial termination of pregnancy for up to 22 weeks. Currently, there are several methods that apply depending on the term.
Important! On the initiative of a woman, an abortion is performed only up to 12 weeks. Further – only according to strict indications.
Vacuum abortion – extraction of the ovum by vacuum suction:
- Up to 6 weeks: is performed without cervical dilatation on an outpatient basis ( mini-abortion );
- 6-12 weeks: held in the hospital with cervical dilatation.
Drug – made with the help of drugs (mifepristone, pencrofton) that provoke miscarriage:
- Up to 9 weeks: it is possible to conduct a medical interruption on an outpatient basis;
- 9-12 week: only in the hospital;
- 12-22 week: it is carried out strictly according to indications in the conditions of a hospital.
Scraping (surgical abortion) is an operation during which the doctor scrapes the uterus with a sharp obstetric curette and removes the ovum. Currently recommended extremely rarely due to the high probability of the development of complications:
- 6-12 week: it is carried out only in a hospital under general anesthesia.
- 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).
Any abortion, as a serious medical intervention, inevitably carries with it the risk of complications. Some negative consequences and complications of abortion may be characteristic of a particular method of abortion.
With medical abortion
Medical termination of pregnancy is considered the safest, however, and it carries risks.
- 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 a vacuum and surgical abortion
Occur directly during the procedure and on the first day of the postoperative period.
- Bleeding during the procedure – may occur in case of a violation of the blood coagulation system in the patient, as well as in the absence of a proper contraction of the uterine walls during the procedure. The walls of the uterus that have given birth to or undergone a large number of abortions (inferior muscle tissue) do not contract well. This condition requires the use of large doses of uterine-reducing drugs, in very rare cases when it is impossible to stop the bleeding, the uterus is removed. In case of violations of the blood coagulation system, coagulation factors are compensated by the use of drugs or blood transfusions.
- Perforation of the uterus (accidental puncture) when performing a vacuum abortion is rare, since sharp tools are not used. Nevertheless, although rarely, this can happen when the cervix is dilated or the length of the uterus is examined before the procedure with a uterine probe.
- When performing curettage with an acute curette, the risk of perforation of the uterine wall increases. With a sharp instrument you can pass through the wall of the uterus and wound the adjacent intestinal loops, the bladder. In this case, the abortion operation ends with the transition to abdominal surgery (for suturing an intestinal wound, for example, or stopping bleeding from a perforated uterine wall).
- Directly during the procedure, an allergic reaction to drugs for anesthesia may occur.
- When the cervical canal dilates, the cervix may be injured.
May occur within a week, several months after surgery:
- After an abortion is normal, the bleeding continues for several more days. Sometimes, after an abortion and cervical dilatation, the cervical canal closes too early, blood accumulates in the uterus and a so-called hematometer complication occurs. Such a complication can be suspected if the next day after the abortion a woman complains of sharp pains in the lower abdomen and notes the cessation of bloody discharge from the genital tract on the first evening. The hematometer is also visible on the ultrasound (the uterine cavity is clogged with blood clots, and the cervix is closed). Depending on the volume of accumulated blood, this situation is resolved with the help of medications or the re-expansion of the cervical canal and vacuum aspiration of clots. This complication can be prevented by taking antispasmodics in the evening after an abortion (for example, 1-2-3 tablets of drotaverine or no-spa).
- Prolonged bleeding, as well as pain in the lower abdomen, may indicate that the procedure was not fully completed, and germinal elements remained in the uterus, which could initiate serious inflammatory processes. In the case of incomplete abortion, there is a need for additional surgery (curettage of the remains of the ovum from the uterus).
- Placental polyp – on the control ultrasound 2-4 months after the abortion a polypous outgrowth of the uterine lining mucosa appears. Clinically, it can manifest painful and irregular menstruation after abortion. Placental polyp grows from the remnants of villi of the tissues of the ovum. It is also necessary to remove the placental polyp under general anesthesia, with dilated cervix, usually with a curette and a hysteroscope (a tool with a video camera for inspecting the uterus from the inside).
- Post-abortion depression.
Inflammation after abortion
Another late complication of abortion may be the addition of an inflammatory process. With abortion, this usually happens if the patient has lowered immunity and there is a chronic infection in the lower genital tract. Even after the rehabilitation of an inflammatory smear type, before an abortion in the genital tract, aggressive microorganisms can remain, which, when inserting instruments into the uterus, enter the vagina from the vagina. Microtraumas of the walls and cervix contribute to the development of inflammation.
In case of acute inflammation, the patient will appear:
- lower abdominal pain
- purulent or mucous discharge from the genital tract.
This is the clinic of endometritis (inflammation of the uterine lining). From the uterus, the inflammatory process can ascend to the fallopian tubes and into the small pelvis.
With inflammation and the appearance of pus in the fallopian tubes, salpingitis develops.
When the ovary is pulled into the process, salpingo-oophoritis occurs and adhesions form between the ovary, the tubes and the uterus.
Patients after treatment for a long time may be disturbed by leucorrhoea from the genital tract.
When pus is poured out of the fallopian tubes, peritonitis develops in the pelvic cavity, inflammation and adhesions spread to adjacent organs (intestinal loops, bladder). Long-lasting anti-inflammatory and antibacterial therapy will be required, if there is pus in the fallopian tubes and small pelvis, surgical treatment is required.
May be observed years after surgery:
- After an abortion there is always a risk of a hormonal shift, in connection with which the menstrual cycle and the normal maturation of the follicles in the ovaries can be disrupted. This, in turn, increases the risk of endocrine infertility.
- The above inflammatory processes of the genital organs can lead to the development of adhesions and obstruction of the fallopian tubes (hereinafter – the tubal factor of infertility). Inflammation of the uterine lining is also a common cause of irregular menstruation.
- The postponed inflammatory processes and the presence of adhesions in the small pelvis can cause chronic pelvic pain syndrome in women, which is very difficult to correct.
- A cervix injured during abortion may not perform enough locking function during pregnancy. Due to insufficiency of the cervix, pregnancy may be lost in different periods or indications are created for applying a surgical suture to the cervix to preserve the pregnancy.
If an abortion is complicated, then it can “haunt” the woman to unfavorable course of the subsequent desired pregnancy.
- First, in patients with inflammatory diseases of the female genital organs and adhesions in the pelvis after a complicated abortion, ectopic pregnancy may occur . This happens because, as a result of inflammation, the fallopian tubes become convoluted, edematous, with excesses due to adjacent adhesions, the movement of the egg cell along them is difficult.
- When a fertilized egg enters the uterine cavity with chronic inflammation of the mucous membrane after an abortion, it can fail to attach to the wall of the uterus. This leads to a frozen pregnancy or the development of bleeding and pregnancy rejection. If the pregnancy has taken root and develops further, then the placenta attached to the inferior wall of the uterus may be thin, not provide nutritional function, low-flow or high-water deficiency, growth of the child may be described on ultrasound.
- If a woman has an abortion complicated by perforation of the uterine wall, now she has a scar on the uterus. During pregnancy and childbirth, some uterine scars are untenable (rarely, but there is a rupture of the uterus through an insolvent scar in late pregnancy and childbirth).
- If during abortion the dilation of the cervix was traumatic, then with the next desired pregnancy , cervical insufficiency ( cervical insufficiency ) may appear . This is clinically manifested by signs of threatened abortion, premature cervical dilatation, and may result in miscarriage. Sometimes during pregnancy, cervical insufficiency has to be corrected by suturing or setting up an unloading pessary .
- If a patient with a Rh-negative blood group performs an abortion from a Rh-positive partner, then in her body during the next pregnancy there may be a Rh incompatibility with an unborn baby. To prevent this complication of Rh-negative women during an abortion, it is recommended to always administer a dose of Rh immunoglobulin.
The length of the recovery period is influenced by the woman’s age, her state of health, the number of previous abortions and the presence of children. Easier abortion endure healthy young women who already have children.
Medical rehabilitation involves providing rest to the female reproductive system, which has suffered a hormonal explosion due to an artificial abortion. Because of the hormones drop, the menstrual cycle may not recover, and cysts often occur in the ovaries and mammary glands. Within six months, at a minimum, the next (desired or undesired) pregnancy should not occur, there should be no sharp fluctuations in the hormonal background of the woman. A woman should understand that the next abortion will aggravate the hormonal imbalance in the body. You need to provide a reliable means of contraception.
If abortion is complicated by the inflammatory process, then the period of rehabilitation and recovery should include additional measures to restore normal microflora in the vagina, physiotherapeutic methods of prevention and resorption of adhesions of internal genital organs. Women are prescribed electrophoresis on the lower abdomen with anti-inflammatory drugs, spa treatment, hirudotherapy, laser irradiation and ultraviolet irradiation of blood, enzyme preparations to reduce the severity of adhesions.
Another important component of recovery is psychological rehabilitation. Women may develop depression , guilt, and sexual function. Therefore, in many cases, the help of psychologists is recommended.
After an abortion, it is recommended to abstain from sex for at least 3 weeks. The fact is that after an abortion, the inner surface of the uterus is an extensive wound surface, very vulnerable to any infection. During sex immediately after an abortion, the likelihood of infection increases significantly, which can cause serious complications.
Another reason for limiting sex after an abortion is the high probability of a second pregnancy.
Unfortunately, no contraceptive method currently provides a 100% guarantee, and until the menstrual cycle is not established, the probability of pregnancy after an abortion is high, even if the woman considers these days to be “safe.”
Pregnancy immediately after an abortion is very dangerous for an organism that has not yet had time to recover. In addition, a fertilized egg that adheres to fresh scar tissue will receive little nutrition.
Important! It is recommended to plan a pregnancy after an abortion no earlier than in half a year. All this time it is necessary to use contraception during sex.
The most convenient after an abortion will be combined oral contraceptives (OCCs), or their non-tablet counterparts. In the case of COC use in a woman’s body, a constant hormonal background will be maintained without hesitation, therefore the ovaries and mammary glands will be in a “resting state” (that is, they will not appear cysts). The uterine lining will also be restored in protected conditions.
Important! In no case is it recommended to protect yourself with disposable emergency contraception after unprotected sexual intercourse (for example, the drug “postinor” or “escagel”).
Such drugs contain hormones in large doses, they will also be stressful for the body and can provoke disorders of the endocrine function. Many women with irregular sexual life use emergency contraception several times a year, and then they end up with an unbalanced hormonal system, overweight and menstrual disorders.
For permanent contraception it is also possible to use a condom and an intrauterine device. But for reliable results when using condoms, both partners’ discipline is needed, and besides, buying quality condoms is now more expensive than KOC packaging. The intrauterine device is a capricious method of contraception, not suitable for all women, and for patients at risk of inflammatory diseases is not indicated for use at all. On the other hand, it is a budget cheap version of contraception.
Compliance with a few simple rules can significantly reduce the risk of complications after artificial abortion.
- Early attendance at an appointment (the shorter the gestation period, the more benign the method of interruption can be applied, for example, to confine to mini-abortion or the method of medication)
- Perform instrumental abortion only with the sanitized vagina (vaginal purity 1-2);
- Antibacterial prophylaxis of infectious complications once a day of abortion in all patients;
- A course of antibiotic therapy in patients with chlamydia, other infections and patients at risk of developing an infectious process;
- Rhesus immunization and Rhesus prophylaxis (introduction of Rh-immunoglobulin Rh-negative women);
- Banning sex in the first three weeks after an abortion,
- Control of abdominal discharges and, if necessary, consultation with a doctor,
- Carrying out the procedure of instrumental abortion in the empty bladder and intestines;
- Compliance with the rules of hygiene, selection of a suitable method of contraception;
- Perform a control ultrasound of the pelvic organs;
- Visit the gynecologist at least once every six months.