What is abortion

Abortion - is abortion in the first seven months of pregnancy (28 weeks), even when the fetus is not viable. Abortion may be spontaneous, then it is called abortion and artificial. Induced abortion in turn divided into medical (made in the hospital) and criminal (made outside the facility). Criminal abortion - is an illegal operation that is punishable by law enforcement agencies.

All abortions are also divided into early - within the first three months of pregnancy and later, from three to seven months. In early pregnancy abortion can be carried out in the form of medical abortion, vacuum abortion or instrumental abortion.

What is medical abortion

Medical abortion is carried out with the help of drugs that block the formation of the female sex hormone progesterone Progesterone - norm and pathology , Prepares the uterus for pregnancy and promoting gestation. The international non-proprietary name of the drug - mifepristone, various firms, he also issued under the names mifegin and mifepreks.

Medical abortion is carried out no later than the second week of pregnancy. Mifepristone causes increased motor activity of muscles of the uterus, which promotes detachment of endometrium, together with the introduction of its thickness fetal egg. After the expulsion of the ovum begins bleeding that has the form and duration of natural menstruation. But not all so simple: a woman's body can react in their own way and cause heavy bleeding, which deal with only by a doctor in a hospital. That is why mifepristone sold in pharmacies by prescription only and is used only as intended (after a preliminary examination), and under the supervision of a gynecologist.

Medical abortion is contraindicated if the muscle layer of the uterus of a pregnant woman disturbed by the presence of scarring (eg, after cesarean section) or nodes (such as fibroids), if a pregnant woman suffering from blood diseases, epilepsy, glaucoma, severe diseases of internal organs or hormonal disorders.

But medical abortion has its advantages: excluded from entering the bloodstream to various infections, reduced risk of inflammatory diseases and hormonal disorders Hormonal disorders - oversupply and a lack of equally dangerous .

Vacuum or mini-abortion

Vacuum abortions (mini-abortions) is carried out by means of vacuum suction of pregnancy for up to four weeks. Vacuum abortion is not traumatic, it can reduce the risk of infection, damage to the uterus and bleeding.

Contraindications for vacuum abortion are pelvic inflammatory disease, multiple foci of purulent infection in the body, any acute illness and exacerbation of chronic diseases, as well as, if less than six months have passed since the last abortion.

Before the mini-abortion, a woman must be fully examined to confirm the pregnancy and to identify uterine infections.

Vacuum abortion is performed in the antenatal clinic under local anesthesia. After the cervical canal introduced a special catheter connected to the electric pumps, in the uterus creates a negative pressure and the ovum, which is embedded in the lining of the uterus, is separated and removed. Today, these abortions are often carried out under the supervision of the ultrasonic beam, which improves the quality of the meeting.

The menstrual cycle after the vacuum abortion is restored after an average of 1, 5 months. Mini abortion may be complicated if the fertilized egg is not deleted completely (in such cases, a tool abortion). Other complications - a persistent violation of hormonal and infertility, infection joining.

Operation instrumental abortion

Tool abortion is performed that scraping Scraping - heavy and unsafe procedure   mucous membrane of the uterus along with the fetal egg gestation up to three months (12 weeks). This is the most difficult and dangerous type of abortion, so it is held in the gynecological department of the hospital under general anesthesia. After instrumental abortion for a few days stand out blood clots, resembling menstruation.

Tool abortion can be complicated by bleeding, damage to the instrument wall or cervix, incomplete extraction of the ovum, followed by decomposition of tissue and inflammation, hitting the uterus infection of the external genitalia. In addition, after a medical abortion may begin hormonal disorders, which will be an obstacle for carrying future pregnancies.

Medical abortion late in pregnancy

After twelve weeks of pregnancy, abortion can be done only under medical indications in severe diseases of women, if a woman has a condition that prevents carrying a child, as a late abortion Late abortion: indications, consequences, risk   - It's too big a risk for the woman. Abortion in these cases is done in a hospital setting by introduction into the uterus of a high concentration salt solution. In some cases, make a small cesarean section.

Any abortion - it is always a risk.

Galina Romanenko

What mifegin and its mechanism of action

It is known that pregnancy is supported by two hormones: estrogen Estrogen - the key to bone health   and progesterone, which prepares the uterus for pregnancy. Mifegin (INN - mifepreston) - a progesterone antagonist, it blocks progesterone Progesterone - norm and pathology   and it does not give him the opportunity to perform its function.

As a result of blocking progesterone is the destruction of the capillaries in the lining of the uterus and the mucous membrane is rejected. In addition, the impact of an increase Mifegin concentration of specific substances prostaglandins, which cause uterine contractions contribute to pregnancy termination and separation of the ovum, as well as softening and dilatation of the cervix and expulsion of the ovum. To enhance the action Mifegin (enhance the contractility of the uterus) prostaglandins introduce additional 36-48 hours after receiving Mifegin.

Due to its effect on the mucous membrane and the contractile ability of the uterus, mifegin used for termination of pregnancy for up to 6 weeks, in combination with a prostaglandin analog. Application Mifegin approved by the State Committee of the Russian Ministry of Health 30.12.99g., It is included in the Register of medicines Russia in 2000.

Indications for use

Indications for use Mifegin are:

• medical termination of pregnancy up to 6 weeks; emergency contraception as the prevention of unwanted pregnancy after "unprotected" sexual intercourse.

Contraindications

Contraindications:

• irregular menstrual cycle, uterine fibroids, endometriosis Endometriosis - a serious problem with serious consequences ;
• ectopic pregnancy;
• the scars on the uterus;
• anemia (anemia);
• severe diseases of the cardiovascular system, asthma and others.);
• age 18 and after 35 years, and smoking;
• the use of an intrauterine device or hormonal contraceptives for less than three months prior to conception.

Advantages and disadvantages of medical abortion

Advantages of medical abortion:

• provide a high degree of efficiency (up to 98, 2%);
• avoids surgery;
• flow is usually less painful than surgical;
• abortion can be carried out at a very early;
• does not require anesthesia;
• completely no risk of infection (HIV, hepatitis, etc.).

Disadvantages of a medical abortion:

• may start to bleed heavily at the time when you are at home;
• Surgical intervention may be required due to the fact that the ovum has not departed.

Preparations for medical abortion

Abortion medical methods performed after careful patient obsledovaniya.Vnachale visiting on a chair, then take a smear (to exclude inflammatory diseases) and carried ultrasound to ascertain pregnancy and exclude ectopic pregnancy.

How is medical abortion

The reception was at the gynecologist woman taking pills Mifegin, is under observation for two hours and then goes home. A few hours later she appeared spotting Spotting - it is important to rule out pathology .

Two days later, the woman comes to the reception again and takes pills prostaglandin. At this time, it is under supervision for about 4 hours, and then goes home. After receiving prostaglandin spotting become more abundant and resemble normal menstruation. There is the complete expulsion of the ovum, and then spotting may continue for about 10-12 days.

After 10-14 days, an ultrasound study to check whether it was removed completely fertilized egg.

results

In most cases, medical abortion painless efficiency - 98, 2%.

In some cases, the results are not always satisfactory - it all depends on the patient's individual response to the drug mifegin and is directly dependent on the duration of pregnancy.

If a longer term the number of poor outcomes increases (from 5 to 15% incomplete abortion). The negative results of medical abortion:

• cases of ongoing pregnancy (1, 0 - 4, 5%);
• rervannaya pregnancy, but without the expulsion of the ovum, or incomplete expulsion of the (2, 0 - 7, 0%);
• bleeding requiring surgical intervention (1, 0 to 5, 5%).