Methods of termination of pregnancy for medical reasons. Medical indications for abortion
Every woman has a choice whether to have a baby or terminate the pregnancy. But, such a decision must be made up to 12 weeks. During this period, abortion is the least risky for women's health. True, there is the possibility of terminating a pregnancy in the later stages for medical reasons. Such an operation is necessary to save the health and life of the mother or if the fetus is not viable.
Reasons for late termination
Every expectant mother must undergo regular examinations and tests. This allows doctors to monitor the development of the fetus, the health of the pregnant woman. One of the most important methods is ultrasound, which allows to determine the degree of development of the systems and organs of the child.Ultrasound, which is performed at a period of 12 to 14 weeks, can show that the fetus has anomalies, defects that will prevent the child from developing properly. In such cases, the expectant mother is assigned an MRI to clarify the diagnosis. If the presence of deviations is confirmed, the woman is recommended to terminate the pregnancy. Parents have the right to decide whether to leave a non-viable or sick child.
Sometimes the bearing of a child poses a threat to the health and life of a woman. In this case, abortion is also carried out at a later date. There are other reasons for such operations:
- Death of the child's father.
- Spouse's disability.
- Severe illness of the first child.
- Conception, which is the result of rape.
- Imprisonment of a pregnant woman.
- Deprivation of a woman's parental rights to existing children.
Methods for carrying out an abortion at a later date for medical reasons
Termination of pregnancy is carried out in the later stages for medical reasons in two stages. First, prostaglandins are introduced, which soften, make the walls of the cervix more elastic. This is followed by labor induction. Considering that a live child may be born during an abortion for a long time, fetal fetocide is performed before the operation. This kills the fetus.The procedure is performed using an ultrasound machine. At the same time, potassium chloride is injected into the heart of the fetus. For this, an injection is made through the abdominal wall. As a result, during artificial childbirth, a lifeless body appears.
Experts believe that it is safer to have an abortion at a later date through dilation. This is the dismemberment of the fetus in the uterus and its removal in parts. Such operations are carried out in the second trimester, when the body is not yet ready for childbirth.
If such an abortion is performed for medical reasons, local paracervical or epidural anesthesia is used. Medicines soften the tissues of the cervix, install dilators and a curette, vacuum cleans the uterine cavity.
In carrying out abortions in the later stages, "Rivanol" can be used. Earlier in medicine, this drug was used for resorption of hematomas. This high-alcohol medication is injected into the amniotic fluid. As a result, the child dies, premature birth begins. At the same time, the woman feels attempts and contractions, as in natural childbirth.
If it is necessary to abort a large fetus, a caesarean section is performed. This method is used only when the child has no muscle contractions, breathing, pulsation of the umbilical cord, heartbeat, that is, there is a frozen pregnancy.
Consequences of late termination of pregnancy
Every woman should be aware that late termination of pregnancy is fraught with serious consequences. In addition to the fact that as a result of such an operation it is necessary to kill a child, which is contrary to the rules of morality, mental and physiological health complications may also arise.There may be a stressful condition, after premature birth, bleeding often occurs. If you need to have an abortion at a later date, you should be prepared for the fact that this procedure is painful.
Sometimes women who go to medical institutions for abortion are refused, as there are no medical or social indications for a late abortion. They find specialists on the Internet or use the information of acquaintances in order to carry out an underground operation.
It should be understood that carrying out an operation at home at a later date can not only lead to serious complications, but also to death. Therefore, this method of getting rid of a child cannot be used.
IN modern world There are many protections against unwanted pregnancy, but there are circumstances in a woman's life when an abortion is required. This situation becomes more complicated when the gestational age is already long. For medical reasons, termination in late pregnancy is allowed in case of pathology of fetal development, maternal illness, intrauterine death of the fetus, and some other reasons associated with a threat to the health of the patient.
Termination of pregnancy in the later stages for medical reasons
Late pregnancy terminations for medical reasons are most often performed between 12 weeks and 22 weeks. Medical termination of pregnancy during these periods is considered dangerous for the health of the mother, so it is resorted to as a last resort. Also, abortion at long gestation periods is allowed for women for social reasons - in the event of the death of the husband; lack of funds for maintenance; if the pregnant woman is a minor; some other reasons. In this case, permission for abortion is issued after consideration by the commission. It consists of a doctor, a social worker, a lawyer and other representatives.
Termination of pregnancy in the later stages for medical reasons is allowed when there is a threat to health, as well as the life of the mother: a serious illness; trauma incompatible with pregnancy; upcoming operation; if medical procedures are performed that can cause irreparable harm to the fetus; under conditions of fetal death; with disorders in the development of the fetus.
Termination of pregnancy in the later stages for medical reasons is possible only in a hospital. A sterile tube with a rod is used, which is inserted into the cervix. Then the rod is removed and the needle is inserted, the fetal bladder is punctured and the amniotic fluid is taken. For the procedure for terminating a pregnancy in the later stages, for medical reasons, a special saline solution is injected into the fetal bladder with a needle. The death of the fetus is painful, he already feels pain. Being in solution, the fetus gets burns of the whole body and dies in agony from a brain hemorrhage.
This method of abortion is possible for a period of no more than 15 weeks. A complication after such a procedure can be a headache, severe chest pain, the development of hypotension, shock, coma, and even death. Late pregnancy termination for medical reasons with curettage of the uterine cavity is considered a very high-risk operation. The risk increases at 15 weeks of gestation.
As a method of terminating a pregnancy in the later stages, for medical reasons, an opening of the fetal bladder is used. If a woman is contraindicated in the introduction of an isotonic solution, then this method is used. With the help of a dilator, the cervix is opened, then the fetal bladder is opened and the presenting part of the fetus is grasped with forceps. A load is fixed on the forceps and means are prescribed that enhance the contraction of the uterus. Such an abortion can go long time. Complications include infection of the uterus, rupture of the cervix. This method is used from 17 to 28 weeks of pregnancy, if there are contraindications to other methods.
Termination of pregnancy in the later stages for medical reasons is also carried out with the help of a small caesarean section. The fetus is most often alive, it stops the access of air to the lungs. A complication in a woman after such an operation may be thromboembolism. This method is used only in cases of emergency abortion, when other methods are contraindicated, as it is dangerous with serious complications.
A transvaginal caesarean section is another method of terminating a pregnancy in the later stages for medical reasons. This method is almost never used, as it often causes complications and the operation itself is technically complex.
Termination of pregnancy in the later stages of folk remedies
Termination of pregnancy in the later stages of folk remedies may not be successful, cause severe bleeding, large blood loss and death of the woman. Failure when a woman tries to get rid of pregnancy with the help of folk remedies will lead to the birth of a weakened baby, with developmental pathologies of the baby, or to an abortion with complications, to psychological trauma, and the development of infertility.
Late term abortion pills
One of the gentle methods of miscarriage is with the help of various medications. Late term abortion pills are not used. The maximum term for medical abortion is 6 weeks. But even when taking the pills during these periods, there is no guarantee that they will help you. In the later stages of pregnancy, only more radical and dangerous abortion methods are possible.
Seeking an abortion should be a last resort when there is no other solution. Be responsible for your health and newly emerging life, use contraception, and unwanted pregnancy will not appear in your life.
indications for termination of pregnancy Medical
105. Social indications for abortion.
induced abortion- surgical or medical intervention, with the help of which the pregnancy is terminated before 22 weeks (previously performed up to 28 weeks). Artificial termination of pregnancy is performed at the request of a woman or for medical reasons and is performed by a doctor in compliance with the rules of asepsis and taking into account contraindications.
At the request of a woman abortion is performed in early dates- up to 12 weeks This period is set due to the fact that it is possible to remove the fetal egg with a lower risk of complications than at a later date.
Termination of pregnancy after 13 weeks is called late abortion.
The shorter the gestational age at which it is interrupted, the less pronounced subsequent hormonal disorders. Termination of pregnancy at any time can be accompanied by a large number of complications that are difficult to foresee and avoid. With all patients, especially those who have not given birth, who have Rh-negative blood, a conversation should be held about the dangers of abortion. Termination of pregnancy at a later date is carried out for medical, and more recently in order to avoid out-of-hospital - criminal abortions - and for social reasons.
Medical indications for termination of pregnancy are established by a commission consisting of an obstetrician-gynecologist, a doctor of the specialty to which the disease of the pregnant woman belongs, and the head of an outpatient or inpatient institution.
List of medical indications for abortion:
2. malignant neoplasms of all localizations -
3. Diseases of the endocrine system (severe and moderate diffuse toxic goiter, congenital and acquired hypothyroidism, complicated diabetes, hyper- and hypoparathyroidism, diabetes insipidus, active form of Itsenko-Cushing's syndrome, pheochromocytoma);
4. diseases of the hematopoietic system (hypo- and aplastic anemia, thalassemia, acute and chronic leukemia, lymphogranulomatosis, thrombocytopenia, hemorrhagic capillary toxicosis);
5. mental disorders (alcoholic, drug, schizophrenic and affective psychoses, neurotic disorders, chronic alcoholism, substance abuse, mental retardation, taking psychotropic drugs during pregnancy);
6. diseases of the nervous system and sensory organs (inflammatory diseases, hereditary and degenerative diseases of the central nervous system, multiple sclerosis, epilepsy, myasthenia gravis, vascular diseases of the brain, brain tumors, retinal detachment, glaucoma, otosclerosis, congenital deafness and deafness);
7. diseases of the circulatory system [all heart defects accompanied by the activity of a rheumatic process, congenital heart defects, diseases of the myocardium, endocardium and pericardium, cardiac arrhythmias, operated heart, vascular disease, hypertension PB - stage III (according to A.L. Myasnikov) , malignant forms of hypertension],
8. diseases of the respiratory system (chronic pneumonia stage III, bronchiectasis, stenosis of the trachea or bronchi, condition after pneumonectomy or lobectomy);
9. diseases of the digestive system (stenosis of the esophagus, chronic active hepatitis, peptic ulcer of the stomach or duodenum, cirrhosis of the liver with signs of portal insufficiency, acute fatty degeneration of the liver, cholelithiasis with frequent exacerbations, malabsorption in the intestine);
10. diseases of the genitourinary system (acute glomerulonephritis, exacerbation of chronic glomerulonephritis, chronic pyelonephritis occurring with chronic renal failure and arterial hypertension, bilateral hydronephrosis, hydronephrosis of a single kidney, polycystic kidney disease, renal artery stenosis, acute and chronic renal failure of any etiology );
11. complications of pregnancy, childbirth and the postpartum period (cystic drift, transferred at least two years ago, preeclampsia, not amenable to complex treatment in a hospital, indomitable vomiting of pregnant women, a critical state of uterofetal-placental blood flow, chorionepithelioma);
12. diseases of the skin and subcutaneous fatty tissue (pemphigus, severe forms of dermatoses of pregnant women);
13. diseases of the musculoskeletal system and connective tissue (osteochondropathy, amputation of an arm or leg, acute or chronic course of systemic lupus erythematosus, polyarteritis nodosa);
14. congenital malformations and hereditary diseases (congenital pathology established by prenatal diagnosis, high risk of having a child with congenital, hereditary pathology, admission medicines during pregnancy, which have an embryo- and fetotoxic effect);
15. physiological conditions (physiological immaturity - minority, a woman's age is 40 years and older);
The list of social indications for the interruption of ber-sti:
The presence of a disability of 1-11 groups in the husband.
The death of a husband during his wife's pregnancy.
The stay of a woman or her husband in places of deprivation of liberty.
Recognition in accordance with the established procedure as unemployed of a woman or her husband,
The presence of a court decision on the deprivation or restriction of parental rights.
An unmarried woman.
Divorce during pregnancy.
Pregnancy as a result of rape.
Lack of housing, living in a hostel, in a private apartment.
A woman has the status of a refugee or forced migrant.
Large families (number of children 3 or more).
Having a child with a disability in the family
Income per family member is less than the subsistence level established by the day of the given region.
Contraindications to induced abortion are acute and subacute inflammatory diseases of the genital organs (inflammation of the uterine appendages, purulent colpitis, endocervicitis, etc.) and inflammatory processes of extragenital localization (furunculosis, periodontal disease, acute appendicitis, tuberculous meningitis, miliary tuberculosis, etc.) , acute infectious diseases. The question of termination of pregnancy is subsequently decided by the doctor, depending on the results of the treatment and the duration of the pregnancy.
Late pregnancy termination is possible only in exceptional cases. The desire of a woman is not an indication for surgical intervention. Doctors fear possible negative consequences late abortion, the main of which is secondary infertility.
Do late term abortions?
Interruption of gestation at the request of a woman can be carried out at the initial stages of fetal development. The latest term for terminating a pregnancy initiated by the mother is 12 weeks. An abortion later than this time is called late and is carried out only in exceptional cases. The choice of the method by which the termination of the pregnancy process is carried out is made on the basis of the current term, the age of the pregnant woman and her state of health. So, after 20 weeks of gestation, doctors do not use classic abortive methods, but carry out artificial childbirth.
Indications for termination of pregnancy
The decision that there is a need for an abortion at a later date is made by the medical commission. The doctors included in it (obstetrician-gynecologist, specialist in the field that causes the need for an abortion (sociologist, representatives of state bodies)) take into account the results of the medical examination, the social conditions in which the pregnant woman lives. The final decision on the need to interrupt gestation for a period after can be made on the basis of:
- medical indications;
- social testimony.
Medical indications for abortion
This kind of indications for termination of pregnancy in the later stages are taken into account initially. In most cases, they are associated with the presence of diseases in a pregnant woman that can prevent her from carrying and giving birth to a baby. In addition, a late abortion can be indicated if the fetus has malformations and developmental disorders that, after birth, will cause disability or death of the baby. Among the main medical indications for abortion after 12 weeks are:
- mental and somatic diseases of a pregnant woman;
- the presence of chromosomal pathologies in the fetus that are incompatible with life;
- severe diseases of the pregnant woman (hematitis, viral infections, tuberculosis);
- the possibility of death of a woman with further progression and development of pregnancy.
Social indications for abortion
The social causes of late pregnancy termination are due to the presence of factors that can worsen the living conditions of the pregnant woman herself or the unborn baby. Often, doctors take into account those social factors that arose directly during the pregnancy itself:
- the death of a spouse;
- divorce;
- the arrest of one of the child's parents.
In addition, there are a number of social factors that can also be taken into account when deciding on an abortion, but their presence is not a strict indication for interruption of gestation:
- lack of housing;
- the presence in the family of more than 3 children;
- the age of the future mother is less than 18 years.
How is an abortion done in the later stages?
Late pregnancy termination methods are practically the same as those used by doctors on early stages gestation. However, termination of pregnancy in the later stages is not carried out with pills. The choice of technique is carried out by a medical commission based on the results of the examination, taking into account the duration of pregnancy and the characteristics of its course. Each of the methods has its own characteristics, a certain technique. Among the methods used to terminate pregnancy, after 12 weeks use:
- Intra-amniotic administration of fluids.
- Forced opening of the neck.
- Small caesarean section.
Method of intra-amniotic administration of fluids
Abortion in late pregnancy using hypertonic solutions is a common technique. The mechanism of action of this method of interrupting gestation is associated with a change in the volume of amniotic fluid, its osmotic pressure. As a result of such changes, there is a stretching of the muscular structures of the uterus, followed by their contraction.
In this case, doctors also associate an increase in the tone of the uterus with the possible toxic effect of substances that begin to be released after the death of the fetus (as a result of exposure to hypertonic saline). Strong contractile movements of the myometrium lead to the expulsion of the fetus outward, as a result of which the pregnancy is completely interrupted. According to its mechanism, the method resembles medical abortion, which is not used in the later stages. After the procedure, doctors carefully examine the uterine cavity to exclude the presence of remnants of fetal tissue.
Dilation and evacuation
Termination of pregnancy in the later stages for medical reasons is often carried out by the method of dilation and evacuation. The optimal period for the implementation of an abortion by the named method is 15–18 weeks. First, the doctor performs an artificial expansion of the cervical canal, using surgical instruments with a gradual increase in the dilator (dilatation).
After gaining access to the uterine cavity, physicians dissect the fetus and scrape the membranes. At the end of this stage, proceed to the evacuation - the extraction of the remains of the fetus outside with the help of vacuum suction. Evacuation with pre-dilation is recognized as a gentle method of terminating a pregnancy at a later date and is recommended by WHO as an alternative method of abortion.
Small caesarean section
This type in the later stages has practically no differences from the usual caesarean. Access to the fetus is through an incision in the anterior abdominal wall, through which the fetus is subsequently removed. The operation is performed under general anesthesia. This method is rarely used, in cases where there are contraindications to the method described above. During the operation, there is a high risk of developing uncontrolled bleeding, so the decision to perform it is made when there is a threat to the life of the woman herself.
Artificial birth method
When it becomes necessary to terminate a pregnancy in the later stages, after, doctors change the tactics of artificial birth. In this case, the fetus is not removed from the uterine cavity, but procedures are carried out that cause its independent expulsion to the outside. Talking about how the termination of pregnancy occurs in the later stages, doctors often use the term "stimulation of premature delivery."
At a later stage, abortion is not called an abortion from the point of view of psychology: by this time, the fetus can already be called a child, and the expectant mother already has an attachment to the baby. The hormones synthesized in it form the feeling of motherhood. Artificial childbirth begins with stimulation - prostaglandins are introduced into the body of a woman, which increase the tone of the uterine muscles and cause its contractions. As a result, labor activity begins.
Allocations after termination of pregnancy in the later stages
Abortion is always a factor for the body that weakens the immune system, so it is important to monitor the well-being of a woman. In the reproductive system, a favorable environment is created for the development of infection and inflammation. Discharge after an abortion is evaluated as an indicator of the state of the reproductive system. Normally, they appear on the 2-3rd day after the procedure, they may have small blood impurities, but do not smell. A change in these parameters may indicate the addition of an infection. Yellow discharge with a rotten smell should be a reason to see a doctor.
Brown discharge that appears after a late pregnancy is terminated can last up to 10 days. In some cases, women may notice the appearance of blood clots (clotting occurs under the influence of body temperature). The volume of such secretions is moderate, and they themselves are not accompanied by pain in the lower abdomen or in the vaginal area. A change in discharge to dark brown may indicate polyps in the uterus.
Recovery after a late pregnancy termination
The duration of the recovery period is determined by the method of termination of pregnancy and the period at which it was carried out. Late abortions are highly painful and stressful for the body. To exclude possible early complications, the woman is under the supervision of a specialized doctor in a hospital setting. In general, recovery after an abortion involves:
- Prevention of blood loss.
- Exclusion of the possibility of attaching an infection (antibiotic therapy, anti-inflammatory drugs).
- Instrumental examination of the female reproductive system to exclude residual membranes.
Consequences of late pregnancy termination
Asking doctors about the possible consequences, women are trying to find out if it is possible to have an abortion and why this procedure is dangerous. Gynecologists say that this procedure is highly undesirable - complications and consequences of an abortion can appear after several months and years. Given the time of their development, doctors divide possible complications into:
- Early- occur during the interruption procedure (perforation of the uterus, bleeding).
- Delayed- develop within a month after surgery (endometritis, hematometra, progression of pregnancy).
- distant- appear a year later and later (cicatricial changes in the internal os, cervix, damage to the endometrium, impaired patency of the fallopian tubes).
Pregnancy does not always proceed joyfully and cloudlessly, as we would like, there are often cases when it needs to be interrupted for a long time. It should be noted that no one will have an abortion simply out of "wish" in the later stages. According to existing legislation, pregnancy for a period of more than twelve weeks can only be terminated for existing medical or social reasons.
Termination of pregnancy after 20 weeks is accompanied by an extremely high risk to the health and life of the mother. On the other hand, abortion at such times can be equated with murder, since the fetus is viable by this time. In such situations, a woman must have very weighty arguments in order to decide on such a step.
Indications for late abortion.
The decision to terminate a pregnancy in the later stages can be based on medical and social reasons. The first group of indications includes a serious deterioration in the general health of the mother against the background of complications. diabetes available serious illness blood, heart and blood vessels, central nervous system, various kinds of tumors that require immediate therapy. In addition, an indication for late abortion is the identification of chromosomal abnormalities in the fetus, malformations that interfere with its further normal development or provoke its death, as well as if there is a risk of genetic diseases. I must say that some infectious diseases can lead to abortion. In these situations, abortion is the only salvation for mother and child from future suffering.
In order to obtain documentary permission for a surgical operation to stop intrauterine development of the fetus in the later stages of a pregnant woman, it is recommended to contact an obstetrician-gynecologist at the place of observation, who will issue it after the examination and tests, as well as after the exclusion of any contraindications to its implementation. Based on the results of the tests, the general health of the woman and the degree of abnormalities in the development of the fetus are assessed.
It also happens that a woman, due to physiology, did not immediately determine that she was pregnant, or she made a mistake when calculating the gestational age (sometimes it happens that menstruation continues for several months after fertilization), or she did not immediately tell this news to her lover or loved ones, therefore, the decision to terminate is made at a later date. It is for such cases that there is a second group of indications for abortion - social. This group of reasons should also include extremely unpleasant situations when the husband or father of the unborn baby suddenly dies in a pregnant woman, when this pregnancy is the result of rape, or when the expectant mother is in “places not so remote”. Deprivation or restriction of parental rights, as well as disability of the first and second groups can also serve as a serious reason for carrying out an artificial termination of pregnancy at a later date. In each specific case, a special commission of doctors at the place of observation of the pregnant woman is considering the issue.
It should be noted that, despite the presence of a significant social or medical indication for late abortion, in the presence of inflammatory diseases of the female genital organs in an acute form, inflammatory processes in an acute form and infectious diseases in an acute form, such surgical intervention is not permissible.
Pre-abortion examination.
Before the abortion operation, an ultrasound of the fetus and uterus is prescribed, the blood group and Rh factor are determined, a blood test is done for HIV, syphilis, hepatitis, a hemostasiogram, a biochemical blood test, urine, smears from the urethra, cervical canal and vagina are examined, antibodies are determined to hepatitis C, a chest X-ray, and an examination by a general practitioner and other specialists, if necessary.
If there are social or medical reasons for terminating the pregnancy, the woman is issued with a certified conclusion outlining the full clinical diagnosis with the signatures of specialists and the seal of the institution. If a woman is diagnosed with mental and venereal diseases, the documents are transferred to an obstetric and gynecological institution. In the absence of medical contraindications, a woman is given a referral to a medical institution, where the gestational age, the results of the examination, the conclusion of the commission (diagnosis) and social indications are indicated.
Since late abortion is associated with many risks, this operation is performed using painkillers in a hospital setting and only by specialists with special training. At the end of the surgery, an ultrasound is performed to accurately assess the result (check whether all parts of the fetus and placenta are removed).
Methods for terminating a pregnancy at a later date.
Taking into account the gestational age, the doctor selects the appropriate method of abortion. The least number of complications gives termination of pregnancy for a period of no more than 21-22 weeks, and in general, abortion is possible up to 27 weeks.
Cervical dilation and fetal extraction is performed between 12-20 weeks of pregnancy. A vacuum aspirator is introduced into the uterus, through which the fetus and fetal membrane are removed in parts. With this technique, there is a high risk of injury to the uterine wall, which results in severe bleeding, often resulting in death.
Another method used to terminate a pregnancy at 20-28 weeks is vaginal fluids (one of the artificial birth methods). Having expanded the cervix, a small amount of fetal fluid is sucked out of the fetal bladder using special instruments, after which the same volume of a highly concentrated solution of salts and glucose is injected into the uterus. As a result, the fetus dies, and after a day and a half, the woman starts contractions, and the dead fetus is rejected by the body (a kind of miscarriage occurs). On average, such an abortion occurs within thirty hours.
In rare cases, kelp sticks are injected into the cervical canal to induce labor. If in this case the contractions do not begin, special substances-stimulants of labor (prostaglandins, oxytocin, antispasmodics) are introduced.
Very rarely, but in the presence of medical contraindications with simultaneous medical or social indications for late abortion, a small caesarean section is performed. During such an operation, surgeons open the anterior abdominal wall and the anterior wall of the uterus, then the fetus and surrounding tissues are removed from the uterus, and the uterine wall is scraped. As a result of using this technique, the fetus may be alive, but no resuscitation is applied to it, and it dies.
Complications after late abortion.
- Incomplete cleansing of the uterine cavity from fragments and parts of the fetus with the addition of infection.
- placental polyp.
- Hematometer.
- Ruptures of the cervix.
- perforation of the uterus.
- Diseases of purulent-inflammatory course.