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 the early stages - 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 DM, 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, a high risk of having a child with a congenital, hereditary pathology, taking medications during pregnancy that 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 artificial 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.
The public in all ages condemned women who wanted to get rid of their unborn child, motivating this with selfish desires, an elementary unwillingness to spoil the figure and their lives.
Not everyone knows that doctors can give indications for abortion for a number of reasons. Each of them is approved by the Ministry of Health of Russia and recorded in the order. This law was revised six years ago by the Ministry of Health and Social Development and the list of diseases after the revision was somewhat reduced. Now women can fight for the life of their baby and not worry about the development of the fetus, even if the pregnant woman has already reached the age of 40.
abortion for medical reasons
Officially, according to the law and according to medical indications, the doctor has the right to have an abortion before the 22nd week of pregnancy. In the later stages, it is possible to get rid of the fetus only according to indications of a medical or social nature. A child in the 3rd trimester of pregnancy has already been formed, and the deprivation of his life for no apparent reason can be safely called murder. Artificial childbirth in all physical indicators resembles the standard birth process, only the extraction of the fetus occurs ahead of time.
Abortion according to medical indications is most often done in cases where the life of the pregnant woman is in danger or serious abnormalities in the development of the fetus are found.
Stories end with unconditional abortion after the diagnosis of severe heart failure, acute hypertensive crisis and insulin-dependent diabetes mellitus.
It is recommended to terminate the pregnancy if the mother or father has a genetic hereditary disease. If a pregnant woman suffers from chronic inflammatory processes in the kidneys or she has severe liver damage with obvious violations of its functioning.
Doctors will strongly recommend agreeing to an abortion in women who have obvious signs indicating the presence of Graves' disease, pernicious anemia, retinitis or optic neuritis, severe corneal diseases.
Termination of pregnancy for medical reasons is planned if there is a deep deformation of the bone tissue of the pelvic region, which leads to a narrowing of the pelvis.
It should be emphasized that an abortion for medical reasons will not be possible if the woman does not agree.
In any trimester, the examination may reveal a disease that can negatively affect the physical condition of the fetus or lead to its death. But if the disease does not appear in the list of the law, then the final decision on the future of the mother and child is made by a specially assembled commission. The following physicians must be included in its composition: the attending gynecologist, a doctor who is a specialist in the field in which the problem was found, and the head physician of the hospital (medical center).
An abortion for medical reasons must take place if the doctors are sure that with further gestation, the woman risks her life. The doctor will also insist on an abortion if the examination of the fetus reveals malformations that will inevitably lead to his death. But in any case, the doctor will not go against the law and will be guided by this document when issuing a “sentence”.
Remember the list of diseases that are listed in order No. 736 of the Ministry of Health of the Russian Federation. Abortion according to medical indications is recommended when diagnosing a pregnant woman:
- actively developing tuberculosis;
- rubella (if a pregnant woman for up to 12 weeks had close contact with a carrier of this disease);
- malignant tumors, the treatment of which involves x-rays of the pelvic organs or other irradiation procedures;
- severe diabetes mellitus, which led to kidney damage;
- Graves' disease;
- acute leukemia and some severe blood diseases;
- severe forms of mental illness;
- dependence on any type of drug;
- neuroinfections that led to meningitis, encephalitis, etc.,
- acute cerebral hemorrhage;
- epilepsy, which is not treatable and manifests itself in the form of frequent convulsions;
- severe heart defects;
- bleeding ulcer;
- the last stage of hepatitis or cirrhosis of the liver;
- glomerulonephritis;
- acute intoxication, which is not treatable;
- exacerbation of chronic rheumatic diseases.
After the onset of the 12th week of pregnancy, a woman no longer has the right to make a decision on her own, but thanks to social indications, this issue can be resolved. However, today the Ministry of Health and Social Development revised the list of aspects that are considered social indications for abortion, and reduced their list.
Every woman should know that having received indications for an abortion, the doctor must, based on the gestational age, the physical condition of the pregnant woman and a number of other factors, choose the most appropriate method.
Today, gynecologists perform abortions according to the following principles:
- with the use of medications (for up to 6 weeks);
- using a vacuum unit (mini-abortion, carried out for up to 5 weeks);
- using special surgical instruments (scraping method);
- calling labor activity by an artificial method (at a later date) with subsequent curettage.
Women's right to motherhood
A woman who has received indications for termination of pregnancy for medical or social reasons should remember the following. Under Russian law, a pregnant woman has the right to decide for herself whether she is ready to become a mother or not.
Also remember that only a special commission has the right to make indications for termination of pregnancy, based on the results of tests and procedures that were carried out under the supervision of doctors in a hospital. The council usually consists of the attending physician (gynecologist), a specialist in the profile of the problem (surgeon, oncologist, therapist, etc.) and the head physician of the hospital or maternity center. And this suggests that during a routine scheduled examination, the doctor of the antenatal clinic has no right to make a verdict on his own, and even more so to persuade the woman to terminate the pregnancy.
Today, more and more often you can hear the following shocking facts from women. During a visit to the antenatal clinic, the attending physician begins to assure the expectant mother that she will not be able to bear a healthy child (for medical or social reasons) and suggests an abortion. If this situation has also affected you, then before falling into hysterics, think about how one doctor can make diagnoses so confidently without a comprehensive examination? In order to convict this doctor of incompetence, you must immediately write a complaint against him addressed to the head physician.
But, if after all the studies, the diagnosis made at the consultation turns out to be disappointing, try not to lose your sobriety of mind. If you want to give birth to a healthy baby in the future and save your life today, then it is better to trust the doctors and their testimony.
Having gone through this test, the main thing is not to give up and not push away loved ones who will try to help you. Do not dwell on your grief, if it is still hard to survive the loss, ask a psychologist for help, who will restore your faith in the future.
After any type of abortion, a woman must follow the following instructions:
- For 21 days, you should refrain from sexual relations. This is not just a recommendation. This caution will save a woman from the possibility of infection in a wounded uterus. Sexual life can be resumed after the end of the first menstruation, after surgery;
- Listen to your body for two weeks after the abortion. Measure body temperature daily, try not to freeze and do not overwork the weakened body with strong physical exertion. If you notice even the slightest deterioration in your condition (bloody discharge, pain), immediately go to the doctor;
- Do not neglect personal hygiene (wash yourself daily and change your underwear);
- For the first 2 weeks, avoid swimming in open water and pools. Try to limit water procedures to taking a shower;
- Maintain regular bowel movements and do not retain urine in the bladder. These procedures, performed on time, will provoke a better uterine contraction;
- If after an abortion your menstrual cycle has gone astray (which should not be), immediately contact your gynecologist with this problem;
- To prevent more unplanned pregnancies, ask your gynecologist to find the right contraceptive for you.
Causes and consequences of criminal abortion
It was only at the beginning of the 20th century that abortion became legally permitted. At this time, any manipulation aimed at terminating a pregnancy was considered prohibited. During the youth of our grandmothers in special clinics, it was already possible, with the direction of a gynecologist, to have an abortion legally.
If a woman seeks “help” from people who do not have the right to perform abortions or provokes a miscarriage by her own efforts, then she is at great risk not only to her life, but also to her freedom.
Manipulations aimed at terminating the pregnancy of the pregnant woman herself or by other persons outside the hospital are called criminal abortion. The person performing this operation is punishable by law.
Often the reason for such a rash act is the desire of a pregnant woman to hide her interesting situation from relatives, relatives, parents, and sometimes even from her husband. Criminal abortions are carried out illegally, so often the process takes place in premises that are completely not intended for this. Unsanitary conditions, instruments not disinfected at a sufficient level can lead to the most terrible complications, infectious infections that lead to infectious-toxic shock, kidney failure and even death of the client.
Complications after a criminal abortion can cause enormous irreparable harm to women's health. The list of the most common complications includes: blood poisoning, festering of the internal genital organs, rupture of the uterine cavity, severe bleeding, drug poisoning, infertility, and sometimes criminal abortion can lead to death.
Termination of a late pregnancy is an unpleasant procedure, regardless of its cause. Understanding the severity of the consequences for the physical health and psyche of a woman, doctors carry out this procedure only in emergency cases.
Diagnosis before abortion
Termination of pregnancy in the later stages in most cases is associated with medical indications. If at an early stage (up to 12 weeks) an abortion can be performed simply at the request of a woman, then in a later period, a gynecologist rarely decides on surgery without appropriate indications and supporting documents.
The complex of diagnostic measures includes:
- examination on a gynecological chair;
- smears from the vagina, cervical canal and urethra;
- bacteriological culture from the cervical canal;
- general and biochemical blood tests;
- blood test for antibodies to hepatitis, HIV infection;
- blood test for syphilis;
- determination of blood group and Rh factor;
- X-ray or fluorogram of the chest;
- ultrasound examination of the pelvic area;
- Analysis of urine;
- therapist consultation;
- consultations of related specialists who have identified a pathology of fetal development or mother's illness.
A specially created commission, consisting of a gynecologist, related specialists and the head physician, decides on the termination of pregnancy after studying the patient's history. The commission also decides what type of abortion will be performed: in each case, the choice is made in favor of the least traumatic method.
After examining the reason for the termination of pregnancy, the data of the diagnostic examination, in the absence of contraindications, the commission issues a permit for an abortion and sends the patient to a medical institution.
Until the 22nd week of pregnancy, its termination is carried out in an abortion clinic located in the gynecological department of a medical institution. Over 22 weeks, surgery is performed only in an obstetric hospital.
Late pregnancy termination is always a risk not only for a woman's reproductive health, but also for her life.
The course of the operation and the rehabilitation period depend not only on the type of surgical intervention, but also on the individual characteristics of the patient's body.
Reasons for late abortion
The main reasons why women decide to terminate a pregnancy at a later date include:
- medical indications: severe anomalies in the development of the fetus or diseases of the mother that threaten her health and life;
- social indications: deprivation of parental rights, pregnancy as a result of rape.
The issue of the possibility of termination of pregnancy for a period of 12 to 22 weeks is decided by an expert commission. At the request of a woman alone, an abortion is not done at this time. After 22 weeks, artificial termination of pregnancy is also not carried out. In this case, the child born into the world is considered a newborn, and he needs special care and medical attention.
More about the causes of late-term abortion:
- Anomalies of intrauterine development, hereditary genetic diseases, chromosomal disorders are the main cause of late pregnancy termination.
- Viral infectious diseases, transferred by a woman in early pregnancy, can cause a child's disability and the development of congenital deformities that are incompatible with life. Of particular danger to the fetus are diseases such as rubella, toxoplasmosis, hepatitis, HIV infection. Bacterial infections are no less dangerous than the antibiotic therapy prescribed to eliminate them.
- Fetal fading (regressive pregnancy) at any time is a direct indication for its termination. This pathological phenomenon is very dangerous for a woman's life. The risk of sepsis and bleeding requires immediate removal of the dead fetus from the uterine cavity.
- mental illness diagnosed in a pregnant woman can cause a late abortion in case of complete inadequacy of the expectant mother or lack of support from relatives.
- Rape is also a reason for late pregnancy termination. In rare cases, a woman decides to keep the child.
- The decision to terminate a pregnancy at a later date may be caused by unfavorable social and living conditions for the unborn baby. These include: a woman's stay in places of deprivation of liberty, the deprivation of the mother of parental rights, the death of the child's father, and other circumstances.
Despite the above reasons, many women decide to have a late abortion only as a last resort. Support from loved ones helps to avoid an unpleasant procedure.
Ways to terminate a pregnancy at a later date
After 12 weeks, abortion is considered late. The maximum period for artificial termination of pregnancy is 22 weeks.
Termination of pregnancy can be medical or instrumental.
Medical methods
Instrumental methods
To prepare the cervix for abortion, the following methods are practiced:
- Introduction to the cervical canal of seaweed sticks(kelp) a day before a planned termination of pregnancy contributes to the expansion of the cervix by increasing the size of algae when absorbing amniotic fluid.
- Dilation of the cervical canal with the help of Hegar dilators, they are used from the 15th to the 28th week of pregnancy. The higher the gestational age, the more instruments will be used to dilate the cervix.
After dilating the cervix and opening the fetal bladder, the fetus is removed by the legs using Muso forceps. This method is very traumatic, time-consuming, threatens with tissue ruptures and secondary infection. To reduce trauma to the uterus, an incision is made in the fetal neck and a tube is inserted deep into the skull. The brain is then aspirated using a vacuum apparatus. As a result of the manipulations, the head decreases in size and freely passes through the vagina.
Possible Complications
Termination of pregnancy at a later date threatens the development of various complications:
- infection of the wound surface with pathogenic flora;
- infection of the ovaries and fallopian tubes (salpingitis and salpingo-oophoritis);
- in reproductive and neighboring organs;
- development of sepsis;
- uterine bleeding;
- perforation of the body of the uterus;
- thrombosis of blood vessels;
- pulmonary embolism;
- incomplete removal of the placenta or parts of the fetus;
- violation of the natural hormonal background;
- hypernatremia;
- infertility;
- miscarriage in the future;
- severe psychological trauma.
To minimize the risk of complications, it is necessary not only to choose a highly professional specialist for abortion, but also to follow his recommendations in the postoperative period:
- careful intimate hygiene;
- lack of sexual intercourse until the wound surface is completely healed;
- bed rest until the body recovers after surgery;
- a ban on lifting weights;
- antibacterial and anti-inflammatory therapy prescribed by the attending physician;
- regular visits to the gynecologist;
- consultation of a psychologist (psychotherapist);
- consultations of related specialists who observed the woman during pregnancy;
- immediate appeal for qualified help to a medical institution in case of any alarming symptoms;
- adequate contraception after an abortion.
Despite the reason why a woman decided to have a late abortion, one must understand the danger of the manipulations being carried out. Preventing unwanted pregnancies with contraceptives will reduce the sad statistics of abortions at any time.
Medical abortion is an artificial termination of pregnancy, which is carried out in a specialized institution by qualified specialists. The choice of the artificial termination method depends on the gestational age and is carried out with the written consent of the woman, having previously completed the relevant documentation. Medical abortion is done for a variety of reasons. A woman can terminate a pregnancy at her own request for up to 12 weeks. According to social indications, abortion is possible up to 22 weeks. For medical reasons, such an interruption is possible at any time.
Indications
A woman decides to terminate her pregnancy for reasons that may adversely affect the birth and future fate of the child and mother (change in personal life, absence of the father of the unborn child, financial difficulties, lack of housing). You can have an abortion of your own free will up to 12 weeks of pregnancy.
For medical reasons, abortion is performed in two situations:
- diseases in which pregnancy and childbirth can significantly worsen a woman's health and become a threat to life;
- severe fetal anomalies.
Termination of pregnancy is carried out at the conclusion of a gynecologist, the head of the institution and specialists of the relevant profile (oncologist, therapist, surgeon). This termination is carried out regardless of the gestational age after a written application from the woman, considered and signed by a commission specially created for this. For non-medical reasons, abortion occurs with the participation of a lawyer.
According to social indicators, pregnancy is terminated in the following situations:
- rape;
- disability or death of the husband during pregnancy;
- stay of a woman in places of deprivation of liberty;
- deprivation of parental rights.
The issue of abortion for social reasons is decided by a specially created commission, which gives an opinion with full execution of legal documentation.
An overview of the timing and methods of abortion is presented in the table
Examination before abortion
Required list of tests:
- general blood analysis;
- blood chemistry;
- coagulogram;
- analysis for the Rh factor and determination of the blood group;
- blood test for HIV, syphilis and hepatitis;
- general urine analysis;
- smear on flora;
- therapist consultation.
Interruption methods:
- medical abortion;
- surgical abortion: vacuum aspiration of the fetal egg and curettage of the uterine cavity;
- abortion with drugs;
- small caesarean section.
Surgical method
The surgical method or instrumental is the termination of pregnancy by scraping the uterine cavity. This method is not safe for the further reproduction of a woman. However, the surgical method also has undoubted advantages. Initially, it guarantees almost 100% interruption with complete removal of the ovum and membranes. Surgical intervention is carried out only in a specially equipped hospital.
For anesthesia, intravenous anesthesia is mainly used, which requires the presence of an anesthesiologist. After the introduction of anesthesia, the cervix is expanded mechanically. Then the gynecologist cleans the uterus with an instrument, removes the inner layer and the embryo with membranes. Medical abortion in this case lasts 15-20 minutes. After the operation, the woman remains in the ward for some time under the supervision of medical personnel. This procedure is included in the list of gratuitous services under the medical insurance policy.
vacuum aspiration
Vacuum aspiration, or mini-abortion, is a simple operation performed in many medical clinics. They do a mini-abortion, in the early stages, up to 6 weeks from the date of the last menstruation. A mini-abortion has practically no consequences, but there are cases when the vacuum-aspiration method of abortion may be incomplete, then it is necessary to repeat the operation or do a curettage of the uterine cavity.
Before the procedure, a woman is given an anesthetic and an antispasmodic for self-disclosure of the cervix. The procedure is carried out using an instrument that is inserted into the cervix and, with the help of an electric suction, pressure is created inside. The doctor very carefully circles the uterine cavity with an instrument and pulls the exfoliated fetal egg through the hole into a special container. The operation time is a few minutes.
Medical method
The medical method is the termination of pregnancy with the help of pills. Pharmacological interruption is carried out up to 6 weeks of pregnancy. The method consists in the use of drugs to suppress the secretion of hormones in the body and increase the contractile activity of the uterus. The drug method is optimal for nulliparous women.
Interruption with drugs
For a period of 14-22 weeks, the following means are used for abortion:
- prostaglandins;
- hypertonic solutions.
The use of prostaglandins leads to an increase in the tone of the uterus, which provokes the maturation of the cervix, detachment of the fetal egg and stimulates artificial labor. In the case of using hypertonic solutions, fetal death occurs and labor activity develops. In all these situations, a dead fetus is born.
Small caesarean section
The operation is carried out for a period of 13-22 weeks and only in cases where other methods are recognized as ineffective or unsafe. The procedure is also indicated if a woman decides to undergo surgical sterilization after an abortion. The technique for performing the operation is similar to a conventional caesarean section. After the procedure is completed, antibiotic therapy is performed. In the later stages, drugs are used to suppress lactation.
Complications after medical abortion
The most common complication is the retention of the fetal egg in the uterus. The main symptom of such a complication is strong discharge with blood clots, which do not stop for a long time. If the remains of the fetal egg are detected, it is urgent to contact a specialist and repeat the procedure in stationary conditions.
It should be noted: if a medical abortion was not performed professionally and with the remains of parts of the fetus in the uterus, then this can lead to disastrous results. The development of bacteria will immediately begin in the uterus, since the remains of the fetus are a favorable environment for their reproduction, which contributes to the development of various purulent diseases.
If you experience the following symptoms, you should consult a gynecologist:
- heat;
- copious discharge with blood clots;
- severe pain in the lower abdomen;
- the appearance of an unpleasant odor of secretions;
- dizziness, vomiting, fainting.
What to look out for after a medical abortion:
- After an abortion, it is advisable to consult a gynecologist about the use of contraceptives.
- The use of a bath or a hot shower is not recommended, but daily personal hygiene must be observed.
- Compliance with sexual rest, which is required to prevent and prevent infection from entering the uterus. The resumption of sexual relations is recommended not earlier than after 14 days.
- Going to the toilet regularly to empty the bowels and bladder: this has a beneficial effect on uterine contractions.
- Monitor body temperature daily, avoid hypothermia and exercise.
- Follow a proper diet.
- Give yourself more attention.
When the happiness of a pregnant lady is overshadowed by a formidable verdict of doctors, she has to decide on a serious step - an abortion for medical reasons. Such an interruption of gestation by an artificial method is carried out in two cases - if gross malformations are detected in the baby or if a woman has diseases that are incompatible with pregnancy. Depending on the period, the procedure is carried out by various methods, and the procedure takes place only in a hospital setting. Consider the official medical indications for abortion, what complications can occur and how to survive the "post-abortion syndrome"?
For medical reasons, pregnancy can be unplanned to stop at any time. The method of interruption is closely related to the gestational age.
Until the end of the 1st trimester, the so-called early interruption is undertaken. It is noteworthy that during the first trimester a woman has the right to request an abortion even without strong evidence. Taking into account the term and condition of the woman, the obstetrician will select the optimal method of interruption - instrumental or medical abortion.
After 12 weeks, a late termination of pregnancy is carried out for medical reasons. Between 12 and 22 weeks, various methods of interruption can be used, after 22 gestational weeks - only artificial stimulation of delivery.
The method of interrupting gestation depends not only on the term, but also on the clinical picture, the qualifications of the obstetrician-gynecologist, his experience and the technical base of the clinic.
Specialized medical institutions terminate pregnancy by the following methods:
- Medical interruption. Taking drugs that provoke a miscarriage is allowed for up to 6 weeks. It is the least harmful option for abortion.
- Vacuum aspiration. The safest option is abortion, which can be performed before 12 weeks of gestation. After 12 weeks, dilatation with embryo evacuation is practiced. The essence of the procedure is the mechanical expansion of the cervical passage and pumping out with the help of a vacuum installation of the fetus. The process takes place under strict ultrasound control. This eliminates trauma to the uterus. The woman is under anesthesia during the operation. The duration of the procedure is from 40 minutes to several hours.
- Curettage. A more traumatic option for removing the fetus from the uterus. It is carried out up to 12 weeks in case of ineffectiveness of taking abortive drugs or vacuum aspiration. Also, curettage can be carried out at a later date, if the gynecologist considers this option productive. The essence of the operation: using a curette (medical instrument), the obstetrician-gynecologist scrapes the upper layer of the uterus, capturing the embryo along with it. The method has many disadvantages, including a high probability of damage to the uterus, problems with subsequent conception and gestation.
- Artificial childbirth. If the woman is over 22 weeks and the fetus weighs more than half a kilogram or has no signs of life, it is advisable to induce labor so that the fetus comes out naturally. This eliminates possible complications after interruption by other methods.
- Hysterotomy. Used in emergencies. A cavity incision of the uterus is performed, followed by extraction of the fetus. After 24 weeks of pregnancy, it is considered a full caesarean section. It is used in cases where other methods have not given a positive result.
Legal aspects of abortion for medical reasons
Performing an abortion according to medical indications is a complex procedure not only from a medical, but also from a legal point of view. The decision to carry out the procedure is made on the basis of the current laws of the Russian Federation. Indications for termination of pregnancy contain an order dated December 3, 2007, as amended on December 27, 2011.
If a disease is confirmed in a pregnant woman that serves as a reason for interruption, the gynecologist convenes a council of doctors, at which a complete examination of the pregnant woman is carried out. If pathological processes in the body that are incompatible with the further bearing of the baby are confirmed, an appropriate document is drawn up with a seal. It is he who serves as the basis for the termination of pregnancy.
A woman, according to the law, should be aware of her condition, possible risks in case of refusal to have an abortion. The pregnant woman must consent to the procedure or deliberately refuse it. Without this, abortion is prohibited. If a woman is in a serious condition, permission or refusal to have an abortion is signed by the next of kin.
Artificial termination of pregnancy - medical indications
The decision to terminate prematurely is made when a woman's life is in danger or it has been established that the fetus has medical genetic disorders that, after birth, will lead to lifelong disability.
Medical indications for termination of pregnancy: diseases of a woman
According to the law, abortion for medical indications is carried out in the presence of the following pathologies:
- Age up to 15 years.
- Tuberculosis: all active forms.
- Rubella: primary infection in the first trimester.
- Malignant oncological diseases, the treatment of which requires chemotherapy or radiation therapy to the pelvic organs.
- Diabetes mellitus: with severe nephropathy, after kidney transplantation, with progressive diabetic retinopathy.
- Burnet's syndrome in severe form and active phase.
- Acromegaly in the active phase.
- Prolactinoma (in case of resistance to dopamine agonists and chiasmal disorders).
- The active phase of Itsenko-Cushing's syndrome.
- Primarily diagnosed acute leukemia.
- myelodysplastic syndromes.
- Lymphomas at high risk.
- Hodgkin's disease stage 3-4.
- Chronic myeloid leukemia: in the terminal stage or requiring therapy with tyrosine kinase inhibitors.
- Chronic myeloproliferative diseases in the final phase.
- Severe form of aplastic anemia.
- Hemolytic anemia, accompanied by acute hemolytic crises and severe recurrent course.
- Chronic, constantly relapsing course of Werlhof's disease, which is unresponsive to any type of treatment.
- Porphyrin disease: an acute attack occurring less than 2 years after the last exacerbation.
- Mental disorders: chronic and protracted, hereditary and degenerative, caused by the use of psychoactive drugs, affective and severe psychogenic disorders.
- Inflammatory diseases of the CNS.
- Severe course of Huntington's disease.
- Severe course of Charcot's disease.
- Severe forms of parkinsonism.
- Generalized handicaps of dystonia.
- Progressive course of multiple sclerosis.
- Severe epilepsy.
- Acute disorders of cerebral and / or spinal circulation.
- Narcolepsy, catalepsy.
- Damage to the nerve roots and plexuses.
- Severe Guillain-Barré syndrome.
Important! In case of refusal, the woman takes responsibility for her life, as well as the health of the unborn baby.
List of medical indications for abortion: fetal pathology
List of indications for medical interruption in case of irreparable pathologies of the fetus:
- Ascertaining the intrauterine death of the baby.
- Detected genetic anomalies in the development of the fetus.
- Physical deformities of the fetus incompatible with life after birth.
When the above anomalies are detected, a number of additional tests and studies are carried out to make sure the diagnosis is correct. After that, the woman is explained the expediency of an abortion, and with her consent, the pregnancy is terminated.
Social indications for abortion
According to the order of the Ministry of Health of the Russian Federation, a woman has the right to independently make a decision to terminate a pregnancy for up to 12 weeks of gestation. After this period, she must have strong medical indications, which are documented during the examination.
But there is another reason for interruption - the social factor. Thus, a decree of the government of the Russian Federation gives a woman the right to consult a doctor for subsequent termination of pregnancy up to 21 weeks in case of conception that occurred as a result of rape. In this case, the interruption is carried out within the framework of the state health insurance program.
Late termination of pregnancy: medical indications, contraindications, complications
Late is called interruption at the 2nd, 3rd trimester of gestation. The indications for abortion are the same as in the early stages - fetal deformities, severe illness of the pregnant woman, incompatible with pregnancy, taking teratogenic drugs, transferring viral infections that disrupt the development of the fetus (rubella), etc.
Late termination of pregnancy for medical reasons may be undesirable due to the woman's contraindications:
- Rhesus conflict.
- Pathology of blood clotting.
- Exacerbation of infection of the genitourinary system, including the development of STDs.
- Long-term corticosteroid therapy.
To ensure the safety of abortion in the 2nd and 3rd trimesters, the woman is carefully examined. Be sure to conduct an analysis for the definition of genital infections, a clinical blood test, biochemistry indicators, ultrasound, a cardiogram. If the cause is a genetic abnormality in the fetus, the amniotic fluid is examined to confirm the diagnosis.
It is known that the earlier the interruption occurs, the less complications there will be. For this reason, late interruption for medical reasons is carried out with great care. But this does not exclude the risk of developing negative consequences for a woman, namely:
- damage to the uterus;
- infection of the uterus and appendages as a result of incomplete extraction of the fetus;
- endometritis;
- adhesive process;
- hormonal dysfunction;
- endometriosis;
- secondary infertility.
Important! Given the large list of complications, a future pregnancy after an interruption for medical reasons may not go as smoothly as we would like. Therefore, pregnant women with a honey abortion in the past should be under the close care of a doctor.
How to survive a medical abortion
When you have to consciously abandon an unborn, but already dearly beloved baby, a woman plunges into a state of extreme stress. This is a real test for her and her loved ones. How to cope with this pain of loss and find the strength to live on?
- To begin with, realize that without a personal desire to experience it, you will not succeed. After all, it is impossible to help a person who does not want it. Open up to your loved ones, accept their support.
- Now you need to accept the fact that you agreed to the interruption. You should not blame yourself for something, because the circumstances with this pregnancy did not depend on you. Finally accept the fact that you are not to blame for what happened, and forgive yourself. Without this step, all further actions will be in vain.
- Another effective method will help: try to speak out. A psychologist, a friend, a husband can listen to you. Most importantly, do not fight with memories alone. It does not hurt to be in comfortable conditions - in the park, in the theater, at a cultural event.
- Pay special attention to health. Be sure to take a rehabilitation course prescribed by an obstetrician-gynecologist. Also take steps to prevent pregnancy in the next 2-3 months.
Termination of pregnancy for medical reasons - reviews
Most cases of forced termination of pregnancy occur due to the formation of malformations of the baby. Women who experience this experience depression, blaming themselves for what happened. Doctors call this condition "post-abortion syndrome." Many women need to correct their psycho-emotional background with the participation of a psychologist, but some cope with the help of loved ones.
As for complications after the procedure, women often note a short-term hormonal imbalance, which is manifested by an irregular cycle, abnormal discharge, and problems with conception. But properly formulated treatment allows you to normalize reproductive function.
No matter how hard it is, stay positive. Of course, the forced termination of a desired pregnancy is very difficult to survive, but you have another pregnancy ahead of you and a long-awaited meeting with your baby. Therefore, try to come to this moment in good health and good spirits.