Abortion is any termination of pregnancy: spontaneous or caused by human intervention. And if the first (popularly known as miscarriage) occurs as a result of the influence of external factors or health conditions on a woman’s body, then the reason for the second (i.e., artificial termination of pregnancy) lies in the woman’s reluctance to become a mother or in her inability to bear and give birth to a healthy child. It is about medical abortion, or more precisely about which method of termination of pregnancy is better to choose, that will be discussed further.
What can an abortion be like?
The content of the article
Doctors distinguish several methods of artificial abortion:
- medicinal;
- vacuum aspiration;
- saline abortion;
- surgical intervention: curettage, minor caesarean section, etc.
The choice of method depends on a number of factors, including the length of pregnancy (up to 5-7 weeks, up to 12 weeks, later), age and health of the woman. It is important here to contact a gynecologist as early as possible and discuss the current situation with him.
So what are the features of various abortion methods, what determines their choice, what advantages they may have and, most importantly, consequences?
Medical indications and contraindications for any type of abortion
The absolute indications for any type of abortion include the following factors:
- woman's age over 35 years;
- presence of 3 or more children;
- disability or genetic pathology in a previously born child;
- developmental abnormalities of the embryo or fetus;
- threat to the life and health of the mother associated with pregnancy and childbirth.
You cannot force a woman to have an abortion. If the indications are valid, the pregnant woman is warned about possible risks and consequences, but the final word remains with her.
A doctor has the right to refuse a woman an abortion if there are circumstances that pose a threat to her general and reproductive health. It is highly likely that an abortion will be refused in the following cases:
- underage girls without the consent of their parents/husband/guardian;
- a surgical abortion will not be performed if the patient has diseases for which anesthesia cannot be administered (bronchial asthma, heart disease, epilepsy);
- when a woman has diseases of the reproductive system (no ovary, uterine fibroids), and an abortion will make her infertile;
- in case of critical hormonal imbalances.
Medical abortion
The very name of the method indicates that the course of pregnancy is interrupted by taking special medications, or rather, tablets. For a number of reasons, this can be done early (up to 7 weeks) and only under the supervision of a doctor.
The essence of medical abortion is that a woman takes pills (usually Mifegin, Mifepristone, Mifiprex) that prevent the production of progesterone in her body. As a result, the fertilized egg, which does not receive the hormone important for its development, dies, then, after taking special additional medications, it is rejected by the woman’s body and spontaneously leaves the uterus through the dilated cervix. Thus, with a medical abortion, the same miscarriage occurs, only specially provoked.
The advantage of this method is that the female genital organs (cervix and uterine wall) do not experience any mechanical influence from the outside. It is for this reason that it is recommended for girls who have not yet given birth.
Despite the fact that medical abortion is recognized as the safest of all existing methods of abortion, it can lead to some consequences:
- bleeding - when taking pills, you need to make sure that the discharge is not very heavy;
- incomplete rejection of the fertilized egg - in this case, curettage is additionally used;
- hormonal imbalance in the female body, and this is a change in the menstrual cycle, thyroid function, etc.
For these reasons, a medical abortion should be carried out under the supervision of a doctor, who will definitely clarify the gestational age, prescribe preliminary tests and assess the woman’s health, and conduct 2 ultrasound procedures: before the abortion and two weeks after it. This will ensure that the termination of pregnancy will take place as planned and without consequences.
Metal hooks, knitting needles, hangers
One of the most popular methods of mechanical abortion for many decades. The cervix is dilated with knitting needles, the embryo is pierced or hooked, and pulled out. This method caused the death of Natalya in Sholokhov’s “Quiet Don” and tens of thousands of real women. “And your butterfly was so butchered that it has nothing to live with... The uterus is torn, there is literally no living space. Apparently, the old woman was using an iron hook,” says the old Don paramedic at Sholokhov’s. The method is fraught with perforation of the uterine walls, peritonitis, and heavy bleeding. There is no need to think that hooks and knitting needles are a thing of history. In Lars von Trier's Nymphomaniac, the heroine performs an abortion on herself using improvised means, after boiling a hastily made wire hook in an electric kettle. Trier shows the entire procedure in as detailed and naturalistic a manner as possible.
Abortion using a vacuum device
Usually they resort to it if no more than 5-7 weeks have passed since conception. This method is also considered the least traumatic for the female body, since the fertilized egg is sucked out of the uterus through a special catheter probe connected to a vacuum apparatus pump.
The advantages of vacuum aspiration (popularly known as mini-abortion) are obvious: a thin probe, which is inserted through the cervix without dilation, does not injure the female organs at all, and the rejection of the fetus, which still has weak connections with the walls of the uterus, occurs due to the creation of a negative pressure. It is only important not to miss the deadline and in the future make sure that the fertilized egg is completely extracted.
Modern technologies make it possible to carry out vacuum aspiration with virtually no consequences for the female body. However, this procedure has a number of contraindications:
- less than six months have passed since the previous abortion - any abortion;
- ectopic pregnancy;
- the pregnancy period is more than 5 weeks (maximum - 7) - in this case, the fertilized egg is already quite firmly attached to the walls of the uterus, which significantly complicates its peeling and suction;
- the woman suffers from any inflammatory diseases, including purulent infection of any part of the body.
The entire procedure is carried out under local anesthesia - general anesthesia is used only in exceptional cases - for 10-15 minutes. A woman can go home almost immediately. Next is maintaining personal hygiene and visiting the gynecologist at the appointed time.
Catapult
This method of criminal abortion was practiced in Soviet military camps. The catapult simulator for military pilots to practice emergency escape from an airplane is an excellent way to provoke a miscarriage. One seat flight is usually enough. Serious overloads simply tear the fetus away from the uterine wall. A miscarriage provoked in this way leads to extensive uterine bleeding.
Illustration: Rita Cherepanova for TD
Termination of pregnancy at a later stage
If in the early stages of pregnancy a woman and her gynecologist are given the opportunity to choose: to resort to a medicinal method or vacuum aspiration, then at a period of 7-12 or more weeks, as a rule, saline abortion or surgical termination of pregnancy remains.
The first involves the introduction of a special hypertonic solution of sodium chloride into the amniotic fluid, causing fetal death. After a couple of days, the doctor provokes contractions of the uterus, as a result of which the fertilized egg is naturally released. It should be noted that such a procedure is not considered highly effective and, moreover, takes a long time. Therefore, saline solution is used extremely rarely - if it is impossible to use another, more effective method.
The most common way to get rid of an unwanted pregnancy for a period of 7-8 to 12 weeks remains curettage. Such an abortion should be performed only in a hospital, by an experienced doctor, and preferably with the simultaneous use of ultrasound. As a rule, the procedure is performed under local anesthesia, less often - mainly at the request of the patient under general anesthesia.
The gynecologist mechanically - using special instruments - expands the wall of the uterus, then, using a curette and forceps, scrapes out and removes its contents. Risks: the cervix and walls of the uterus often suffer from mechanical impact, which subsequently leads to inflammatory processes and the development of gynecological diseases, including infertility. Moreover, the longer the pregnancy, the more likely complications after an abortion are.
Abortion for a period of 12 or more weeks is carried out only for medical reasons, and after 22 weeks, surgical intervention during pregnancy is called artificial premature birth or a minor cesarean section. During the latter, the patient’s lower segment of the uterus is dissected and the fertilized egg along with the placenta is removed from it. A similar method is also used if sterilization is expected after an abortion.
What should you remember when choosing the type of abortion?
In order for a woman who wants to get rid of an unplanned pregnancy to have an alternative when choosing an abortion method, there are several things to remember.
The shorter the pregnancy, the greater the likelihood that the abortion will take place with minimal consequences. Therefore, you need to contact a gynecologist in the first days of a delayed menstrual cycle. This will allow you to timely assess the woman’s health and choose the most suitable method for terminating the pregnancy.
You should not trust advertising and advice from friends. For example, pills for medical abortion can be bought at a pharmacy. This is where the danger lurks - if they suddenly do not suit the woman or if the fertilized egg is rejected incorrectly, then even in the early stages you will have to resort to surgical abortion. Yes, and hormonal imbalance, the occurrence of which could be predicted during tests and examination of the medical record by a gynecologist, can cause enormous harm to a woman’s health.
When choosing an abortion method, you should not forget about such important things as the equipment of the clinic and the qualifications of the doctor.
The birth of a baby is a long-awaited event in the life of most women. However, there are situations when continuing pregnancy is undesirable for medical or other reasons. And a qualified gynecologist who is able to correctly assess the health status of his patient and then individually select for her the most gentle method of terminating a pregnancy should be a faithful adviser in such a situation.
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Tests and algorithm for examining a woman before an abortion
- If menstruation is delayed and pregnancy is suspected, it is wise to start with a test for the presence of human chorionic gonadotropin hormone (hCG) in the woman’s body. At home, women use a regular “two strip” pregnancy test for these purposes, and when preparing an abortion, a blood sample is tested for hCG in the laboratory. The patient consults a gynecologist, the duration of pregnancy is clarified.
- Then an ultrasound examination (ultrasound) is performed, which determines the presence of a fertilized egg in the uterine cavity. Confirmation of intrauterine pregnancy by ultrasound is a prerequisite before an abortion (ectopic pregnancy is excluded).
- At an appointment with a gynecologist, the uterus is examined and the discharge from the genital tract is assessed. A smear is taken to determine the degree of vaginal cleanliness and oncocytology. If there is inflammation in the smear or inflammatory discharge during examination on the gynecological chair, sanitation of the genital tract is prescribed. It is impossible to perform an abortion if there is an infection - with instruments for performing an abortion and dilating the cervix, microorganisms from the vagina will spread higher into the uterus and fallopian tubes.
- A general clinical examination is also prescribed: a general blood and urine test, determination of blood group and Rh factor, blood testing for syphilis, HIV infection, hepatitis B and C.
- An ECG result and an examination by a therapist are needed before using intravenous anesthesia (usually an abortion at a period of more than 5 weeks requires complete pain relief).
- If a woman has concomitant diseases, the scope of the examination can be expanded. For example, in case of blood diseases, severe anemia, bleeding during surgical procedures, studies of the blood coagulation system are previously prescribed.
- When a patient first approaches an unwanted pregnancy, the gynecologist should refer her for a consultation with a psychologist, if there is one at the pregnant woman’s place of residence. In large cities, antenatal clinics are creating special medical and social rooms to support pregnant women who find themselves in difficult life situations.
