Abortion

Description:

Abortion, or abortion, abortion in term up to 28 weeks is called. All abortions can be divided on spontaneous and artificial. To spontaneous the abortions which took place spontaneously treat without any intervention. Artificial abortion is called abortion in an obstetric and gynecologic hospital. And the abortions made out of hospital are considered as criminal. Operation of abortion is performed only by the doctor the obstetrician-gynecologist. For carrying out various interventions directed to abortion by other persons criminal liability is provided.

Now it is made:

    * Abortion in early terms up to 12 weeks is made at the request of the woman in the absence of contraindications.

Necessary inspections:

    * Gynecologic survey (for establishment of existence of pregnancy and determination of its term), in certain cases for confirmation of pregnancy is used by immunoassays and ultrasonography.
    * The smear from a vagina and an urethra undertakes for an exception of infectious process of generative organs.
    * Blood test on RW (syphilis) and HIV infection.
    * Blood test on blood typing and a Rhesus factor.

Contraindications for abortion are acute and subacute inflammatory diseases of female generative organs, acute infectious diseases and inflammatory processes of any other localization. Artificial abortion can be made only after elimination of inflammatory processes as existence of the centers of an infection in an organism, represents big risk of development of complications after an operative measure.

In certain cases in term up to 12 weeks interrupt pregnancy and on medical indications (it conditions of the woman at which incubation pregnancy and childbirth is threat for her life).

Medical indications for abortion is the following:

  1. Diseases of cardiovascular system with circulatory unefficiency signs.
  2. Blood diseases (leukoses, lymphogranulomatosis).
  3. Serious chronic illness of lungs.
  4. Peptic ulcer of a stomach and duodenum, chronic diseases of a liver, cholelithiasis.
  5. Diseases of kidneys and lack of one kidney.
  6. Tuberculosis (open form, tuberculosis of bones and joints, etc. bodies)
  7. Diseases of endocrine organs (severe damages of a thyroid gland, diabetes mellitus).
  8. The undergone heavy surgeries.
  9. Diseases of joints.
  10. Existence in the present or in the past of malignant tumors.
  11. Serious diseases of eyes.
  12. Hearing disorder (full deafness, surdomutism).
  13. Syphilis, HIV infection.
  14. Mental diseases (psychoses, schizophrenia, weak-mindedness, epilepsy).
  15. Severe defeats of a nervous system.
  16. The pregnancies of a disease transferred to time causing malformations in a fruit (a rubella, a Cytomegaloviral infection, a toxoplasmosis).
  17. The pregnancy complications posing a threat of life of the woman (severe forms of early and late toxicosis, the stood pregnancy).
  18. The fruit malformations revealed during inspection of the pregnant woman.
  19. Age of the pregnant woman up to 16 years.

For abortion up to 12 weeks are used:

Mini-abortion (operation of vacuum aspiration of fetal egg)

Vacuum of aspiration is allowed to perform operation of abortion by method at a periods delay no more than 20 days. It is carried out in clinic for women or a gynecologic hospital.

The procedure of abortion carry out without expansion of the channel of a neck of uterus, by introduction to a cavity of the uterus of the tip attached to the device creating vacuum, as a result the fetal egg having weak communication with a uterus wall in early durations of gestation easily separates. Issues of anesthesia are resolved individually. As a rule, operation is performed under a short-term intravenous anesthesia or a local anesthesia.

After operation the woman within 1-2 hours has to be in specially allocated restroom under observation of medical personnel.

Uterus scraping

Operation is performed in a gynecologic hospital, as a rule, under intravenous anesthesia. Local anesthesia at which novocaine solution is entered into a neck of uterus in this case does not provide sufficient anesthesia therefore it is practically not applied. Now intravenous anesthesia by means of drugs of Sombrevinum and Kalipsolum is widely used. Operation is performed thus: in the beginning make preliminary expansion of the channel of a neck of uterus special dilators, and then delete fetal egg by a scraping of a cavity of the uterus with the curette. Having removed fetal egg, carry out a control scraping of walls of a uterus to be convinced that the fruit and covers are removed completely, a uterus it was reduced in a size and bleeding is absent.

After operation the woman is transported in chamber, administer the drugs reducing a uterus, watched its health, pulse, arterial pressure, the nature of allocations from a genital tract. In the absence of complications the woman is written out home next day.

To all women about a Rhesus factor - negative accessory of blood, for prevention of development of complications during the following pregnancy, within 72 hours after abortion enter antirezusny gamma-globulin.

Vacuum aspiration is more sparing method in comparison with a scraping of a cavity of the uterus as is followed by minimile blood loss and traumatization of fabrics. The histologic research of the material received at operation of abortion showed that at abortion by means of the curette there is not only a removal of fetal egg, but also traumatization of a basal layer of an endometria, and also a muscular layer of a uterus. At a research of the contents of a uterus received at aspiration, layers of a basal layer and elements of a myometrium met slightly less often.
During operation of artificial abortion at rejection of fetal egg there is traumatization of vessels of a uterus owing to what there is bleeding. Usually this bleeding happens small as in the first weeks of pregnancy there is no dense communication of egg from a mucous uterus yet and during its removal vessels of big diameter are not injured. Average blood loss at pregnancy of 6-9 weeks makes 151±31мл, when carrying out operation by a vacuum aspiration method blood loss is slightly lower.

Abortion by means of prostaglandins

Tablet about which told the whole world of RU 486, or mifepristone it is invented in France by the doctor of Etinne-Emile Baulieu in 1980. For the first time the medicine was presented in the homeland, and its action was checked for 4 000 women soon. Hundreds of scientific research in 20 countries, including the CIS were carried out. Today the medicine is allowed for use only in England (about 6% of all abortions), France (20% of women resort to RU 486), Sweden (17%) and China.
In Ukraine the RU 486 capsules are prohibited to use. Motive - high percent of complications, namely: trophoblastic diseases (in a uterus there is a part of a germ).

Abortion in late terms

In later terms from 13 to 28 weeks pregnancy is interrupted only on the medical (listed above) or social indications. For abortion treat social indications:

  1. Possession of many children (presence of 3 and more children).
  2. The death of the husband during pregnancy.
  3. A divorce during pregnancy.
  4. Presence of the child of the disabled person.
  5. Deprivation of the maternal rights.

The main way of abortion of late terms is intraamnialny (inside the shell) introduction of hypertonic salt solutions. The technique at what the sterile tube with a length a needle which the bag of waters is punctured is entered into the canal of a neck of uterus is used, a part of amniotic waters is produced, and then the same quantity of hypertonic salt solution is entered into a cavity of amnion. Administration of drugs of oxytocin and prostaglandins is in addition applied to acceleration of abortion.