May 21, 2011
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Abortion - Termination of pregnancy up to 22 weeks, accompanied by the destruction of the embryo or fetal death, incapable of independent existence. There are spontaneous abortions and artificial interruptions, which are divided into early, up to 12 weeks, and later, more than 12 weeks. The world produces 40-60 million abortions a year, and quite a lot of such interventions can be carried out illegally in the relevant conditions are not favorable medical reasons. Such action often leads to complications in some cases, loss of efficiency or fatal consequences.
Early abortion
Early abortion - Abortion in the early stages is carried out by the decision of the woman. Often abortion is a method of family planning, rather than safer methods of using contraceptives. In any case, women should understand that there are no safe abortion. Doctor convincing the patient that early abortions are safe compared with late interrupts can not be considered a competent, professional, each doctor knows that's not true.
Pregnancy even at low timing causes changes in a woman's body. There is a reconstruction of many systems, the first changes occur in the nervous and endocrine systems. From the moment of fertilization, the body produces more hormones, releasing substances such as Estrogens . progestins . prostaglandins That cause changes in the ovaries, uterus, mammary glands. Abortion provokes sharp hormonal failure in the body, which are suffering as a result of all hormone-dependent organs. Disrupt the normal operation of the endocrine glands, ovaries, adrenal glands and the thyroid gland. Therefore, the first disorders after abortion are violations of autonomic dysfunction, nervous disorders, depression, nervosa and other abnormalities.
Before the procedure, abortion should undergo some laboratory tests. And only after that a woman is allowed to have an abortion. This is important, as each method has its own contraindications, failure, which can lead to complications after abortion. ALWAYS general blood analysis , Smear analysis hCG on syphilis - RW, hepatitis B and C, HIV, is blood coagulation . At a later date list can be supplemented at the discretion of the physician, further analysis of the case and in the case of pathology.
Medical abortion
Quite common method of abortion for a period of 2 to 8 weeks. In fact, this method is the drug provocation of an organism to a spontaneous abortion or miscarriage. Today, it becomes a better alternative to surgical interruption. It is recommended to use this method to 4 weeks, as the fertilized egg is still poorly attached to the uterus and the effectiveness of the method above. In addition, hormonal changes the body, still poorly expressed that avoids many of the consequences of abortion.
In fact, medical abortion is taking steroid mifepristone . It means provoking the death of the fetus and blocking the action of progesterone. The drug is taken strictly under medical supervision and control in the next two hours. The dose of mifepristone was 600 ml. That is sufficient for the death of the fetus, increasing the sensitivity of the myometrium to oxytocin causes uterine contractions. After 36-48 hours after administration of the first drug the patient should take analog prostaglandins It can be 400 g Misoprostol orally or 1 mg hypersimple vaginally. These funds provoke the expulsion of the fetus from the uterus.
Before taking mifepristone should be mandatory to pass ultrasound to confirm a normal pregnancy and its duration. The survey is conducted due to contraindications to the drug. Mifepristone is not suitable for a period exceeding 49 days from the first day of last menstrual period - amenorrhea . When the drug is contraindicated ectopic pregnancy , Chronic diseases of the adrenal glands, severe asthma, problems with blood clotting. Do not take it the same way and with the infectious-inflammatory processes of the reproductive system, as it contributes to the spread of infection. The general contraindications include expressed exhaustion, kidney and liver failure and allergy to the components of the drug.
Ultrasound examination is repeated after abortion and after 8-14 days, for that would ensure complete expulsion of the fetus. In the case of incomplete abortion held vacuum aspiration abortion or instrumental. But such cases are not much, as only 2% of women are resistant to the drug.
Complications from abortion through mifepristone can be of a different nature. In 5% of cases of complications appears profuse bleeding that lasts longer due. In 10-45% there are very frequent contractions of the uterus. In rare cases, women who have had previous cesarean section, uterine rupture can occur.
Side effects of mifepristone on the part of the digestive tract are shown moderate or mild abdominal pain, nausea and vomiting. Less common cases of increased blood pressure, cause allergic rash, urticaria, erythema and epidermal necrosis. Sometimes it may appear vegetative disorders, fever, chills, dizziness, or flushing.
Vacuum aspiration or mini-abortion
The method is widely used for abortion for a period of 3 to 6 weeks. Its popularity is due to the use of simple technology, aseptic, in the usual outpatient basis. Anesthesia is used for nulliparous patients, and is a local anesthetic, sometimes made complete anesthesia lasting a few minutes. The period of the return to normal life of the patient for 1 hour, which is associated with a painless procedure and the absence of surgical trauma.
Mini abortion is often carried out without the extension of the cervix in nulliparous patients and with a slight expansion in nulliparous. In the second case uses metal dilators that open the cervix only in so far as is necessary to enter the abortive instruments. This makes it possible to avoid injury to the neck. To determine the need for expanders use a probe if it is difficult to use the introduction of anesthetics and expanders. After that is entered into the uterus Aspiration Catheter Connected to a syringe or elektroaspiratoru. The catheter is made violating the integrity of the ovum and its aspiration.
After the procedure, it is advisable to carry out ultrasound in 7-10 days, as there are cases of incomplete abortion, and the fertilized egg is in the uterus. In this case, the tool is used abortion.
The principle of vacuum aspiration is using a suction abortion instrument egg without breaking the uterine lining, it allows you to avoid such complications like cervical incompetence and neurodystrophic processes endometrium. But the difficulty of accurate diagnosis of pregnancy and the exclusion of ectopic pregnancy. Complications from abortion are limited by pain in the abdomen, which are very similar to menstrual cramps, menstrual disorders, inflammatory diseases and hormonal disorders.
More serious complications after an abortion is, for example, pnevmoeboliya , It arises from the ingress of air into the circulatory system forming air thrombus which occludes a major vessel. This complication is extremely rare, since modern vacuum aspirators do not admit the possibility of air entering into the uterus. But illegal abortions using obsolete tools is a complication often leads to lethality. Another complication is the perforation of the uterus and the wounding of related bodies. This may occur when the lack of qualification of the expert conducting an abortion. Perforation of the uterus occurs during sensing her uterine cavity of a metal probe.
Abrasion Tool or abortion
In the past, the most common abortion procedure. To date, it is carried out less frequently, since it has a more serious complications than other methods of abortion small period. Abortion performed on period of 6-12 weeks, and only in a hospital. During the abrasion cervix open with metal stents, after which the doctor scrapes the fertilized egg along with the placenta and the uterine lining. For curettage used a special tool - curette Therefore, such a procedure is often called curettage .
The procedure is performed under general anesthesia, which is selected depending on the individual characteristics of women. It can be as an intravenous anesthetic, so an epidural or endobronchial anesthesia. In the second case, the inhalation drug is administered into the trachea using a special tube. But any of these types of anesthesia should be performed anesthesiologist after the necessary analyzes.
When abortion is performed instrumental vaginal ultrasound guidance sensor, and after the procedure is carried out inspection of the uterine cavity gistereskopom . But often such inspections a loss in connection with the introduction of anesthesia and completely eliminate the complication is almost impossible. Therefore, treatment is prescribed after an abortion, to prevent complications such as bleeding and infection.
The most common complications are bleeding after curettage, cervical spasm because of what in the uterus formed blood clots that trigger inflammation. With this complication requires repeated scraping and further treatment. Much rarer cases such complication as a breakthrough of the uterine wall, in which there is severe bleeding, peritonitis, trauma of the abdominal cavity. When an illegal abortion instrumental virtually all the complications are dangerous to a woman's life, because often there is no opportunity or time to help the doctor tries to hide the fact of illegal abortion.
Late abortion
Unlike earlier abortions, abortion after 12 weeks of fetal development can not be solved only by women. Such intervention must be authorized by a special commission, where a pregnant submit an application. In the later stages of abortions carried out either for medical or social reasons. In the first case, an abortion is performed in severe fetal development, his frailty, serious illness pregnant are not compatible with pregnancy, when the mother's life is placed above the life of another child's birth. Social reasons, which allow to carry out an abortion can be a pregnancy resulting from rape, refugee status, death or disability 1-2 group husband, lack of housing, large families or the status of single mothers.
It should be noted that abortion in late pregnancy often leads to complications. Such procedures must be performed in a specialized hospital. But as you know the choice of method of abortion is often not based on medical conditions, and depending on the material possibilities women. The world spends a lot of illegal late-term abortions, which in almost all countries is considered a crime by how patient and physician.
Vacuum curettage
For a period of 6-14 weeks is the procedure of termination of pregnancy, in which the combined two other methods - vacuum aspiration and abrasion. Abortion occurs according to the principle of the first method, but the difference is that in the uterus thin tube is introduced, which is connected to vacuum suction. With its help the body break in pieces and removed the fetus from the uterus, followed by scraping the control to avoid complications. This operation is used general anesthesia and intravenous solutions oxacillin . This drug helps uterine contractility.
Vacuum curettage at time of 13-22 weeks of pregnancy is carried out slightly differently, since the size of the fruit does not make it possible to use vacuum suction. In this case, the cervix dilates much broader than abortion in the early stages, the major part of the body of the fetus is removed with forceps and only then use the suction that removes small parts of the body of the fetus, placenta and caul. Then spend control scraping.
Complications after such an abortion include inflammation of the genital organs, infectious diseases, severe uterine bleeding . There are often damaged cervical subsequently lead to erosion and neoplastic diseases. There is a strong hormonal disorders, adhesions, failure of the menstrual cycle. All this leads to infertility and nurturing future pregnancies. The last complication is most likely to occur when the first interruption of pregnancy.
Gisteromiya
Gisteromiya - Similar caesarean section that includes general anesthesia, a long postoperative period, and all the complications associated with caesarean section. This method is used in rare cases for special reasons, so its use is limited as the high rate of mortality and morbidity. Gisteromiya a complete operation that requires examination and preparation of the patient.
Artificial birth
From 13 to 22 weeks, and often 21-22 weeks, abortion is used, which is called artificial birth . This method is based on the induction of labor, in which 24-36 hours miscarriage occurs. For medical maternal artificial birth appointed in the case of diseases of the central nervous system, renal failure, when diabetes and blood diseases. From the testimony of the child are chromosomal abnormalities, fetal malformations, fetal death in utero.
Saline Abortion
Saline Abortion is poured into a bag of sodium chloride from the amniotic fluid. Pre membranes of pumped 200 ml of amniotic fluid, which is introduced instead of 20% saline solution. Under the influence of the solution and the fetus dies after 24-48 hours using prostaglandins to induce labor contractions. In some cases the prostaglandins and oxytocin administered with brine. What increases the efficiency rate, but this method often during the interruption of children born viable. For this reason, the saline abortion is performed much less frequently than instrumental.
Late medical abortion
Medical abortion at a late stage of pregnancy is considered to be quite an outdated method. It involves taking a patient hormone prostaglandin Which provokes a slow dilatation of the cervix and causes contractions. This procedure is very painful and quite long. Therefore, today in such abortion using a combination of mifepristone and prostaglandin. But this combination leads to the birth of a living child with severe abnormalities. Therefore, this method is much inferior saline abortion in their humanity.
If the patient is contraindicated artificial birth, termination is performed by alternative methods. In the case of contraindications to all processes assigned gisteromiya . These contraindications may be some violations of the cardiovascular system, central nervous system, placenta previa, the presence of scar due to previous cesarean section. Complications occur more frequently for a shorter period than at 21-22 weeks of pregnancy, it may also be bleeding, and pelvic inflammatory disease, and 2, 5% of incomplete abortion.
Complications from abortion
The most common complication after abortion is bleeding . Such complications occur when there is insufficient hormone support the endometrium. In some cases it may be caused by trauma vagina, cervix, or uterus. Sometimes such damage tools or chemicals cause excessive bleeding. For example, this complication occurs when using certain anesthetic drugs that act on the uterine contractile function.
Bleeding can occur in the presence of residual fetal tissue in the uterus. Less uterine bleeding occurs when a blood coagulation disorder, the development of which can be caused by severe infection, administration of hyperosmolar solutions, scraping in the later stages. Missed miscarriage and cause severe bleeding.
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