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Medical way to terminate pregnancy drugs. Complications after a pharmacist for a woman and how to avoid them. Bleeding from the reproductive organ

Medical methods of abortion are based on the use of drugs of various groups that affect the function of the corpus luteum and the contractile activity of the uterus, which leads to termination of pregnancy.

Medical termination of pregnancy is considered effective in the case when there is a complete expulsion of the products of conception from the uterus without the use of surgical intervention. Medical abortion is performed after confirmation of pregnancy and the establishment of its term. In the Russian Federation, it is allowed to use medical abortion up to 6 weeks of pregnancy. Considering that the success of medical termination of pregnancy largely depends on the gestational age, the latter is best confirmed with a transvaginal ultrasound.

With medical abortion, medical supervision of the patient should be more intense than with surgical methods of abortion. After the examination and signing of a written informed consent for the manipulation, the woman takes the drug in the presence of a doctor. In some cases, it is necessary to observe her for 3-6 hours. In cases where the combined method is chosen, the woman visits the doctor at each dose of the drug. After 4 weeks, a woman's examination is indicated to confirm a successful termination of pregnancy.

In the case when medical abortion is ineffective, ends with incomplete abortion, progressing pregnancy, or is complicated by bleeding, surgical termination of pregnancy is performed. In some cases, vacuum aspiration is performed for other medical reasons (uncontrollable vomiting, intense pain).

DRUGS USED FOR MEDICAL ABORTION

For medical termination of pregnancy, the following groups of drugs are used.
· Inhibitors of progesterone synthesis (epostan©, not registered in Russia).
Synthetic analogues of PG (misoprostol).
Antiprogestins (mifepristone).
Cytotoxic drugs (methotrexate).

progesterone synthesis inhibitors

Progesterone synthesis inhibitor (epostane, not registered in Russia) is an inhibitor of ovarian and placental 3b hydroxysteroid dehydrogenase, which inhibits the synthesis of progesterone from its precursor pregnenolone.

A decrease in the concentration of progesterone in the blood is accompanied by the expulsion of the fetal egg. The use of epostane is of historical significance. The US Food and Drug Administration does not recommend the use of epostane for medical abortion.

Synthetic analogues of prostaglandins

Synthetic PGs are used to terminate pregnancy because they increase the contractile activity of the uterus. PGE1 (mirolute©) exerts its effect by increasing adrenergic transmission at the presynaptic level, which leads to the release of norepinephrine from adrenergic endings. In addition, PG, like oxytocin, bind to specific receptors on the surface of myocytes, resulting in increased calcium release from the endoplasmic reticulum and increased contractile activity of the myometrium.

In Russia, among the synthetic analogues of PGE1, only misoprostol (mirolute ©) ​​is registered.

Unlike all PGs used to terminate pregnancy, misoprostol is stable at room temperature and can be given orally. Its half-life is 30 minutes. Side effects from the gastrointestinal tract are not very pronounced, however, they occur in 35% of patients when taking the drug orally. There is no information about the development of dangerous side effects. According to various authors, misoprostol can be used up to 7-9 weeks of gestation. Studied various doses (from 400 to 3200 mcg) and regimens of the drug. Misoprostol can be administered both orally and vaginally (effectiveness is higher when administered vaginally). In monotherapy, misoprostol is used in an initial dose of 800 mcg vaginally and then 400 mcg every 3 hours for 9 hours or 800 mcg every 12 hours 3 times. The effectiveness of monotherapy is 90–96%, and the average duration of spotting is 11.7 days. It has been proven that the drug at a dose of 600 mcg is not effective enough.

Some authors consider misoprostol so safe that they allow women to take it on their own without a doctor's prescription, but this opinion cannot be accepted. In cases where misoprostol is ineffective, the examination often reveals fetal malformations (skull defects, cranial nerve palsies, "horse foot"). This can probably be explained by the teratogenic effect of ischemia caused by vascular spasm with a prolonged increase in uterine tone.

The use of PG is associated with a fairly high risk of side effects. Pain, dizziness, nausea, vomiting, diarrhea, rash are more common. In the appointment of narcotic analgesics needed 53% of women who received gemeprost at a dose of 5 mg and 16% of patients at a dose of 3 mg. For this reason, if a woman is prescribed gemeprost at a dose of more than 3 mg, her hospitalization is indicated.

PG monotherapy can be carried out, however, due to the high incidence of side effects, it is better to use them in combination with mifepristone or methotrexate to reduce the dose of the latter. In addition, PG is sometimes prescribed together with tamoxifen (20 mg for 4 days). The effectiveness of treatment in these cases is 92%.

Antiprogestins

Antiprogestins (progesterone antagonists) are a group of compounds with a pronounced antiprogestogenic effect, the appointment of which can terminate a pregnancy at almost any time. Mifepristone is a synthetic steroid. The mechanism of its action lies in the specific blocking of progesterone receptors, which is accompanied by detachment of the fetal egg, a gradual increase in uterine contractions and termination of pregnancy.

The affinity for progesterone receptors in mifepristone is 5 times greater than that of progesterone. Unlike progesterone, whose dimer binds to the promoter regions of many genes, causing changes in the structure of epithelial cells and the synthesis of pregnancy proteins, mifepristone blocks the transcription of the corresponding genes, which leads to necrosis and rejection of the ovum. Under the action of mifepristone, not only progesterone receptors are blocked, but the concentration of this hormone in the blood is also significantly reduced. It is possible that the decrease in the content of progesterone in the blood under the influence of mifepristone is due to the luteolytic effect of the latter, as well as the ability of mifepristone to reduce the concentration of hCG in the blood.

Under the influence of mifepristone, changes also occur in the decidua (hypoplasia, necrosis), which contribute to its falling off. The drug is able to increase the sensitivity of the myometrium to endogenous and exogenous PGs. Mifepristone and PG act on the pregnant uterus as synergists.

Mifepristone monotherapy is not currently used.

· The appointment of mifepristone in combination with PG is the most common and studied method of medical termination of pregnancy, recommended by WHO.

Mifepristone is used in medical practice not only for abortion. Different doses of the drug and different regimens of administration are registered for the preparation of the cervix for childbirth, adjuvant therapy for uterine fibroids, emergency contraception. Mifepristone for medical termination of pregnancy in the Russian Federation can be used when the gestational age does not exceed 6 weeks (42 days from the first day of the last menstruation). Mifepristone is taken once at a dose of 600 mg orally (3 tablets of 200 mg) in the presence of a doctor. 36–48 hours after taking mifepristone, the woman is given misoprostol (Mirolut®) at a dose of 400–800 mcg.

After taking PG, a woman should be under the supervision of a doctor for 2 hours. 10-14 days after the use of mifepristone, a second examination is indicated. The efficiency of the method is approximately 94–98%.

Complete expulsion of the fetal egg before the appointment of PG is extremely rare (in 1-6% of cases).

The most severe side effects of the method include uterine bleeding, but the need for blood transfusion is rare (in 0.1% of patients treated with drugs). The volume of blood loss varies from 84 to 101 ml and significantly increases with increasing gestational age.

Side effects of mifepristone include pain that disturbs almost all women and pain relief is necessary in 9-73% of cases, malaise, weakness, nausea, and vomiting. Mifepristone has not been shown to be teratogenic in rats, mice or monkeys. If medical abortion fails, the pregnancy should be terminated surgically due to the high risk of fetal malformations resulting from the use of PG.

Cytostatics

The mechanism of action of cytostatics is to suppress the division of trophoblast cells, which leads to the rejection of the fetal egg. Methotrexate is an antagonist of folic acid involved in the synthesis of deoxyribonucleic acid (DNA). Actively dividing cells, including tumor cells, bone marrow cells, and trophoblast cells, are sensitive to methotrexate.

Monotherapy with methotrexate is less effective than combined treatment. Usually, the expulsion of the fetal egg occurs 3 weeks or more after the administration of the drug.

The combined use of methotrexate and PG is a very effective method of terminating a pregnancy.

Usually, methotrexate is prescribed at a dose of 50 mg/m2 of body surface intramuscularly. You can take the drug orally at a dose of 25-50 mg. 3-7 days after the introduction of methotrexate, misoprostol 800 mcg is administered vaginally. The effectiveness of the method for termination of pregnancy for up to 8 weeks is 84-97%. The effect can be immediate (completed abortion occurs before the use of misoprostol or within 24 hours after the administration of this drug) and delayed (completed abortion is recorded 24 hours or more after the administration of misoprostol). The average duration of spotting is 10–17 days.

· Data on side effects of concomitant treatment are contradictory. Some authors believe that the side effects of misoprostol occur more often when it is used in conjunction with methotrexate. Nausea is noted in 3-66% of cases, vomiting - in 2-25% of cases, diarrhea - in 3-52% of cases, catarrhal phenomena - in 8-60% of cases, pain syndrome - in 40-90% of cases. There are complications specific to methotrexate: 5% of patients develop stomatitis, ulceration of the oral mucosa.

Methotrexate has a pronounced cytotoxic effect on the trophoblast, which leads to a high incidence of fetal malformations when using this drug. Limb lesions are mainly noted (shortening of the limbs, absence of fingers). If medical abortion fails, surgical termination of the pregnancy is necessary.

Contraindications for medical abortion

Contraindications for medical abortion are listed below.

Allergic reaction to a drug.
· The gestation period is more than allowed for this method.
Suspicion of ectopic pregnancy.
· Chronic adrenal insufficiency.
· Long-term therapy with glucocorticoids.
Hemorrhages and treatment with anticoagulants.
· Renal failure.
· Liver failure.

Mifepristone and PG should not be used in women with adrenal insufficiency, severe asthma and COPD complicated by diabetes.

Do not prescribe folic acid and its derivatives during treatment with methotrexate.

Acceptability and accessibility of medical abortion

In a survey of women in whom medical abortion with methotrexate and misoprostol was effective, 84% of patients answered that they would prefer this method to surgical termination of pregnancy if necessary. 91% of women responded similarly after mifepristone and misoprostol.

Psychologically, women tolerate medical abortion more easily than surgical intervention under anesthesia. However, medical abortion has disadvantages: it is painful, accompanied by side effects, long, expensive, requires repeated visits to the doctor, and as the duration of pregnancy increases, the effectiveness of medical abortion decreases.

Currently, medical abortion is acceptable in most countries of the world. However, for most specialists, it is not routine, and it is not carried out in all medical institutions.

Conclusion

With medical abortion, compared with surgical abortion, longer bleeding, intense and prolonged pain, and other side effects are noted.

The long-term consequences of these methods have not been studied enough. When performed correctly, vacuum aspiration in the first trimester of pregnancy is effective in 98-99% of cases, and failures occur at the earliest stages of pregnancy. However, medical abortion is practically not associated with traumatic lesions of the uterus and cervix.

It is probably safest to terminate a pregnancy with medication in the very early stages. With an increase in the gestational age, the effectiveness of medical methods decreases, so it is necessary to carry out vacuum aspiration.

Ultrasound should be used more extensively to detect residual products of conception after abortion, especially in nulliparous women.

To prevent traumatic complications, it is recommended to prepare the cervix for surgery (preferably using PG).

With all types of abortion, you should carefully monitor the microflora of the vagina, and, if necessary, carry out preliminary sanitation of the genital tract.

It is necessary to pay attention to nulliparous (especially primigravida), carefully choose and perform an abortion technique with them.

With rehabilitation therapy aimed at restoring reproductive function, combined oral contraceptives, vitamin E are prescribed, the microbiocenosis of the vagina and intestines is corrected, and physiotherapy procedures are carried out.

The most gentle way to conduct an abortion is medical abortion. It is practically safe for the health and emotional state of a woman. For its implementation, drugs are used that provoke the expulsion of the fetal egg to the outside.

What is a medical abortion?

The term "farmabort" is used to denote the artificial termination of a pregnancy that has begun with the use of medications. The method completely excludes surgical intervention. During this procedure, the patient takes pills in the presence of a doctor. Under the action of the components of this drug, the death of the embryo occurs. This concludes the first stage of medical abortion.

After a certain time, the woman takes another drug. Its components provoke an increase in the contractile activity of the uterine myometrium. As a result, the rejected fetal egg is expelled outward, an abortion occurs. This procedure has a number of advantages over other methods (scraping,):

  • no trauma to the uterus;
  • quick recovery of the menstrual cycle;
  • low risk of complications;
  • does not require anesthesia.

Medical termination of pregnancy - terms

Answering the question of a woman, how long a medical abortion can be carried out, doctors call 6-7 weeks. Pharmabort can be carried out no later than 42-49 days from the moment when the first day of the last menstruation was celebrated. At the same time, the effectiveness of this procedure decreases over time, and the likelihood of complications increases.

Doctors call the optimal time for a medical abortion up to 4 weeks. The fetal egg does not have time to securely fix itself in the uterine wall, therefore it is better and faster rejected and released. In addition, the hormonal background has not yet been fully established, the restructuring of the body has not been completed, so it will be easier for him to return to the previous state, before pregnancy.

Medical termination of pregnancy - contraindications

The main indication for such termination of pregnancy is the desire of the woman herself. However, not all pregnant women and not in all cases can undergo medical abortion. In addition to the time frame indicated above, there are other contraindications to the implementation of the medabort:

  • allergic reactions to medications in history;
  • liver failure;
  • adrenal insufficiency;
  • pathological bleeding;
  • active inflammatory process in a woman's body;
  • pulmonary tuberculosis;
  • suspicions of;
  • oncological processes;
  • lactation process;
  • implementation of corticosteroid therapy;
  • blood coagulation disorders.

How is a medical abortion performed?

Talking about how the pharmabort goes, the doctor explains the stages of the procedure. Previously, a woman needs to undergo a small examination, which is prescribed on the day of treatment:

  • ultrasound of the uterus;
  • smear on microflora;
  • blood test for syphilis.

After receiving the results, the exact time is assigned when the medical abortion will be performed, the terms of which are indicated above. During a second visit, the doctor re-talks with the woman, clarifies the seriousness of her intentions, whether she has changed her mind. Then the patient is given a drug that she drinks in the presence of a doctor. Under the action of the drug, the growth of the endometrium stops, and the muscle layer begins to contract. The woman is observed for 2-3 hours, after which she leaves the clinic.

The patient is given a tablet of another drug that stimulates uterine contractions. Take it after 36-48 hours, as directed by the doctor. Under the action of the drug, the dead embryo is expelled outward. Only after this medical abortion is considered complete. A woman fixes spotting.

Medical termination of pregnancy - drugs

A woman, even if she wishes, cannot independently carry out a pharmacist - pills for its implementation are not sold in the pharmacy chain. When performing a medical abortion, drugs are used with a high content of hormones, so they are issued by a doctor in a medical institution. To carry out medical termination of pregnancy, the following groups of drugs are used:

  1. Antigestagens- suppress the action of natural progestogens at the receptor level. The representative of this group is Mifepristone, Mifegin. For pharmaceutical use 600 mg of the drug.
  2. Prostaglandins- increase the contractility of the uterine myometrium. More often from this group, Mirolut is used. 400 mg of the drug is prescribed. It is taken 36-48 hours after the antigestagen.

How to understand that the farmabort was successful?

Complications are possible with any medical procedure, so women are often interested in doctors about how to understand that a medical abortion has failed. In order to exclude possible violations, after 14 days a woman should visit the clinic and undergo a control ultrasound. The doctor must make sure that the fetal egg, its remnants have completely left the uterine cavity. Examine the organ itself, determining the size. In a woman, the doctor specifies the nature of the discharge, the presence and severity of the pain syndrome. Often, after a pharmaceutical abortion, the test is positive - this is due to an altered hormonal background.


Menstruation after pharmaceutical abortion

Normally, menstruation after a pharmaceutical abortion comes in 28–30 days. Taking abortive drugs practically does not affect the hormonal background of a woman, so menstruation is not disturbed. However, in some cases, there is a change in the volume of secretions: they can be scarce or excessively abundant. So, a small amount of discharge after medical termination of pregnancy may be due to:

  1. Small opening of the cervix during the abortion process - fragments of the fetus cannot normally come out, accumulating in the uterine cavity.
  2. Incomplete abortion - the fetal egg is not completely rejected, and the fetus continues to develop.

Within 2-3 days, bleeding is observed after pharmaceutical abortion. Normally, it lasts up to 10-14 days. The fertilized egg is separated in parts, so the discharge lasts a long time. Their volume exceeds the number of menstrual. You need to be careful about the volume, making sure that they do not go into. Signs of such a complication are:

  • a large amount of blood secreted from the vagina - in half an hour the sanitary pad (“maxi”) is completely saturated;
  • pain in the lower abdomen;
  • dizziness;
  • skin blanching;
  • increase in the number of heartbeats;
  • lowering blood pressure.

Sex after pharmacist

After the pharmacist is carried out, what cannot be done and what rules to follow - the doctor explains to the woman. At the same time, special attention is paid to intimate life. Doctors do not recommend women to have sexual intercourse until the spotting stops. Otherwise, there is a high risk of infection of the reproductive system. On average, the period of abstinence should be 2-3 weeks from the moment of abortion.

Pregnancy after pharmaceutical abortion

Properly performed pharmaceutical abortion does not affect the reproductive function. after such an abortion is possible already a month later, in the next menstrual cycle. Given this fact, doctors strongly recommend protection. Often women regret their deeds and wish to become pregnant again. In addition, there are cases when the interruption was carried out for medical reasons, so a woman wants to quickly get pregnant again.

The reproductive system needs time to recover, so you should refrain from planning a pregnancy for 6 months after the medical abortion was performed. During this period, doctors recommend using. In this case, it is better to give preference to mechanical (condom), since the use of hormonal agents can affect the hormonal background.

There are several ways to terminate an unwanted pregnancy - with the help of surgical procedures or using pharmacological agents. It is easier for a woman to survive a pill abortion both physically and psychologically. This method is considered the safest, but it can be accessed only in the early stages. A woman who has made a difficult decision needs to be aware of the nuances and risks of the abortion method.

You should carefully weigh the pros and cons before making a choice.

What is an abortion pill? This is the name of the procedure for terminating an early pregnancy with pills. Manipulation is also called pharmacological or medical abortion. Special "pills" were invented by French pharmacists in the early 80s. The experts decided to turn the idea of ​​how to get rid of an unwanted pregnancy in the early stages, and came up with a painless method. While the fetus is small, you can do without surgical procedures. Pharmaceutical development was tested for a long time to understand how it works, and for how long it is possible to terminate a pregnancy with a pill with minimal risks. After six years of clinical research, "pills" began to be actively used in medical practice.

How is a medical abortion performed? Simplified, it looks like this: if a woman wants to get rid of an unwanted pregnancy, she takes a “pill” - and the problem is solved. Tablets provoke uterine contractions, block the production of progesterone, after which the fetus is rejected. The success of the manipulation is evidenced by post-abortion bleeding. It is similar to menstruation.

In fact, the procedure is not as simple as it seems. There are a number of nuances that are important to consider. You need to know how long it is possible to terminate a pregnancy with pills, which drugs to use, and take into account contraindications. A pregnant girl should contact the clinic to clarify all the nuances.

Drinking abortion pills without first consulting a doctor is strictly prohibited.: You can cause irreparable harm to your health. The risks are especially high in case of violation of the established terms of medical termination of pregnancy.

Optimal time

The first thing you need to know when deciding on a pharmacist is how long it can be done: medical abortion has clear boundaries. All features of medical termination of pregnancy (including timing) are regulated by the protocol drawn up by the Ministry of Health. In Russia, up to 9 weeks, you can have a pill abortion. This period corresponds to 63 days of gestation. In European countries, the possibility of medical termination of pregnancy has been reduced to 49 days, which is equal to seven weeks.

It will take a lot of effort to recover

It is no coincidence that medical abortion is limited to seven to nine weeks. At the eighth week, the embryo is already moving into a new stage - the fetus. This means that he gradually takes on a human form. From this moment, the formation of placental vessels begins. Even if you do not consider the ethical point, getting rid of a late pregnancy with the help of pills is impossible due to the high risks of heavy bleeding. The blood loss can be so great that it can be fatal.

Having made a difficult decision, you need to find out how long the procedure is done in a particular clinic. Doctors believe that the optimal time is the fourth or fifth week. The minimum period reduces risks to zero and guarantees high efficiency of manipulation.

Benefits of medical interruption

Pill abortion is considered the safest way to solve the problem of an onset, but unwanted conception. The main advantage of this procedure is the low level of stress. It is much easier to take a pill than to decide on curettage. Pill abortion is not a traumatic procedure, which is important for a woman who is in a difficult situation. Not always a girl does not want to give birth due to some of her personal beliefs: there is a situation when the pregnancy cannot be maintained due to the patient's health. Among the indications for interruption is a high probability of the birth of a baby with genetic diseases. In such cases, the medical method of abortion is the best option so that the woman does not get hung up on the problem. The procedure is non-invasive. Everything happens as if the pregnancy was interrupted as a result of a miscarriage.

Pharmaceutical abortion, in addition to the psychological aspect, has other advantages. The main ones are:

  • high efficiency (up to 98%);
  • painlessness;
  • no possibility of injury to the reproductive organs;
  • low risk of post-abortion infections;
  • exclusion of the possibility of contracting hepatitis or HIV;
  • lack of anesthesia.

Medical abortion recommended for first pregnancy. The effect of the pharmabort on the female body is minimal. Naturally, if the terms of the procedure are observed, and the pills for terminating early pregnancy are selected by a qualified doctor. The likelihood that a woman can easily become pregnant after a medical abortion is high, while after a surgical interruption there is always a risk of reproductive dysfunction, up to infertility.

Preparation for manipulation

Before terminating a pregnancy with medication, you will need to undergo a series of tests. The first step is to go to the gynecologist. He will conduct initial inspections. Mandatory diagnostic studies include:

  • vaginal swabs;
  • determination of blood group/rhesus;
  • tests for syphilis, HIV, hepatitis.

Carrying out the procedure

How is a medical abortion performed? Definitely in a hospital setting. The principle of medical abortion is based on drugs of different pharmaceutical groups. Two types of pills are immediately involved from abortion in the early stages.

  • progesterone antagonists. Drugs reduce the level of progesterone in the blood fluid. The result is the destruction of the corpus luteum, necrosis of the fetal egg, rejection of the embryo. There are many names of abortion pills. It is not necessary to remember which pills can terminate a pregnancy. It is important to know that the primary drug is the one in which the active ingredient is mifepristone. The description of the "work" of the funds is the same. Specific abortion pills are effective for how long - you need to check with your doctor, as there are small nuances. For example, some are effective only up to the sixth week, the second - up to the ninth.
  • Prostaglandins. The peculiarity of any drug in this group is that it starts the process of rejection of the embryo. How does medical abortion occur in the second stage? The drugs stimulate the process of opening the cervical canal. The myometrium and uterus contract strongly, which contributes to the release of the remnants of the dead fetal egg. Derivative drugs for early termination of pregnancy in Europe are used differently, in Russia - only Misoprostol.

Abortion pills must be selected by a gynecologist. It is important to find a specialist whom a woman will trust. For medical termination of pregnancy, the hospital will have to visit twice. First, the doctor gives the first pill, observes the patient for three to four hours. If everything went well, she is allowed to go home and given time to continue the manipulation. You need to return to the hospital to take medication interruption pills from another pharmaceutical group after about 36 to 48 hours.

On the third day after the completion of the procedure, a control examination should be carried out. Two weeks later, the woman is examined again, an ultrasound is always done. Only then can we conclude that the procedure was successful.

Is it possible to carry out the procedure at home

Taking drugs - a blow to the hormonal system

Even in the early stages of the house, it is undesirable to carry out a pill abortion. The procedure must be supervised by a doctor. He determines the dosage of drugs, monitors the patient's condition, checks whether the abortion has occurred and whether it was complete. If there is heavy bleeding, the medical facility will provide professional assistance. For medical termination of pregnancy, you will have to return to the hospital, which is not very convenient. However, it is important to take medication interruption pills under medical supervision, so convenience issues are secondary here.

If a woman still decides to have a pharmacological abortion at home, then there should be a person next to her who, if necessary, will call an ambulance. Before taking the medicine, be sure to say: "I'm taking a pill called ...". A loved one should know which pills for medical abortion the woman took, so that in the event of a critical situation, tell the doctors what the drugs were called.

Body reaction

Medical abortion drugs cause bleeding. This is a natural reaction of the body to the rejection of the fetus. How long the bleeding lasts and what character it is depends on the duration of the medical abortion. The earlier the manipulation is carried out, the better. If the procedure is done before the fourth week, then the bleeding is as similar as possible to normal menstruation. Normal discharge after a medical abortion lasts seven to nine days. Moderate pulling pains may appear, as before critical days. When the procedure is done late, the discharge is observed longer. They are profuse and painful.

The pills used to terminate a pregnancy affect the general well-being of a woman. The body can react to the procedure with a number of unpleasant symptoms:

  • general weakness;
  • dizziness;
  • nausea;
  • vomiting;
  • high temperature;
  • diarrhea.

Medical abortion in the early stages is usually easy. Whereas in those patients who delayed the decision, there is a whole list of reactions in severe form. You need to tell your doctor about them. If unpleasant manifestations do not go away for a long time or are too pronounced, post-abortion therapy may be required. It aims to relieve symptoms and regulate hormonal balance.

Recovery

It takes about a month to recover from the procedure. In order for the recovery to be successful and fast, you need to follow a number of rules:

  • do not lift weights;
  • exclude physical activity;
  • do not take a hot bath;
  • do not visit the bath, sauna, swimming pool;
  • do not swim in open water;
  • avoid hypothermia.

During the recovery period, it is important to pay close attention to strengthening immunity. A balanced diet and vitamin complexes will help to increase the protective functions of the body. Vitamins should be selected by a doctor. Alcohol should be abandoned. In the first month, you can not use tampons, only pads are allowed. It is recommended to avoid intimacy until the first menstruation is over.

In the first six months, it is important to exclude the possibility of pregnancy. It will become a serious burden for the body. With the question of selecting reliable contraceptives, you need to contact your gynecologist.

Possible Complications

Although medical abortion is considered the safest, a woman may experience side effects of the pills. Complications arising after medical abortion are dangerous to health and threaten the loss of reproductive function. The risks largely depend on how many weeks the interruption takes. If the procedure is carried out at an early stage, then the consequences rarely occur. The longer the gestational period, the more dangerous it is to take abortion pills. Complications include:

  • Blood loss. After the procedure, the presence of severe bleeding is dangerous with large losses of blood fluid. If you do not see a doctor in time, the consequences can be irreversible - even fatal. With strong secretions that threaten a large loss of blood fluid, the doctor prescribes hemostatic drugs after an abortion. In an emergency, a blood transfusion may be required.
  • Allergic reactions. An allergy occurs to the components of the drug that the patient took to solve the problem of unwanted pregnancy. There are different manifestations of allergies: it depends on individual characteristics, the “sensitivity” of the immune system.
  • Strong pains. After manipulation, a persistent pain syndrome may be observed. Usually, such a complication occurs when medical abortion is done late - closer to the ninth week. If the pain is so severe that it is impossible to withstand it, you should immediately consult a doctor. The pain syndrome may indicate an inflammatory process that has arisen due to the particles of the embryo remaining in the uterus.
  • Hormonal disbalance. Immediately after conception, the hormonal background of a woman begins to change. Pills disrupt the natural process of change. This can cause hormonal imbalance. “Knocked down” hormones can lead to infertility in the future, so the condition needs to be corrected.

Additional factors

It is important to choose the right method of protection

Incomplete interruption. The procedure may not give the full effect if it was carried out at a later date in the time period allotted for the abortion. Every week the fruit grows and "strengthens" its position. After rejection, particles of the embryo may remain in the uterus, which leads to inflammation and infectious diseases. Because of them, reproductive function may be lost. Incomplete rejection is usually indicated by severe pain and severe fever. Ultrasound can confirm incomplete interruption. After diagnosis, curettage of the uterine cavity or vacuum aspiration is performed. Such procedures are an additional burden on the body and severe stress for a woman.

It happens that the pills do not work: the pregnancy progresses. Doctors diagnose only 1% of such cases. If the patient insists on interruption, then they turn to invasive methods. Women who change their minds and wish to continue the pregnancy should be aware that the drugs could have a teratogenic effect on the fetus. This means that there is a high probability that the baby will be born with deviations.

Contraindications

Medical abortion has many contraindications, so not every woman can turn to this method. Only a doctor can determine contraindications for medical abortion. He draws conclusions after examination, analysis, anamnesis. Contraindications include:

  • ectopic pregnancy;
  • acute infections of the genital organs;
  • large myoma;
  • porphyria;
  • anemia;
  • poor blood clotting;
  • long-term use of glucocorticoids;
  • exhaustion;
  • kidney disease;
  • liver disease;
  • diabetes;
  • lactation period.


Medabort is indeed the safest among modern abortion methods. If you know how long you can do it, then you can not be afraid of medical abortion: the likelihood of complications is minimal. It is not worth delaying the decision, otherwise you will have to turn to the surgical method, which is much more dangerous than the medical one, and is psychologically much more difficult to tolerate.

Not every pregnancy these days ends with the birth of a child. About five out of ten women who find out about their new situation decide to have an abortion. It is worth noting that interruption can be done in several ways. For each representative of the weaker sex, an individual approach is chosen taking into account the state of health, age and duration of pregnancy. This article will tell you about what a pill abortion is. Until how many weeks of fetal development it is carried out - you will find out later. It is also worth informing about the consequences that this procedure has.

Pill abortion - what is it?

Medical termination of pregnancy is a way to stop the life of the fetus, followed by expulsion from the uterus. Doctors say that this is one of the most gentle methods of abortion.

For such an impact, special preparations are selected. It is worth noting that it is impossible to purchase them yourself. To do this, you must have a prescription from a doctor. Pilled abortion is performed exclusively within the walls of the hospital. In this case, the patient must take medication in the presence of doctors.

Drugs and their action

To terminate a pregnancy by this method, medicines containing mifepristone are used. These include the means "Mifegin", "Miropristol", "Mifeprex" and others. These hormonal agents act on the reproductive organ, pituitary gland and ovaries. Mifepristone blocks the production of progesterone. Because of this, the death of the ovum containing the embryo occurs. After that, pregnancy can no longer develop. Also, these drugs increase the sensitivity of the inner layer of the uterus to oxytocin. As a result, a gradual contraction of the reproductive organ begins. How does a pill abortion proceed?

Some time after the destruction of the fetal egg, a woman needs to take prostaglandins or their analogues. These medicines include "Misoprostol", "Gemeprost", as well as the same mifepristone. It must be remembered that the dosage of certain drugs is selected exclusively by a doctor. Under the influence of prostaglandin analogues, the genital organ begins to contract strongly. As a result of this, detachment of the membranes and the overgrown endometrium occurs. Next, the embryo is expelled from the uterine cavity, and abortion occurs.

What is the time frame for the procedure?

When is a pill abortion prescribed? Deadlines should be short. Many women delay the termination of pregnancy and therefore are forced to lie down on the surgical table. The procedure can be carried out within 42 days after the last menstruation. So, the period of development of the fetal egg during this period will be 6-7 weeks. In some cases, the described restrictions are shifted. If ultrasound diagnostics show that the embryo has not yet reached seven weeks of development, then the woman can undergo the procedure after 42 days of amenorrhea. This often happens due to late ovulation.

Can all women get a pill abortion?

Reviews of doctors suggest that this manipulation has some contraindications. These include the following situations:

  • bleeding disorders (there is a risk of severe bleeding);
  • inflammatory diseases of the uterine cavity and ovaries;
  • pregnancy that develops outside the uterine cavity (more often in the fallopian tubes and ovaries);
  • diseases of the stomach and intestines in an acute form;
  • the presence of scars on the uterine walls;
  • individual intolerance to the active ingredients of the drug.

There may also be other contraindications. They are always reported by the doctor before the manipulation.

Are there any consequences?

After a pill abortion, as well as after a surgical termination of pregnancy, there may be complications. It is worth noting that the consequences of such manipulation are not so dangerous. So, with gynecological curettage or curettage, perforation of the uterine wall can occur. Due to medical termination of pregnancy, this is not possible. Also, the adhesive process, which often occurs after cleaning, is excluded when exposed to drugs with mifepristone. Consider the main consequences that a pill abortion has.

Strong pain sensations

Pilled abortion absolutely always causes pain. Sometimes women who have given birth compare such uterine contractions with ordinary contractions. However, the intensity of discomfort is less than during childbirth.

Pain after a pill abortion persists for several days. Most often this happens until the fetal egg and endometrium leave the uterine cavity. It is worth noting that discomfort is intensified after taking prostaglandin analogues.

Bleeding from the reproductive organ

Discharge after a pill abortion lasts about one week. If you have to change your sanitary napkin every hour, then it could be bleeding. In this case, the discharge does not decrease, but retains its intensity.

Such a pathology can occur when a woman has a violation of blood clotting. That is why it is so important to take tests and undergo an examination before the procedure. Bleeding after medical termination of pregnancy can be eliminated surgically or conservatively.

Lack of effect from the procedure: preservation of pregnancy

Pregnancy after a pill abortion may simply not be interrupted. It should be noted that the longer the period of development of the fetal egg, the higher the likelihood of such a consequence. Sometimes it happens that after an unsuccessful exposure, a woman still decides to have a baby. However, in this case, there is a high probability that the baby will have congenital pathologies. Sometimes they are incompatible with life.

If the pregnancy is not interrupted after drug exposure, then the woman still has to go for curettage or vacuum aspiration. You can learn about the effectiveness of the effects of the above drugs after one or two weeks, during ultrasound diagnostics.

Nausea and vomiting without relief

Medicines containing mifepristone in their composition quite often cause nausea and subsequent vomiting. That is why the patient is recommended to stop eating on the day of the manipulation. This consequence has a very simple explanation.

The above drugs increase the contractility of the uterus. This leads to a slight opening of the cervical canal. Such a procedure, in turn, is always accompanied by nausea and vomiting.

Sexual intercourse with discomfort

Sex after a pill abortion is possible only after two weeks. Otherwise, there is a high risk of infection. Quite often, hormonal failure after such a manipulation leads to increased dryness in the vagina. This causes discomfort during sexual intercourse.

Rapid re-pregnancy

A frequent consequence of a pill abortion is that the next ovulation occurs within two weeks. In this case, the first sexual intercourse without the use of contraceptives can lead to re-conception. To avoid such consequences, it is necessary to be protected and follow all the recommendations of the attending physician.

female depression

Any abortion, including pill abortion, often leads to depression. Approximately 70 percent of patients out of 100 experience this phenomenon. The body of the fairer sex is programmed to conceive and bear a child. Even voluntary termination of pregnancy leads to a depressed state.

Many women do not admit their depression and inner emptiness. However, this only aggravates the situation and drives the patient into a dead end.

Allergy

Such a consequence occurs quite rarely. However, it is also worth mentioning. There are situations when a woman has an allergic reaction to the above drugs. Most often, the representatives of the weaker sex have itching and a rash like hives. You may also experience sneezing or a runny nose. With vaginal administration of drugs, women note itching in the genital area.

Careful reading of the instructions will help to avoid such consequences. If you have at least one contraindication, then you should choose a different drug or method of abortion.

Despite the availability of various effective contraceptives on the market, abortion remains one of the main methods of birth control and family planning.

Adverse effects of medical termination of pregnancy in the early stages (bleeding, chronic inflammation, miscarriage of subsequent pregnancies, endometritis, etc.) are very rare.

The pharmacological method, used since 1980 in France and since 1998 in Russia, is the safest and most gentle, compared with traditional curettage, vacuum curettage and vacuum aspiration (mini-abortion).

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How does a medical abortion work?

Termination of an unplanned pregnancy by pharmacological means is achieved through the use of antiprogestins and prostaglandins.

Antiprogestins are synthetic antiprogestogenic steroids with no hormonal effects. Currently, such proven drugs for medical termination of pregnancy are used, such as Mifepristone and its analogues from different manufacturing companies - Pencrofton, Mifegin, Mifeprex, Mifolian, Postinor. All of them are synthetic means of antiprogestogenic action.

The mechanism of their influence is to bind to receptors that normally perceive and respond to the ovarian corpus luteum hormone progesterone, which is the main hormone of pregnancy. As a result:

  • blocking the effects of progesterone;
  • the concentration of prostaglandins synthesized by the cells of the decidual (falling away) membrane of a fertilized egg increases;
  • increases the sensitivity of the myometrium to the influence of prostaglandins (prostaglandin E1);
  • the capillaries of the mother in the decidua are destroyed.

Prostaglandins are produced in the body. They cause uterine contractions and intensify them, which leads to detachment of the membranes of the fertilized egg from the uterine wall, to necrosis (death) of the latter and its removal from the uterine cavity. This is preceded by softening of the cervix and expansion of its cervical (cervical) canal. However, in most cases they are not able to provide sufficient uterine contractility. Therefore, to enhance the effect of natural prostaglandins, that is, to ensure adequate strength of uterine contractions and cervical opening, their synthetic analogues are additionally used - Misoprostol, Mirolut, Cytotec.

The method of medical abortion and contraindications to it

When a woman establishes the presence of an unwanted pregnancy, it is necessary to contact a gynecologist as early as possible due to the fact that the terms of medical termination of pregnancy are limited to 42 days (6 weeks), counting from the first day of the last menstrual cycle.

The patient first receives information from the doctor about the essence of the method of pill termination of pregnancy, the symptoms and options for its course, possible complications and consequences. After conducting generally accepted examinations and clarifying the gestational age, a woman takes a written consent to an abortion.

The accepted scheme for medical termination of pregnancy is as follows:

  1. In the presence of a doctor, the patient takes Mifepristone or one of its analogues at a dose of 600 mg (3 tablets) and is under the supervision of medical personnel for 1-1.5 hours. This is necessary to prevent the occurrence of side effects (nausea, vomiting, allergic reaction, etc.).

    After 2 hours, the content of this drug in plasma becomes as high as possible. Within 12 hours after taking it, the tone and contractility of the uterus increase, which after 36-48 hours reach their highest level. During this period, a menstrual-like reaction occurs (usually after 24 hours), which may be accompanied by pain in the lower abdomen, dizziness and headache, skin rash, weakness, nausea and vomiting, diarrhea, high fever.

    On the recommendation of a doctor, pain can be stopped by taking analgesics (Ketanov, Ketarol) and antispasmodic (No-shpa) drugs. It is not recommended to take acetylsalicylic acid preparations, as they can increase the amount of blood loss.

  2. At the second visit to the doctor, which is appointed after 36-48 hours, the woman takes prostaglandin Mirolut inside at a dose of 200 mcg (1 tablet) or 400 mcg (at the discretion of the doctor) in order to enhance uterine contractility. The expulsion of a dead fetal egg with membranes occurs within two hours after taking them or in the coming days, during which there may also be nausea, vomiting, dizziness, cramping pains in the lower abdomen.
  3. After 7 and 14 days (as prescribed by the gynecologist), another visit to the clinic is recommended, during which a second ultrasound examination of the uterine cavity is performed in order to ascertain the fact of a successful abortion. Sometimes blood clots remain in the uterine cavity, which come out on their own or after the appointment of injectable or tablet preparations that enhance its contractions.

Contraindications for medical abortion:

  1. Cases of hypersensitivity to mifepristone if it has already been used in the past.
  2. Exceeding the gestational age established for the drug method.
  3. Pregnancy that occurred against the background of the intrauterine method of contraception or after the abolition of hormonal contraceptive drugs.
  4. Suspicion of an ectopic (ectopic) pregnancy.
  5. Breastfeeding (it should be stopped for 2 weeks).
  6. Acute inflammatory processes or exacerbation of chronic diseases of the female genital organs.
  7. Large uterine fibroids, endometriosis.
  8. The presence of a scar on the uterus after cesarean section and malformations of its development (saddle-shaped, bicornuate uterus) are a relative contraindication.
  9. Blood clotting disorders and previous treatment with drugs that reduce clotting.
  10. Chronic adrenal, renal or hepatic insufficiency, severe anemia and blood diseases, bronchial asthma and chronic obstructive pulmonary disease and other severe somatic diseases.
  11. Long-term use of glucocorticosteroid drugs.
  12. Age over 35 years in the presence of vascular hypertension, coronary heart disease or in case of consumption of more than 20 cigarettes per day (relative contraindications). Smoking before the specified age in the absence of concomitant diseases does not lead to negative consequences and is not a contraindication.

Benefits and possible consequences of pharmacological abortion

Despite the fact that it is impossible to completely eliminate the negative consequences of medical abortion, the use of antiprogestins in combination with prostaglandins is the most optimal and highly effective method of abortion in the early stages. Its advantages over other methods are:

  • relatively physiological effect on the body of a woman;
  • minimal hormonal and psychological stress;
  • no need for the use of rough instrumental intervention, which significantly reduces the risks of mechanical injuries, subsequent inflammatory and adhesive processes and associated secondary infertility, as well as the risks of possible complications associated with anesthesia;
  • no danger of introducing the immunodeficiency virus (HIV), hepatitis B and C viruses;
  • a significant reduction in the risk of developing antibodies to the Rh factor in women with Rh-negative blood group, the development of Rh-conflict in the fetus during repeated pregnancy.

The main negative consequences include:

  1. Bleeding.
  2. Change in the frequency and duration of menstruation.
  3. Pregnancy.

As a rule, bleeding after medical termination of pregnancy in terms of blood loss is the same as during normal menstruation or slightly exceeds menstrual bleeding (in 85% of cases). But in 10-11% it is abundant with clots, which occurs most often with incomplete detachment of the fetal egg or retention of its parts or blood clots in the uterus. This may require vacuum extraction (removal), instrumental revision followed by curettage of the uterine cavity, hemostatic (hemostatic) therapy, and even transfusion of blood substitutes.

Quite often (in 40% of women) there is a menstrual delay after medical termination of pregnancy, which is explained by a change in the psychological state of the woman and, more importantly, a double hormonal change in the body. It occurs during the fertilization of the egg, and then after the termination of pregnancy.

The restoration of menstrual cycles occurs in each woman individually. It is impossible and unnecessary to influence this. A new countdown of the first day of menstruation should be carried out from the moment bleeding occurs during an abortion. The next cycle of menstruation may be delayed by 7-10 days, which is considered normal. Minor delays are possible in the following months, and the duration of the cycles themselves often increases. The process of restoring regular menstruation can last from 2 to 7 months.

If the delay in menstruation exceeds the named periods, this may indicate that the pregnancy after medical abortion has not been eliminated (occurs in 2-4% of women) or a new pregnancy has occurred. In these cases, it is necessary to conduct an analysis for the level of human chorionic gonadotropin (hCG) in the blood and an ultrasound examination, followed by a visit to the gynecologist in order to determine the cause of the delay in menstruation. If there is no pregnancy, the doctor may recommend the use of hormonal contraceptives to prevent it later.

The effectiveness of the pharmacological method is 98%. Thus, medications used to terminate early pregnancy are completely safe for a woman's body. Subject to all the rules of use, they are usually well tolerated, do not affect the hormonal background and metabolic processes, and also allow you to almost completely eliminate the risks of infections and related complications, reduce the severity of psychological stress, which almost always accompanies the traditional method. Medical abortion is the method of choice when planning a pregnancy in the future, especially for women who have not yet given birth.