Home termination of pregnancy in late stages. Why is a late termination of pregnancy dangerous?

In the later stages, it cannot be carried out at any request of the patient, because it can entail serious consequences. Carrying out this procedure in an unofficial way poses a threat not only to the health, but also to the woman's life. But there are times when doctors are forced to do the so-called, for medical reasons.

Since for a period exceeding 20 weeks, all many of the child's life processes have already been formed, therefore, many perceive the termination of pregnancy at a later date as killing a baby. But how can you judge so harshly if there are life-threatening pathologies. As a rule, such a radical method as a surgical abortion is resorted to only as a last resort. These include serious deviations in the physical or moral state of a woman or pathology in the development of the fetus.

Influence the determination of the method of the procedure. There are three options for terminating a pregnancy:

1. Surgical abortion
2. Artificial premature birth
3. Partial birth

The first method involves expanding the cervix and removing the fetus using a special instrument. It is impossible to remove all the parts at once, so the uterus is cleared of residues using This procedure is carried out under the influence of general anesthesia and lasts no more than half an hour. If complications arise, the duration of the operation increases, for example, if bleeding has begun. Such an operation is prescribed in the second trimester and no later.

A late termination of pregnancy can be accomplished with a partial birth. This method is characterized by a long process of implementation, since it is performed on average in 3 days. First of all, the specialist expands the cervix, after which he pulls the fetus by the leg with a special tool, and only the body is taken out. Then the body is separated from the head with scissors. In the next step, a tube is inserted through the vagina into the head of the fetus, with which the brain is sucked out. After such manipulation, the skull decreases in size and becomes easier to remove; this is also done through a suction tube. As a rule, the appointment of such a procedure is rarely done, around the third trimester.

Termination of pregnancy at a later date by the method is carried out in exceptional cases and is extremely rare. A special drug is injected into the woman's body, which stimulates the walls of the uterus to actively contract. In this case, the amniotic fluid is filled with saline, which has a fatal effect on the embryo.

There must be significant reasons for carrying out each of these procedures for a significant period. Basically, the indications for termination of pregnancy are either medical or social. Medical indications are the presence of pathologies in the mother or the unborn baby. For example, if a woman is diagnosed with a serious illness that affects the development of the child, for example, rubella, then termination of pregnancy is mandatory. Or, if the fetus has cerebral palsy or fetal pathology, they also resort to surgical abortion.

But there are situations when the pregnancy is proceeding normally, but the woman is not ready to leave the child and wants to get rid of him even at a later date. Then a special commission is assembled, which listens to the reasons why the woman wants such an intervention, and decides on the expediency of the procedure. For example, a serious depressive state as a result of a man breaking up with a woman due to pregnancy is considered a significant social cause.

Late termination of pregnancy is unpleasant, regardless of the 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

Late termination of pregnancy in most cases is associated with medical indications. If in an early period (up to 12 weeks) an abortion can be performed simply at the request of a woman, then in a later period the gynecologist rarely decides to have 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;
• a blood test for syphilis;
• determination of blood group and Rh factor;
• chest x-ray or fluorogram;
• ultrasound examination of the pelvic area;
• Analysis of urine;
• consultation with a therapist;
• consultations of related specialists who have identified the pathology of the development of the fetus or the mother's disease.

A specially created commission, consisting of a gynecologist, related specialists and the chief 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 studying 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, her 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.

A late termination of pregnancy 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.

Causes of late abortion

The main reasons for which women decide on a late date include:

• medical indications: severe abnormalities 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 question of the possibility of abortion from 12 to 22 weeks is decided by an expert commission. At the woman's request alone, an abortion is not performed during this period. After 22 weeks, artificial termination of pregnancy is also not performed. In this case, the child born into the world is considered a newborn, and he requires special care and medical assistance.

More about the reasons for late abortion:

1. Anomalies of intrauterine development, hereditary genetic diseases, chromosomal abnormalities are the main cause of late termination of pregnancy.
2. Viral infectious diseases transferred by a woman at an early stage of pregnancy can cause the child's disability and the development of congenital deformities that are incompatible with life. Diseases such as rubella, toxoplasmosis, hepatitis, and HIV infection pose a particular danger to the fetus. Bacterial infections are just as dangerous as antibiotic therapy prescribed to eliminate them.
3. Freezing of the fetus (regressing 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 developing sepsis and bleeding requires immediate removal of the dead fetus from the uterine cavity.
4. Mental illness diagnosed in a pregnant woman can cause late abortion in case of complete inadequacy of the expectant mother or lack of support from relatives.
5. Rape is also a reason for late termination of pregnancy. In rare cases, the woman decides to keep the child.
6. The decision to be caused by unfavorable social conditions for the unborn baby. These include: a woman's stay in places of imprisonment, deprivation of parental rights from a mother, death of the child's father and other circumstances.

Despite the above reasons, many women only in extreme cases decide to have an abortion at a later date. Support from loved ones helps to avoid an unpleasant procedure.

Late pregnancy termination methods

Abortion is considered late after 12 weeks. The maximum term for artificial termination of pregnancy is 22 weeks.

Termination of pregnancy can be medication or instrumental.

Medication methods

Instrumental methods

To prepare the cervix for abortion, the following methods are practiced:

• Introduction of seaweed rods into the cervical canal(kelp) a day before the planned termination of pregnancy promotes the expansion of the cervix due to an increase in the size of algae during absorption of amniotic fluid.
• Dilation of the cervical canal with the help of Gegara dilators, they are used from 15 to 28 weeks of pregnancy. The longer the pregnancy, the more instruments will be used to dilate the cervix.

After the expansion of the neck and opening of the fetal bladder, the fetus is removed by the legs with the help of Musot forceps. This method is very traumatic, time-consuming, threatens with tissue rupture and secondary infection. To reduce trauma to the uterus, an incision is made in the fetus's neck and a tube is inserted deep into the skull. Then, using a vacuum apparatus, the brain is aspirated. As a result of the manipulations, the head decreases in size and freely passes through the vagina.

Possible complications

A late termination of pregnancy threatens the development of all sorts of complications:

1. infection of the wound surface with pathogenic flora;
2. infection of the ovaries and fallopian tubes (salpingitis and salpingo-oophoritis);
3. in reproductive and adjacent organs;
4. the development of sepsis;
5. uterine bleeding;
6. perforation of the body of the uterus;
7. vascular thrombosis;
8. pulmonary embolism;
9. incomplete removal of the placenta or parts of the fetus;
10. violation of the natural hormonal background;
11. hypernatremia;
12. infertility;
13. miscarriage in the future;
14. severe psychological trauma.

To minimize the risk of complications, it is necessary not only to choose a highly professional specialist for the abortion, but also to follow his recommendations in the postoperative period:

• thorough intimate hygiene;
• lack of sexual intercourse until the wound surface is completely healed;
• bed rest until the body is restored 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 a woman during pregnancy;
• immediate appeal for qualified help to a medical institution if any alarming symptoms appear;
• adequate contraception after abortion.

Despite the reason why the woman decided on a late abortion, you need to understand the danger of the manipulations being carried out. Prevention of unwanted pregnancy with the help of contraceptives will reduce the sad statistics of abortions at any time.

Late abortion - termination of pregnancy from 13 weeks. and more. From 13 weeks. the period of embryonic (embryonic) development ends, and the fetal begins. Unlike the embryo, the fetus has already established organs and systems.

Starting from 20 weeks. he has already formed all parts of his body, he can move, and even feel, feel pain.

It goes without saying that the shorter the gestation period, the easier it is to carry out an abortion from a technical point of view, and the less negative consequences for a woman's health. Therefore, it is difficult to say why the woman decided to terminate the pregnancy at this particular stage.

There can be a lot of reasons: the deterioration of a woman's health, pathologies, financial situation that has changed for the worse, and simply - banal sexual illiteracy.

In other words, not all of the above factors are the reason for a late abortion. The bottom line is that late termination of pregnancy is carried out according to strict indications, and the simple desire of the woman (or his spouse) is no longer considered here as a reason.

Indications for late abortion may be associated with a woman's health (severe chronic diseases of organs and systems, mental disorders, infections). With these diseases, the risk of pregnancy for the health and life of a woman should exceed the risk of abortion.

Indications from the fetus are severe physical deformities diagnosed during pregnancy, Down's disease and other chromosomal abnormalities, lack of heartbeat, indicating a frozen pregnancy. In some cases, late abortion can be carried out for social reasons.

The circle of these testimonies is strictly delineated: pregnancy as a result of rape, death or group 1 of disability of a husband during pregnancy, a woman's stay in prison or deprivation of her parental rights in relation to children already born.

Compliance with all of these indications for late abortion, both medical and social, is monitored by the judicial authorities.

Methods

Getting rid of the fetus at a later date can be done in several ways. Among them:

1. Dilation and extraction. This is a rather lengthy method, which can take a day or more. Indeed, for extraction, which at this stage has reached a relatively large size, the cervical (cervical) canal needs significant dilatation (expansion). Further, the whole fetus is removed with special obstetric forceps, or after preliminary fragmentation.
2. Salt filling... Preliminarily, amniocentesis is performed - the fetal bladder is pierced, and removed by suctioning 200 ml of amniotic fluid. Instead, the same amount of hypertonic (highly concentrated) sodium chloride solution is introduced. Sometimes a hypertonic glucose solution is used. The introduction of hypertonic solutions leads to burns of the skin and mucous membranes, and to brain damage in the fetus. Intrauterine fetal death provokes contractions and miscarriage within the next 1.5 days after the administration of solutions. If this does not happen, drug stimulation is performed to expel the dead fetus.
3. Artificial childbirth. Synthetic analogs of prostaglandins are introduced. Prostaglandins are biologically active substances produced by various tissues. One of the effects of prostaglandins is to increase the tone and contractility of the uterine muscles. This method is used at a later date, starting at 22 weeks. pregnancy.
4. Small cesarean section. Also performed in late pregnancy. The technique in this case is the same as for a conventional cesarean section - the uterus is cut and the fetus is removed.

Carrying out all these methods is fraught with dangerous complications (bleeding, inflammation, perforation of the uterus) not only for health, but also for the life of a woman. Do not forget about the moral aspect.

Many of the above methods, in particular, a small cesarean section, salt filling, in which the fetus receives burns from hypertonic solutions, are inherently barbaric. A live child is born starting at 28 weeks, although in some cases earlier dates are noted, starting at 24 weeks.

And therefore, in some cases, the release of a still living fetus is possible, which requires additional measures to kill it by asphyxiation (strangulation) or the administration of drugs. All this causes irreparable psychological trauma to the failed mother.

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Unfortunately, pregnancy does not always go so smoothly and without complications. There are often cases when it is necessary to stop pregnancy in its later stages. And no one has the right to do this, if there is no special permission, which is obtained according to certain medical and social indications. Otherwise, in another case, it is a criminal offense.

Terminating a pregnancy beyond twenty weeks can be fatal for a woman. But also, such a late abortion is often spoken of as the murder of a child, since by this period he is already fully ripe. Therefore, the arguments must be extremely weighty for a woman to be allowed to terminate the pregnancy.

Indications for termination of pregnancy

Legislation can allow a woman to have an abortion at such a late date only upon presentation of certain medical and social substantiated reasons.

Medical reasons include: diabetes mellitus, problems with cardiovascular dystonia, problems with the woman's central nervous system. And another abortion is carried out if there are pathologies in the fetus, and the risk of genetic diseases, which can lead to the death of the fetus.

As for social reasons, then they talk about them if a woman finds out about her pregnancy late, or was afraid to immediately confess to relatives about this news, which delayed her decision to terminate the pregnancy.

Social reasons include: the death of a husband during pregnancy, pregnancy as a consequence of rape, and the mother's disability.
Each of these reasons is zealously considered by a special commission of doctors.

Examination of a woman before termination of pregnancy

Before having an abortion, the doctor must make sure of the woman's health to be sure that she can undergo this operation. Here are the examinations that a woman must undergo: ultrasound, determination of the woman's Rh factor, blood donation for the determination of sexually transmitted diseases, smear sampling, blood test, chest x-ray and much more.

If there are medical or social reasons, then the woman is given an opinion, with signatures and seals.

If a woman has venereal diseases, then the documents confirming this are transferred to the gynecological department.

As a rule, the operation is performed under anesthesia in a hospital. And after the operation by a specialist, at the end of the operation, a second ultrasound is performed in order to make sure that the fetus is completely scraped.

Late pregnancy termination methods

The type of abortion is determined by the doctor, based on the gestational age.

The latest term for termination of pregnancy (abortion) is 26 weeks inclusive, no more.

The easiest, in terms of transfer, is the operation for a period of twenty weeks.

The cervix is ​​dilated and the extraction of the fetus is carried out from the twelfth to the twentieth week. In this case, a vacuum aspirator is used, which sucks out the fetus in parts. In this case, there is a risk of injury to the walls of the uterus, which is accompanied by severe bleeding.

For a period of twenty to twenty-eight weeks, the method of introducing fluids into the vagina is used. In this case, fetal water is sucked out of the fetal bladder, and then a saline solution is injected. And within a day, with bleeding, the fetus is also rejected.

Complications after abortion

• Rupture of the cervix is ​​possible.
• The appearance of polyps.
• Poor cleansing of the uterus from the fetus.
• Purulent-inflammatory diseases.
• Hematometer.

A woman is given a sick leave for three days, when she is under a thorough examination by a doctor. After that, in case of a positive healing process, and a high-quality abortion, the woman is discharged and sent home.

Pregnancy is not always desirable for a woman. Sometimes it becomes necessary to interrupt it. This procedure is called an abortion.

Abortion

Abortion is officially allowed only in early pregnancy. In this case, there is no need to take into account medical or social contraindications for bearing a baby, just a woman's unwillingness to give birth is enough.

In the first trimester, any pregnant woman has the right to contact a gynecologist to terminate her pregnancy. However, starting from the second trimester, the situation changes.

After 12 weeks of pregnancy, abortion at the request of the woman is prohibited. And the doctor who performed this procedure is responsible before the law.

The only exceptions are certain situations. Late abortion is only possible if indicated. They can be related to medical or social reasons.

Social indications

Late abortion is the termination of pregnancy between 13 and 22 weeks. Such a procedure is very dangerous for a pregnant woman, and sometimes even threatens her life. It is not surprising that it is quite difficult to have an abortion at a later date, because the state protects the woman's health and the child's right to birth.

Previously, the list of social indications was expanded. These included the following situations:

• Stay of a pregnant woman in MLS.
• The death of a husband while carrying a child or his disability of the first group.
• Pregnancy as a result of rape.
• Difficult material and everyday living conditions.
• Having a disabled child.
• Large families.

However, this list contributed to the formation of the opinion that late termination of pregnancy is a procedure quite affordable, it is enough just to adjust it to the necessary social indications.

Modern doctors will carry out a late abortion only in a situation where the pregnancy has arisen after the rape. This is the only social indication today for such a dangerous procedure.

Paperwork

To exercise the right to late termination of pregnancy, a woman must provide the following documents:

• Written statement.
• Conclusion of the attending physician about the gestational age.
• Documents that confirm the fact of rape.

• The head of the medical organization where the woman turned for help.
• Attending gynecologist.
• Lawyer.

Sometimes a specialist in social work is also a member of this commission.

After considering the situation, the pregnant woman is issued a conclusion. It is certified by the signatures of all specialists and the seal of the organization.

Medical indications

A late abortion for medical reasons is quite possible. It is performed when the health and life of a woman is in serious danger.

Also, this is often the only way out in a situation when defects that are incompatible with life are revealed in the fetus.

It does not matter what week of pregnancy a woman has. This kind of abortion can be performed at any time for the following diseases and conditions:

• Diabetes mellitus, its most severe forms.
• Some blood diseases - leukemia, severe aplastic anemia.
• Certain mental as well as nervous diseases.
• Certain diseases of the cardiovascular, respiratory and digestive systems.
• Rubella.
• Malignant damage to the organs of vision.
• Severe congenital malformations of the fetus. Chromosomal abnormalities.

In addition, pregnancy can be terminated at any time if the expectant mother is under 15 years old, since in this case the girl is considered physiologically immature for gestation and childbirth.

An abortion is performed after the examination of the documents by a special commission and the issuance of the necessary opinion by it.

Methods

As a rule, in the second trimester, pregnancy is usually terminated between 13 and 22 weeks, but abortion, if indicated, can be done up to 28 weeks. There are such techniques for performing this procedure:

• Instrumental abortion.
• Medical induction of labor.

An instrumental abortion is usually used when the pregnancy is less than 16 weeks. However, it can be performed at a later date - if necessary. But you should know that the risks for a woman - her health and life - are increasing.

Drug induction is also dangerous and has its own complications.

Instrumental method

Instrumental evacuation of the fetus and membranes is preferred before 16 weeks of gestation. The abortion technique is the same as in the first trimester. However, there are certain features of the procedures:

• The cervix must be dilated to a large extent with the help of special dilators.
• Large curettes and abortions required.
• Often, doctors use kelp.

Kelp is seaweed that expands by absorbing water from surrounding tissues. They are placed in the cervical canal the day before the abortion. Thus, a quick and necessary opening of the neck is achieved.

Complications of the instrumental method

The incidence of complications during instrumental abortion is somewhat lower than with medical induction. This is due to the short gestation period. However, the consequences after this procedure can be more serious and even life-threatening.

The main complications of late instrumental abortion are:

• Bleeding.
• Perforation (perforation) of the uterus.
• Damage to the cervix.
• Remains of the placenta in the uterine cavity.
• Accession of infection with the development of purulent complications and septic shock.

The most formidable complications are bleeding and perforation of the uterus. This can happen if the procedure is performed by a young inexperienced specialist, or if a pregnant woman has anatomical features of the reproductive system.

With profuse bleeding, the count can go on for minutes, and the woman is saved only by the complete removal of the uterus and the ligation of large vessels. But this complication is rare.

Perforation of the uterine wall occurs more often. The doctor notices this after the instrument is freely lowered inward to a great depth. Small perforations may go unnoticed.

Sometimes an obstetrician-gynecologist can even capture intestinal loops through the damaged wall, which subsequently turns into a formidable surgical pathology - peritonitis.

Drug induction

Medical induction of labor is usually done between 17 and 24 weeks, but sometimes later. As a rule, it includes three components:

• The use of drugs that stimulate the dilatation of the cervix.
• Dissection of the fetal bladder - amniotomy.
• Administration of oxytocin, a pain-inducing drug.

The dilatation of the cervix is ​​usually stimulated with prostaglandins. These drugs can be administered in three different ways:

• intramuscularly;
• orally;
• intravaginally.

They are introduced three to four hours before the onset of labor.

There is another method of drug induction. In this case, drugs are injected directly into the amniotic cavity. The procedure is called amnioinfusion, or instillation. The goal is to stimulate uterine contractions, expulsion of the fetus and placenta.

The following drugs are used for amnioinfusion:

• Hypertonic sodium chloride solution (saline solution).
• Enzaprost (prostaglandin F2α).
• Hyperosmolar solutions (eg, Gramicidin).

Complications of the induction method

The induction of late labor can be quite lengthy. Sometimes this period is up to two days. In addition, it is often accompanied by complications.

If the procedure uses oral and intravaginal prostaglandins, it can cause the following symptoms:

• Vomiting.
• Nausea.
• Diarrhea.

In addition, you should be aware that children after drug induction with prostaglandins can be born alive. There are known cases when it was possible to leave them. This is true for an interruption at the end of the second trimester. However, in such a situation, infants have an increased risk of developing cerebral palsy and other pathologies leading to disability.

During abortion by amnioinfusion, it is often possible to find remnants of placental tissue in the uterine cavity, which requires further curettage. This complication occurs in 13–46% of cases, according to various sources.

If a hypertonic sodium chloride solution is used for interruption, for a pregnant woman it is fraught with the following complications:

• Hypernatremia.
• Hyperosmolar coma.
• DIC syndrome (the formation of blood clots in the vessels throughout the body).

These conditions can be fatal to a woman, so the risks must be carefully weighed before interruption.

Cesarean section

If there are contraindications to traditional abortion methods, the doctor may perform a caesarean section. Often this is the method of choice if a woman has a malignant neoplasm that requires removal of the uterus.

Caesarean sections are vaginal and abdominal. The first option is practically not used in modern obstetrics due to its high trauma.

An abdominal cesarean section is called small and does not differ from the operation that is performed for a normal delivery. After it, a scar forms on the uterine wall, which in the future can become an obstacle to the safe bearing of the baby.

Where to get an abortion at a later date?

Abortion location

Traditionally, the abortion site is called an abortion clinic. It means a department or medical institution whose main activity is early termination of pregnancy. Abortion clinics must be equipped with the necessary equipment, instruments for carrying out operations, and appropriate facilities. Specialists provide assistance to women.

You should be aware that up to 22 weeks, the interruption procedure can be carried out in the gynecological department of a general hospital. And after this period, abortion is performed only in an obstetric hospital.

Before terminating a pregnancy, any woman should remember that even the safest methods can further result in infertility. And its treatment is usually long, costly and ineffective.