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Abortion pills - positive and negative aspects of their use. What is medical abortion

Despite the abundance of contraceptives, termination of pregnancy remains one of the most popular medical procedures. Therefore, it is so urgent to develop methods that leave the least damage in the woman's body. Abortion with pills has been studied since the second half of the last century and in 1988 the first license for this activity was obtained in France. In Russia, early medical abortion began to be practiced only ten years later.

The essence of the procedure

By taking the necessary drugs in a certain sequence in the early stages of pregnancy (up to 6 weeks), an artificial miscarriage is provoked. This is possible while the fetus is not yet sufficiently formed and the ovum is poorly attached to the walls of the uterus.

Advantages of the method

Any abortion has a multifaceted effect on the body. Changes occur in the genitals, nervous, endocrine, cardiovascular and other systems of the body. How the abortion will be performed depends not only on the woman's desire, but also on the state of her body. But if there are no contraindications, then a medication is offered, the most gentle of the most commonly used.

Comparison of medical and surgical methods of termination of pregnancy

Indicators / methods Medicated Surgical
Vacuum aspiration Curettage
Method efficiency (%) 95-98 95-99 95-97
Surgical intervention – + +
Perforation of the uterus – + +
Cervical injury – – +
Menstrual irregularities + + +
Inflammatory diseases of the genital organs + + +
Hematometer (accumulation of blood in the uterine cavity) + + +
Infertility – – +

Among the main advantages of medical abortion, women highlight the ability to stay at home, use it early in pregnancy, minimal trauma to the uterus, a lower risk of infectious complications, the absence of manipulations that carry a certain share of risk and complications (consequences of anesthesia, infection with hepatitis, HIV, etc.).

Contraindications

If you put together the list of contraindications for abortion in general and specific contraindications for medical abortion, you get an impressive list:

  • intolerance to the drugs used;
  • inflammation of the genitals or scars on the uterus;
  • infectious diseases;
  • ectopic pregnancy;
  • severe cardiovascular disease;
  • severe liver and kidney dysfunction, including chronic adrenal insufficiency;
  • smoking and age over 35;
  • inflammatory diseases of the gastrointestinal tract with chronic relapses;
  • anemia or blood clotting disorder;
  • lactation;
  • long-term use of hormonal contraceptives discontinued before pregnancy;
  • severe course of obstructive bronchitis or bronchial asthma with the use of glucocorticoids;
  • porphyria (a hereditary disorder of pigmentation disorders).

Drugs used for early abortion

A number of tools have been developed for medical abortion, including:

  • "Mifeprex" (contains the active substance mifepristone),
  • "Mifolian" (the active substance is mifepristone),
  • "Pencrofton" (active substance mifepristone),
  • Mifegin (micronized mifepristone),
  • Misoprostol.

The classic medical abortion remedy is used strictly under the supervision of a physician!

They all contribute to miscarriage. The active substance of the drug initiates the detachment of the ovum from the wall of the uterus and its withdrawal with abundant discharge, similar to menstrual flow. Basically, "Mifepristone" is used on the first day of taking the drug and "Misoprostol" at the next visit to the doctor after 36–48 hours.

The effect of "Misoprostol" is significantly reduced by smoking more than 10 cigarettes per day.

"Mifepristone" breaks the connection of the ovum with the wall of the uterus, slightly increases its tone and opens the cervix, creating conditions for termination of pregnancy. "Misoprostol" increases the activity of the uterus and the egg with the rejected endometrium is removed from the cavity.

Scheme of the

The procedure is performed on an outpatient basis in several stages in the early (up to 6 weeks) stages of pregnancy:


Side effects

A third of women tolerate the procedure with little or no discomfort. Women who have not given birth, especially those who experience earlier soreness during menstruation, may develop pain syndrome, accompanied by diarrhea, nausea, or vomiting. However, the usual pain relievers cannot be used - the abortive effect of the drugs taken in the outpatient clinic may be blocked.

To reduce pain, alternative therapy methods can be used - rest, dry heat, hot drinks. In extreme cases, "No-shpa" or "Drotaverin" are used. The realization that the chosen method of abortion is the most benign of the existing ones and entails the least consequences, should also serve as support in this short-term period of pain.

Remember that taking most pain pills during the process of fetal rejection may not be the best.

Determination of performance

36–48 hours after the abortion, a control ultrasound is performed, revealing cases of hematometers (stagnation of blood in the uterus), and 10–15 days later, a follow-up examination and repeated ultrasound to ensure the effectiveness of the manipulations and the absence of complications.

Possibility of ineffectiveness of the procedure

In 3-5% of cases, there is a partial removal of the ovum. In the first pregnancy, the risk of incomplete abortion is higher. This is recognized on control examinations and ultrasound. The consequences are eliminated by surgical abortion.

With an increase in pregnancy, the possibility of maintaining pregnancy also increases, but the total number of such cases does not exceed 1%. The remaining pregnancy is revealed on examination and ultrasound in 1-2 weeks after the abortion. In such cases, vacuum aspiration is recommended.

Negative consequences

Any termination of pregnancy cannot pass without consequences for the female body, but medication is the most gentle of all, since it is carried out in the early stages and does not provide for surgical intervention that injures the cervix and uterine cavity.

Early

  • Stagnation of blood in the uterus (hematometer). They use drugs that enhance the contraction and eliminate the spasm of the cervix, and in the absence of a result, the contents are sucked out by vacuum aspiration. If inflammation develops, aspiration is delayed and antibiotic therapy is given.
  • Heavy bleeding during abortion. With excessive blood loss, the likelihood of which increases with increasing gestational age, it is possible to use curettage (curettage) of the uterus.
  • Infectious complications are much less common than after surgical termination of pregnancy. To reduce the risk, a bacterioscopic examination is required before the procedure.

Late complications

  • decreased immunity;
  • hormonal imbalance (most often menstrual irregularities, less often weight gain);
  • psycho-emotional problems;
  • dysbiosis of the gastrointestinal tract and vagina (as a rule, it is a consequence of a combination of the above three complications);
  • dysplasia of the mammary gland.

The best way to prevent unwanted pregnancy is to use contraceptives. If you happen to resort to interrupting it, then the most gentle method is medication. It has the least consequences in the short term, and it is not worth talking about the long term, since health problems are not only among those who have abortions, and hardly anyone will be able to pinpoint the past catalyst of current diseases.

Maria Sokolova


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Increasingly, we are faced with advertising for "velvet" abortion. This is a relatively safe method of terminating a pregnancy. Without surgical intervention, without the use of anesthesia, it only requires taking certain medications (hence - medication, or pills).

Drugs for tableted abortion

This method is used in the early stages of pregnancy, up to 49 days of delay from the first day of the last menstruation.

To date, the following drugs are used:

  • Mifegin (made in France);
  • Mifepristone (made in Russia);
  • Pencrofton (made in Russia);
  • Mifolian (made in China).

The mechanism of action of all drugs is the same. The receptors for the hormone progesterone are blocked, which is designed to support the pregnancy process in the body, and as a result, the embryonic membranes are detached from the uterine wall and the ovum is expelled.

All of these drugs cannot be bought in pharmacies without a prescription!

Stages of the

Before undergoing the procedure, make sure that the doctor has all the necessary documents and permits.

Many women wonder how painful the procedure is.

The pain is usually slightly worse than during a normal period. You will feel a cramping pulsation of the uterus. Pain medication can be taken in consultation with your doctor.

  • After a medical abortion, you must abstain from sex for 2-3 weeks: it may well cause bleeding and inflammation. In addition, one of the complications may be a change in ovulation, and a woman may well become pregnant 11-12 days after the procedure;
  • Menstruation usually starts within 1-2 months, but menstrual irregularities are possible.
  • Pregnancy can be planned in 3 months if everything went well. See your doctor before planning.


Contraindications and possible consequences

Tablets are potent drugs that have a number of contraindications:

  • age over 35 and under 18;
  • hormonal contraceptives (oral contraceptives) or an intrauterine device were used within three months before conception;
  • suspicion of an ectopic pregnancy;
  • pregnancy was preceded by an irregular menstrual cycle;
  • diseases of the female genital area (fibroids, endometriosis);
  • hemorrhagic pathologies (anemia, hemophilia);
  • allergies, epilepsy, or adrenal insufficiency
  • long-term use of cortisone or similar medications;
  • recent use of steroids or anti-inflammatory drugs;
  • renal or hepatic impairment;
  • inflammatory diseases of the gastrointestinal tract (colitis, gastritis);
  • bronchial asthma and other pulmonary diseases;
  • pathology of the heart and blood vessels, as well as the presence of cardiovascular risks (high blood pressure, obesity, smoking, diabetes);
  • an allergic reaction or hypersensitivity to mifepristone.

Quite often, after a medical abortion, hormonal disturbances begin, provoking various gynecological diseases (inflammation, endometriosis, cervical erosion, fibroids). All this can subsequently lead to infertility.

Is the safety of velvet abortion a myth or reality?

As we can see, at first glance, this is a fairly simple operation, and most importantly, as they say, it is largely safe in comparison with surgical intervention. However, in reality, not everything is as simple as it seems.

Is this "security" safe?

  • If the procedure is not carried out on time(after 7 weeks of pregnancy), then even a lethal outcome is quite possible. Although there are dozens of proven deaths from mifepristone in the European Union alone, in reality, experts agree, there are many more, and there are thousands of those who have received irreparable damage to their health. Dr. Randy O'Bannon, head of research at the US National Defense Committee, believes it is very difficult to obtain information about a patient's death as a result of medication. This information flows to the manufacturer, and immediately becomes inaccessible to people.

We must remember that abortion, whether pharmacological or surgical, is the murder of the unborn child.

If you find yourself in a difficult life situation and want to have an abortion, call 8-800-200-05-07 (helpline, call from any region is free).

Reviews:

Svetlana:

I went to the antenatal clinic on a paid basis. First, she underwent an ultrasound scan, established the gestational age, then took a smear for infections, made sure that there were no infections, gave the go-ahead. My term was 3-4 weeks. I drank three pills of mefepristone. They can be chewed, not bitter. At first I felt a little nauseous, but the nausea went away after I drank kefir. Before they let me go home, they explained everything to me, and also gave me instructions and 4 Mirolyut tablets. They said to drink two in 48 hours, if it does not work two more in two hours. I drank two tablets on Wednesday at 12-00. nothing happened - drank another one. After that, blood began to flow, profusely with clots, the Abdomen ached, as with menstruation. For two days the blood flowed profusely, and then it just smeared. On the seventh day, the doctor said to start taking Regulon to restore the menstrual cycle. On the day of taking the first pill, I stopped. On the tenth day I did an ultrasound. Everything is okay.

Varya:

I was forbidden to give birth for some reason, so I had a medical abortion. Everything went without complications for me, but with such pains that mom do not grieve !!! I drank 3 pills of no-shpa at a time, so that at least it was a little easier ... psychologically it was very difficult. Now I calmed down, and the doctor said that everything went well.

Helena:

The doctor advised me to undergo a medical termination of pregnancy, underwent an examination, drank mifepristone tablets, and then sat for 2 hours under the supervision of a doctor. I came in 2 days later, they gave me two more pills under the tongue. An hour later, blood began to flow, discharge, a terrible stomach ache, so that I climbed onto the wall. Clots came out. And so my period went 19 days. I went to the doctor, did an ultrasound scan, and found the remains of the ovum. In the end, they still made me a vacuum !!!

Darya:

Good afternoon everyone! I am 27 years old, I have a son who is 6 years old. At 22, I gave birth to my son, when he was 2 years old, I became pregnant again, but they didn’t want to keep the pregnancy, since the little one was very restless and I was just tortured. Made honey. Abortion! Everything went smoothly! After 2 years I got pregnant again and did it again. Everything went well again. Well, time passed and again I made interruption with pills. And the nightmare begins! I drank the pills that the doctor prescribed, at home, it was very bad, there was abundant discharge! The spacers didn't help! In general, horror. In short, the girls sent me to a vacuum .. Two previous honey. abortion. were not painful everything worked out without problems! But 3 of course terrified me! Honestly, I regret ... .. Now I drink antibiotics ...

Natalia:

Apparently everyone has their own way. My girlfriend did it. She said as if her period had gone, no pain, no complications, only nausea ...

If you need advice or support, then go to the page (https: //www..html) and find out the helpline or the address of the nearest motherhood support center.

The medical method of abortion is a modern and safe type of mini-abortion, which is performed without surgery. In this case, the period from the moment of conception should not be more than 63 days. The interruption of a conception that has already occurred is carried out with the help of a drug, the main substance of which is Mifepristone. The registered trademarks of this drug are:

  • Mifegin
  • Pencrofton
  • Mytholian
  • Mifeprex
Many women are often interested in how drug abortion occurs, fearing harm to the body. This type of abortion is much simpler and easier than a surgical one. After Mifepristone enters the body, its components begin to block the action of progesterone, a hormone that performs the main function in maintaining pregnancy. Since the drug prevents the ovum from attaching to the wall of the uterus, the development of the embryo stops completely. Then there is a gradual stimulation of its withdrawal from the uterine cavity. At the same time, Mifepristone helps to soften and slightly open the cervix, which greatly facilitates the abortion process.

The method of medical termination of pregnancy has many advantages over surgical:

  • Painlessness and efficiency of the procedure
  • Lack of risks that arise after surgery
  • Minimal psychological impact
  • Does not require the introduction of anesthesia
  • Reproductive function is not affected
But, despite the large number of advantages, it must be borne in mind that medical termination of pregnancy has contraindications. These include:
  1. Ectopic pregnancy
  2. Pregnancy that occurs immediately after the withdrawal of hormonal drugs
  3. Inflammatory process in the genital area
  4. Allergy to the components of the drug
  5. Long-term use of anticoagulants or glucocorticosteroids
  6. The age of the pregnant woman is more than 35 or less than 18 years old
  7. Pregnancy, not proven by ultrasound
  8. Anemia
  9. Myoma of the uterus
  10. Hemorrhagic syndrome
  11. Liver failure
  12. The presence of pulmonary disease
  13. Cardiovascular pathology
  14. Diabetes
  15. Obesity
  16. Adrenal insufficiency

It is also forbidden to resort to medical termination of pregnancy after a cesarean section or other operations, after which the woman has scars on the uterus. Therefore, it must be borne in mind that before making a decision with a drug method, in the presence of the above contraindications, a woman needs to weigh all the pros and cons of this type of abortion. Otherwise, its result may be irreparable.

Most women feel that the consequences after medical abortion are very small compared to those after surgery. But this is not at all the case, because even such a seemingly harmless method leads to a large number of consequences. For example:

  1. Weakness of the body
  2. Headache
  3. Increased body temperature
  4. Feeling nauseous
  5. Vomiting attacks
  6. Diarrhea
  7. Allergic skin rashes
  8. Decrease in pressure
  9. Severe bleeding that requires urgent surgery

The most serious consequence of this type of abortion is the incomplete termination of pregnancy. It can be expressed either by its continuation, or by incomplete release of the embryo, after which, in almost all cases, inflammation of the uterus begins. This is due to an incorrect calculation of the amount of active substance. Therefore, when many women, having come to the gynecologist, ask him the question: "Is medical abortion dangerous or not?", The doctor must honestly answer: "Yes, it is dangerous." After all, after it, there may be consequences that can cause tangible harm to a woman's health.

For this reason, after performing an abortion with the help of medications, the patient must, in a strict manner, come to the doctor's office and undergo a full examination of the uterine cavity for ultrasound, to identify that there are no particles of the ovum left in it.

As with a normal abortion, a woman will bleed for two to three weeks. At this time, there is an open wound on the uterus, which takes some time to heal. Therefore, sex life after medical abortion, as well as any physical activity under a strict ban, at least until the end of the discharge. If these recommendations are not followed, a woman runs the risk of earning inflammation of the genitals and uterus. Also, this prohibition has one more weighty indication - after any type of termination of pregnancy, a mandatory failure of the menstrual cycle follows, which leads to premature or delayed maturation of the egg. And this, in turn, increases the chance of repeated unwanted conception.

In these cases, you need to know that you should not rely on the results of a pregnancy test. Indeed, for a short time after an abortion, hCG is still present in the blood, on the basis of which the onset of pregnancy is diagnosed. That is, in this case, he may show an incorrect positive result.

A large number of gynecologists claim that after termination of pregnancy, hormonal contraceptives are the best method of contraception. Their use has been proven to help restore the menstrual cycle and also reduce the risk of inflammatory diseases. But it is better to refuse the use of an intrauterine device, because they are the cause of complications.

Most women are interested in the question: "After a medical abortion, will I have children?" A large number of studies have been conducted on this issue, and all doctors have agreed that the likelihood of becoming pregnant after medical abortion remains unchanged. Fertilization of the egg can occur already during the first menstrual cycle. But it is advisable to avoid this, because after the abortion there were changes in the hormonal background and in the mammary glands, and the uterus itself has high irritability, and the pregnancy that occurred at this time may end in miscarriage.

If the medical abortion procedure went without complications, then the best time to plan the next pregnancy is 4-7 months after the previous one was terminated.

Medical methods of termination of pregnancy 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 the termination of pregnancy.

Medical termination of pregnancy is considered effective 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 pregnancy has been confirmed and its term has been established. In the Russian Federation, it is allowed to use medical abortion up to 6 weeks of gestation. Given that the success of medical termination of pregnancy largely depends on the duration of pregnancy, the latter is best confirmed using transvaginal ultrasound.

With medical abortion, medical supervision of the patient should be more intensive than with surgical methods of abortion. After the examination and the 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 when a combined method is chosen, a woman visits a doctor with each drug intake. After 4 weeks, examination of the woman is shown to confirm the successful termination of pregnancy.

In the case when medical abortion is ineffective, ends with incomplete abortion, progressive pregnancy, or is complicated by bleeding, surgical termination of the pregnancy is performed. In some cases, vacuum aspiration is performed for other medical reasons (indomitable 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 analogs of PG (misoprostol).
· Antiprogestins (mifepristone).
· Cytostatic drugs (methotrexate).

Inhibitors of progesterone synthesis

An inhibitor of progesterone synthesis (epostan, not registered in Russia) is an inhibitor of ovarian and placental 3b hydroxysteroid dehydrogenase, which suppresses 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 ovum. The use of the epostane is of historical importance. The FDA does not recommend the use of Epostan for medical abortion.

Synthetic prostaglandin analogs

Synthetic PGs are used to terminate pregnancy, as they increase the contractile activity of the uterus. PGE1 (Mirolut ©) exerts its effect due to the enhancement of 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, as a result of which the release of calcium from the endoplasmic reticulum is enhanced and the contractile activity of the myometrium increases.

In Russia, among the synthetic analogs of PGE1, only misoprostol (Mirolut ©) is registered.

Unlike all PGs used for abortion, misoprostol is stable at room temperature and can be administered orally. Its half-life is 30 minutes. Side effects from the gastrointestinal tract are not very pronounced, but they occur in 35% of patients when taking the drug inside. There are no data on the development of dangerous side effects. According to various authors, misoprostol can be used up to 7–9 weeks of gestation. We studied various doses (from 400 to 3200 μg) and modes of administration of the drug. Misoprostol can be administered orally or vaginally (vaginal efficacy is higher). 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 to be so safe that they allow women to take it on their own without a doctor's prescription, but this opinion cannot be agreed. 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 prolonged increase in uterine tone.

The use of PG is associated with a rather high risk of side effects. More often worried about pain, dizziness, nausea, vomiting, diarrhea, rash. The appointment of narcotic analgesics required 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 in 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, with the appointment of which it is possible to 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 ovum, 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 also the concentration of this hormone in the blood is 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 decidual membrane (hypoplasia, necrosis), which contribute to its disappearance. The drug is able to increase the sensitivity of the myometrium to endogenous and exogenous PG. Mifepristone and PG act as synergists in the pregnant uterus.

· Mifepristone monotherapy is not currently used.

· Prescribing mifepristone in combination with PG is the most common and studied method of medical abortion and is recommended by the WHO.

Mifepristone is used in medical practice not only for abortion. Different doses of the drug and different prescription regimens have been registered for preparing the cervix for childbirth, adjuvant therapy of uterine fibroids, and 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 in a dose of 600 mg by mouth (3 tablets of 200 mg each) in the presence of a doctor. 36–48 hours after taking mifepristone, the woman is prescribed misoprostol (mirolut ©) at a dose of 400–800 mcg.

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

Complete expulsion of the ovum before the appointment of PG is noted extremely rarely (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 who received drugs). The volume of blood loss varies from 84 to 101 ml and significantly increases with an increase in gestational age.

Side effects of mifepristone include pain that bothers almost all women and pain relief is necessary in 9–73% of cases, malaise, weakness, nausea, and vomiting. Teratogenicity of mifepristone has not been identified in studies on rats, mice, and monkeys. If medical abortion fails, the pregnancy should be terminated surgically due to the high risk of fetal malformations as a result of the use of PG.

Cytostatics

The mechanism of action of cytostatics is to suppress trophoblast cell division, which leads to the rejection of the ovum. Methotrexate is an antagonist of folic acid, which is 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 combination therapy. Usually, the expulsion of the ovum occurs 3 weeks or more after the appointment of the drug.

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

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

· The data on the side effects of combination treatments are conflicting. A number of authors believe that side effects of misoprostol are more common when 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 frequency of fetal malformations when using this drug. Mainly, limb lesions are noted (shortening of the limbs, absence of fingers). If medical abortion is ineffective, surgical termination of pregnancy is necessary.

Contraindications for medical abortion

Contraindications for medical abortion are listed below.

· Allergic reaction to a drug.
· The gestational age is longer than the allowed for this method.
· Suspected ectopic pregnancy.
· Chronic adrenal insufficiency.
· Long-term glucocorticoid therapy.
· Hemorrhage and anticoagulant treatment.
· 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 availability of medical abortion

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

Psychologically, women are easier to tolerate medical abortion than surgery under anesthesia. However, medical abortion has drawbacks: it is painful, accompanied by side effects, long-term, expensive, requires repeated visits to the doctor, and as the duration of pregnancy increases, the effectiveness of medical abortion decreases.

Currently, medical termination of pregnancy is acceptable for most countries in 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, more prolonged bleeding, intense and prolonged pain syndrome and other side effects are noted.

The long-term consequences of these methods have not been sufficiently studied. If 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 safer to terminate a pregnancy with medication early in pregnancy. With an increase in the duration of pregnancy, the effectiveness of drug methods decreases, therefore, it is necessary to carry out vacuum aspiration.

To detect the remnants of the products of conception after termination of pregnancy, it is necessary to use ultrasound more widely, especially in nulliparous women.

For the prevention of traumatic complications, it is recommended to prepare the cervix for surgery (preferably with the use of 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 primary pregnant), carefully select and perform their abortion technique.

In rehabilitation therapy aimed at restoring reproductive function, combined oral contraceptives, vitamin E are prescribed, the microbiocenosis of the vagina and intestines is corrected, and physiotherapeutic procedures are performed.

Medical termination of pregnancy sometimes saves a woman from continuing an unwanted pregnancy. Scientists have been looking for a tool-free abortion for many years. Gynecologists in Ukraine have been using drug abortion since 2004.

Preparing for medical abortion

Preparation includes a smear on flora and intravaginal ultrasound to establish the duration of pregnancy and the location of the ovum. It also clarifies whether a woman has chronic diseases that can become contraindications for drug interruption. Before the procedure, do not eat anything salty and fatty, smoked, after a drug abortion, you cannot take a bath or go to the pool until everything is over. Do not eat 3 hours before interruption and less than 2 hours after.

The effectiveness of medical termination of pregnancy

Medical termination of pregnancy manifests itself as more painful than usual periods. The interruption efficiency is 95%. The advantage of medical abortion is that it does not require general anesthesia. You just get a pill and drink it in front of a doctor. After 72 hours, you go back to the clinic where you are given a pill to contract the uterus. A day later, profuse spotting begins.

Terms of medical termination of pregnancy

Terms of medical termination of pregnancy: 5-6 weeks. A medical abortion is done after a full pelvic examination. Side effects: nausea, headache. Contraindicated in heart defects with severe heart failure, tuberculosis, hypertension and fibroids, obesity and diabetes.

How is medical termination of pregnancy carried out?

Medical termination of pregnancy begins with a preliminary conversation between the woman and the doctor. She is informed about possible contraindications and complications and the very essence of the method. Next, they take blood tests for HIV, hepatitis, Rh factor and a smear for flora and do an ultrasound to clarify the time. The woman signs the consent.

As for pain, it all depends on the period: the longer the gestation period, the more intense the pain.

After a drug abortion, contraception is selected for the woman. Conception can occur immediately, so you need to start protecting yourself immediately.

Stages

In any case, a woman goes through the following stages of medical termination of pregnancy:

  • The woman calls the clinic and makes an appointment with the doctor, indicating that she wants to have an abortion with a drug. Food is not accepted for 3 hours.
  • At the reception, the doctor does an ultrasound.
  • You are warned about possible complications of the procedure and contraindications to it, they conduct an introductory conversation.
  • Together with the gynecologist, you choose one of the drugs made in France or Russia.
  • Tests may also be ordered if you have not done them shortly before interruption. Results are ready in 1 day.
  • The drug is taken with a doctor.
  • Pain and discharge similar to menstruation appear within 72 hours.
  • After the onset of pain and bleeding, prostaglandins are taken. Within 5 days, the ovum comes out entirely.
  • The next stage is a control ultrasound.

Remember, the vagina is home to bacteria. This is why smears are done before a medical abortion. When the cervix is ​​dilated, bacteria can enter the uterus. Unfortunately, sometimes fatal toxic shock occurs, but this is stubbornly silent.

Choose a clinic whose doctors have been performing drug abortion procedures for a long time. This will help keep complications to a minimum.

Abortion pills

Tablets for medical abortion: Mifepristone, Mifegin, Mifeprex, Mifolian, RU-486. The active substance of all these drugs is Mifepristone. This is a complex molecule that has a complex effect on the female body, which is configured to maintain pregnancy. If you had an irregular menstrual cycle before taking the pills, the problem may worsen.

Medical abortion is carried out with drugs that include Mifepristone: Mifegin, Mifeprex, Mifolian, RU-486. Specialists always carefully prepare a woman for taking these drugs. The doctor discusses with the patient anamnesis, all diseases that she had or has.

Mifepristone

Mifepristone blocks receptors for a hormone that maintains pregnancy.

Medical termination of pregnancy with mifepristone is better tolerated than surgery. Before the procedure, you confirm that you are aware that in the future, you may need a surgical abortion due to incomplete removal of the ovum. After taking mifepristone, on the 2nd day you come back to the clinic and take another drug that expels the embryo within 1 hour. Bloody discharge lasts 10 days, after which you come for a control ultrasound. In isolated cases, after taking the drug, diarrhea, dizziness and nausea are possible.

Mifepristone has the following contraindications:

  • Pregnancy against the background of the use of an intrauterine device.
  • A scar after a cesarean section.
  • Leiomyoma.
  • Failure of the kidneys, liver.
  • Blood clotting disorder.
  • Anemia.
  • Asthma.
  • Diseases of the female genital area.

After taking, you may experience severe pain in the lower abdomen, dizziness and vomiting. The temperature may rise a lot. Do not take any pain relievers or antipyretics - they can stop the abortion. You can take analgin or no-shpa as a last resort. Better to call the doctor who performed the abortion. You will be given emergency numbers where you can get advice. If for some reason you cannot contact this doctor, in case of severe pain, persistent vomiting and fever, call an ambulance.

Mifegin

Medical termination of pregnancy with mifegin is an alternative to curettage. An unsuccessful result, incomplete extraction of a fertilized egg is possible in 5% of cases.

Mifegin is a progesterone antagonist. Under its influence, the mucous membrane of the uterus begins to be rejected. Abortion with pills is a serious intervention in the body, it cannot be called completely harmless.

The first visit to the doctor includes an examination on a chair, a patient consultation, the signing of the appropriate paper - consent to an abortion, an ultrasound scan to confirm the term and the first pill intake. The next visit should take place in 72 hours. During this visit, the fetus is expelled from the uterus by taking a prostaglandin. In the clinic, you need to be under supervision for 1.5 hours. If the pain is very severe, you may be given a no-shpu. Short-term diarrhea is possible.

After 12-16 days, you need to do an ultrasound. If for some reason the pregnancy persists, a regular abortion is performed.

Sauna and alcohol are not allowed between visits.

Pencrofton

Medical termination of pregnancy with pencrofton is an alternative to surgical abortion. The advantages of medical abortion with the Russian drug Pencrofton:

  • Early termination of pregnancy on the second day after conception (for example, if you have been a victim of violence).
  • No risk of contracting hepatitis, as is the case with abortion, if the instrumentation is poorly sterilized.
  • Lower cost.
  • Curettage can cause uterine scarring or perforation, life-threatening bleeding. This is not the case with pencrofton.
  • Fertility is restored immediately.
  • No anesthesia needed.
  • No need to go to the hospital.
  • The risk of depression after an abortion is reduced.

The drug was developed in 1990. It expels the embryo from the uterus by opening the cervix. Termination of pregnancy with pencrofton is possible up to 7 weeks. It can only be used in clinics. The patient is given 3 tablets once, and she goes home. Then, after 72 hours, she is given a drug that expels the fetus, which has ceased its development during this time. After 16 days, ultrasound and curettage are performed if necessary (this is rare).

When taking pancrofton, a minimum of side effects is observed, as a rule, it is only nausea and a feeling of weakness, a slight increase in body temperature within 4 hours.

Misoprostol

Medical termination of pregnancy with misoprostol in Kiev can be done in many specialized clinics. Misoprostol is a last-generation abortion drug. As a result of the work of the uterine muscles under its action, the ovum is ejected.

The method eliminates psychogenic trauma and is best suited for young nulliparous girls.

Abortion in 1-15 days occurs in 65-85% of cases. The introduction of a prostaglandin analogue after 1-3 days increases this figure to 88-98%. The same results were obtained using Pencrofton. Thus, the optimal scheme for carrying out the procedure for drug termination of pregnancy today is 600 mg of mifepristone with the introduction of prostaglandins after 36-72 hours.

Duphaston

Duphaston after medical termination of pregnancy is prescribed in the post-abortion period. On the 16th day, after ultrasound, Dufaston is prescribed 10 mg twice a day for 10 days. Duphaston is an active progestogen. It is used for a variety of gynecological diseases. When taken, there are no unwanted hormonal disorders. Duphaston does not affect liver cells and blood pressure.

Together with Duphaston, the gynecologist can prescribe you multivitamins or special vitamin complexes that are used in stressful situations. Abortion, whether surgical or medical, is stressful for a woman. As a result, not only the nervous system can suffer, but also the heart. Post-abortion psychosis sometimes develops. The first reaction is always relief. But then a woman often experiences remorse, her self-esteem goes down, on this day every year she can cry. Awareness of what has happened helps. You can mourn your child. The support of loved ones is very important, but, unfortunately, the husband cannot always understand why his wife suddenly became cold with him. The process of finally getting rid of guilt can be long. Medical termination of pregnancy is usually more tolerated by women and does not affect the state of mind so much.

Consequences of medical termination of pregnancy

The consequences of medical termination of pregnancy are mainly reduced to nausea, diarrhea and delayed menstruation up to 12 weeks, headache, chills, endometritis. Side effects such as Quincke's edema, uterine rupture and toxic shock are extremely rare. Toxic shock can lead to death.

Pregnancy is not terminated in 3% of cases. Then you have to do scraping. As a result, inflammatory diseases can worsen, adhesions and infertility develop - it does not happen immediately, it happens that a woman becomes pregnant and gives birth, but the inflammation worsens several times and leads to infertility.

During pregnancy, the nervous system is rebuilt. The body is configured to carry a pregnancy. Medical termination of pregnancy artificially stops this process. Therefore, neuroses are so frequent, the so-called. post-abortion syndrome. Rarely, diseases of the thyroid gland are associated with drug abortion, explaining everything by the accident at the Chernobyl nuclear power plant. But in vain. The thyroid gland is involved in the regulation of hormones that support pregnancy, albeit not as clearly as the ovaries and pituitary gland. It is clear that they go for an abortion because of despair, a sudden collapse of plans. But if you think about it, there is no safe abortion. Most of us have carious teeth, tonsillitis, or rhinitis. These are infectious foci. After an abortion done in any way, a woman's immune system weakens sharply. Harmful bacteria from the vagina can enter the uterus. The risk of infection from the vagina is especially high, because it is located closest, but theoretically, the bloodstream can get the infection into the uterus from any focus in the body, even a carious tooth.

Of course, these consequences most often occur during surgical abortion. But even with medical abortion, the cervix opens when the ovum is expelled. Infection easily penetrates through these gates.

To minimize the consequences, medical termination of pregnancy should end with rest for your body. A month you can not play sports, no sexual intercourse, take a shower and do not swim in open water, do not go to the sauna, pool, do not take the bathroom earlier than 3 weeks after the drug abortion.

Harm

The harm of medical abortion is due to the blocking of progesterone receptors. In this case, there is no injury to the uterus, so complications are much less common than with traditional abortion. A frequent complication is incomplete expulsion of the fetus (about 10%). Prolonged uterine bleeding is possible. There are known cases of toxic shock after taking "pregnancy pills".

Complications

It is rare, but still possible to face serious complications after medical termination of pregnancy. First of all, this is the lack of effect of the drug or incomplete abortion. Also, your periods may become irregular or very heavy. Allergy is possible. If any warning signs appear, you should immediately seek advice from the clinic where the abortion was performed.

Allocations

Discharge after medical termination of pregnancy is usually brownish, bloody and often bothersome even if heavy bleeding has already ended. To remove all suspicions, be sure to visit a gynecologist and do an ultrasound scan 14-16 days after the abortion. If, after a month and a half after a medical abortion, the discharge does not stop, this indicates that there has been a failure in the hormonal system. To correct this condition, the doctor may prescribe oral contraceptives (mini-pills or combined).

You should also pay attention to the yellow discharge. This may be a sign of purulent inflammation, which has developed due to the fact that you carried a dead child in you for some time. Yellow discharge after medical abortion can be a sign of Escherichia coli.

Bleeding

Medical termination of pregnancy is considered the safest method, but this does not mean that it is harmless. Sometimes it happens that profuse bleeding develops after an abortion. It can lead to life-threatening blood loss. In this case, you need to lie down and call an ambulance, not hiding the fact that you had a drug abortion. It is considered normal to have a small, not more than menstrual, bleeding until the onset of menstruation after medical abortion. If you have to change more than one night pad in an hour, seek medical attention.

Pain

Pain after medical termination of pregnancy in every woman is of varying intensity. They are caused by contraction of the uterine muscles. How severe the pain will be depends on the pain threshold and the duration of pregnancy. Pain relievers for unbearable pain should be prescribed by a doctor because many of these drugs can suppress abortion. Pain after a drug abortion lasts for two days. Pains that are slightly more intense than normal pain during menstruation are considered normal. Multiple periods of your period can also be painful. The gynecologist may prescribe you a course of physiotherapy or gynecological massage if the pain and bleeding are very intense, prolonged. To avoid the development of infection in the uterus, a control ultrasound on day 16 must be done without fail, even if you have no complaints. Abdominal pain, fever, green and cheesy discharge are all signs of infection. Medical termination of pregnancy, done according to all the rules, in three visits, rarely leads to such consequences. 98% of cases of complications in drug abortion are associated with ignoring medical recommendations.

Temperature

The temperature after medical termination of pregnancy usually rises no higher than 37.5 ° C and lasts no more than 4 hours. Temperatures up to 37.2C can be kept for about 10 days. It is associated with increased progesterone levels. Delaying the treatment of a possible infectious process in the uterus leads to infertility. Blood clots and fever, too much bleeding should be the reason for an ultrasound examination of the pelvic organs earlier than the doctor's prescribed date (usually 14-16 days after termination). If you have a fever and malaise after an abortion, call your doctor home.

Nausea

Nausea after medical termination of pregnancy is not observed in all women and for a short time. If you vomit within an hour after taking the drug, unfortunately the pills will not work. You will be referred for a vacuum abortion.

If a woman is very worried about pain in the lower abdomen, she may be prescribed no-shpu. Aspirin should not be taken. For nausea, you can take cerucal. It has an antiemetic effect by blocking receptors. The maximum concentration of the drug is reached after 30 minutes. The half-life is 5 hours. The adult dose is 10 mg 3 times a day. Possible side effects: headache, increased fatigue, fear, tachycardia, itching. Contraindications: individual sensitivity, intestinal obstruction, epilepsy.

Recovery after medical termination of pregnancy

Recovery after medical termination of pregnancy should include a number of measures. Abortion is a serious trauma, no matter how it is performed. After a medical abortion, pay special attention to yourself for 2-3 months. Don't lift weights. Ask your family to help you clean. The gynecologist can prescribe you procedures, gynecological massage. Be sure to visit the physiotherapy room if the doctor advised you to do so. After an abortion, vegetative-vascular dystonia and nervous disorders may progress. Avoid stress and colds - medical termination of pregnancy weakens the body's defenses. From water procedures, only showers are allowed for the first month and a half. Prevent constipation. Change your laundry regularly. The first month, exclude significant power loads, sports. Sex can be done after the first menstrual period after an abortion. Mifepristone is incompatible with alcohol intake. We also recommend getting a mammogram.

Sex

Since 1999, every second woman has done medical termination of pregnancy. Alas, these are statistics. Few women manage without abortion in their lifetime. Bloody discharge then lasts another two weeks. At this time from sex, of course, you need to abstain. The risk of inflammation increases if this recommendation is not followed. The same goes for intimacy during your period.

Pregnancy

It is advisable to plan pregnancy after medical termination of pregnancy no earlier than 3 months later. A pregnancy that occurs earlier has a high risk of complications. Medical termination of pregnancy in 95% does not in any way affect the further possibility of conception, you can get pregnant in the next cycle, so take care of contraception. Immunity is often compromised after a drug abortion, so if you do not restore your body, you may catch some kind of infection during pregnancy. Menstruation after medical termination of pregnancy Menstruation after medical termination of pregnancy is normally restored immediately. A delay of up to 20 days is considered normal. But for 70% of women, they come on time. With severe cramping pains during menstruation after a drug abortion, you need to see a doctor - this happens if the embryo is not all out.

You can also do a pharmaceutical abortion by contacting the Kiev clinic "Demetra" (Poznyaki district). It also conducts colposcopy of the cervix and preventive examinations of women at affordable prices, treatment of STDs, menopause, menstrual disorders. Remember that with the latent course of the disease, there are no pronounced symptoms, such as bleeding and pain in the lower abdomen. Regular check-ups help to avoid serious illnesses, incl. oncological. Cancer never occurs on healthy tissue.

The center performs 300 types of analyzes. Here you can comfortably undergo rehabilitation after a drug abortion, receive psychological assistance if necessary.

The Atlanta Medical Center is also located on the left bank of the Dnieper in Kiev. Here you can undergo medical termination of pregnancy in the early stages (6-7 weeks). The center also treats genital infections, gynecological and venereal diseases, performs gynecological and general massage.

In the clinic "Klinitsi Doroslikh" on Lepse Boulevard in Kiev, you can make a medical termination of pregnancy at an affordable price of 1200 UAH (ultrasound is included). You will find understanding here. The gynecologists of the center know that a woman of any age is not 100% insured against unwanted pregnancy, even if she takes contraceptive measures. A medical abortion performed by an experienced gynecologist will not affect your health in any way. The procedure will take place in accordance with all the rules prescribed in the protocol for carrying out a pharmaceutical abortion. The clinic for medical abortion uses the long-established, reliable and effective drug Mifepristone. It is well tolerated by women. After the end of bloody discharge, you must undergo a control ultrasound again.

The medical center "Vemar" at ul. N. Bazhana (Kiev). Here, medical abortion is performed at an early stage - up to 42 days from the 1st day of menstruation. The normal size of the uterus, the absence of the embryo on ultrasound and discomfort during the control examination indicate a successful medical abortion. The doctors at the clinic do their best to keep side effects to a minimum. The center's gynecologists also treat colpitis, vaginitis and inflammation of the uterine appendages, polyps and endometriosis. The center's urologist assists in the treatment of kidney and bladder diseases, as well as inflammatory diseases of the prostate and sexual dysfunctions in men.

As you can see, the choice of medical clinics that provide medical termination of pregnancy is wide. The method of drug abortion is called by WHO to be the most gentle for women's health.