Abortion. Termination of pregnancy in late stages, indications, techniques, complications
Artificial termination of pregnancy performed in a medical institution by qualified specialists with the full consent of the woman, confirmed by documents. Distinguish between medical abortion, vacuum aspiration, surgical curettage and artificial childbirth. Each method has a certain period of application and medical indications.
Indications for abortion
Abortions in Moscow are performed for medical reasons and on the woman's own initiative. Diseases for which it is recommended to interrupt the development of pregnancy:
- active form of tuberculosis;
- rubella;
- diabetes mellitus with kidney damage;
- acute form of leukemia;
- severe mental disorders;
- acute cerebral hemorrhage;
- neuroinfectious diseases;
- hepatitis, liver cirrhosis in the later stages;
- severe heart disease;
- peptic ulcer during the period of open bleeding;
- glomerulonephritis;
- a therapy-resistant form of epilepsy.
Contraindications for termination of pregnancy
Artificial termination of pregnancy is contraindicated if the patient:
- an acute form of an infectious, inflammatory or purulent disease;
- long term.
At what stage of pregnancy is it performed?
Termination of pregnancy in Moscow is carried out medically for up to 7 weeks, surgically for up to 12 weeks. For a period from 13 to 22 weeks, artificial termination of pregnancy is performed only for medical reasons in case of a threat to the mother's life.
How to prepare
Before the procedure, a preliminary outpatient study is shown. A general gynecological examination, ultrasound of the pelvic organs, a clinical analysis of blood and urine, determination of blood coagulability, blood group, Rh factor, tests for viral infections are carried out.
Abortion prices depend on the level of the medical institution and the quality of the services offered.
Possible complications after an abortion
In some cases, complications arise:
- perforation of the uterus;
- incomplete abortion;
- hematometer;
- progressive pregnancy;
- rupture of the cervix;
- inflammation of the genitals;
- placental polyp;
- disorder of the menstrual cycle;
- cervical erosion;
- complications during subsequent pregnancy;
- infertility;
- ectopic pregnancy;
- endometriosis.
The risk of developing complications depends on the duration of the pregnancy. The longer the period, the higher the likelihood of serious consequences.
In the modern world, society is already accustomed to the fact that there is an artificial termination of pregnancy, abortion, and they perceive this normally, if not in the order of things. But still, there are a couple of three people who still bring discord to society, saying that termination of pregnancy is tantamount to murder. But sometimes abortion is the only way to save a woman from death.
To date, a certain list of medical indications for artificial termination of pregnancy is regulated by law. But this list is periodically reduced. So, already in 2008, about a hundred diseases were removed, as a result of which women were forbidden to give birth to a child.
An abortion is called an artificially terminated pregnancy, no later than the twenty-eighth week. Early termination of pregnancy is considered up to twelve weeks.
When a woman is pregnant at a term that exceeds twenty-eight weeks, but there are certain reasons why it is not possible for the mother's life to allow the birth of a child, then she is interrupted. And this process is called premature birth.
An interrupted pregnancy is possible artificially, or it will be a spontaneous miscarriage.
But as for the medical indications of termination of pregnancy, there are certain regulations that every doctor must adhere to.
Medical indications for artificial termination of pregnancy are approved by a gynecologist, a specialty doctor, and the head of the health department. This often happens in both outpatient and inpatient settings.
All specialists consider all the indications of a pregnant woman, after which they must certify this document with a seal and signatures. And after, this document with the diagnosis, they give the woman, or directly send to the obstetric-gynecological department.
When they talk about abortion, it can be prescribed if there are certain physiological indicators of the pregnant woman. For example, this can include the too young age of the expectant mother, namely the underage woman in labor, or, on the contrary, the age after forty years, when the woman's reproductive system is already dying out.
Artificial termination of pregnancy for medical reasons
- Infectious diseases: tuberculosis, hepatitis, HIV, syphilis and rubella.
- Neoplasms: malignant tumors, especially of the hematopoietic and lymphatic systems, as well as malignant neoplasms that a woman has or has today.
- Endocrine diseases: hypothyroidism, diabetes mellitus, diffuse toxic goiter.
- Adrenal insufficiency, not diabetes mellitus, hypoparathyroidism.
About four types of abortion are known:
- If the gestation period is up to six weeks, then artificial termination with the help of medication is possible, which is the safest in modern times.
- Another option, in the early stages of pregnancy, is a mini-operation, or vacuum operation, when using a special apparatus, creating a vacuum, the ovum is sucked out.
- Surgery when the fetus is scraped out of the uterus, which occurs later in pregnancy.
- Artificial childbirth in the third trimester.
But nevertheless, it is worth heeding the conclusion of the doctors, because if the pregnancy continues, there is a high probability that the child will be born with pathologies.
Pregnancy does not always proceed happily and cloudlessly, as we would like, there are often cases when it needs to be interrupted for a long time. It should be noted that no one will have an abortion at a later date simply by "wanting". According to existing legislation, pregnancies longer than twelve weeks can only be terminated for medical or social reasons.
Termination of pregnancy beyond 20 weeks is accompanied by an extremely high risk to the health and life of the mother. On the other hand, an abortion at such a time can be equated with murder, since the fetus is viable by this time. In such situations, a woman must have very strong arguments in order to decide on such a step.
Indications for late abortion.
Medical and social reasons can serve as the basis for making a decision to terminate a pregnancy at a later date. The first group of indications includes a serious deterioration in the general health of the mother against the background of complications of diabetes mellitus, existing serious diseases of the blood, heart and blood vessels, the central nervous system, and various kinds of tumors that require immediate therapy. In addition, the indication for a late abortion is the identification of chromosomal abnormalities in the fetus, malformations that interfere with its further normal development or provoke its death, as well as in the presence of a risk of genetic diseases. I must say that some infectious diseases can lead to abortion. In these situations, abortion is the only salvation for mother and child from future suffering.
In order to obtain documentary permission to carry out a surgical operation to terminate the intrauterine development of the fetus in the late stages of a pregnant woman, it is recommended to contact an obstetrician-gynecologist at the place of observation, who will issue it after the examination and analysis, as well as after excluding any contraindications to its conduct. Based on the results of the analyzes, the general health of the woman and the degree of fetal developmental abnormalities are assessed.
It also happens that a woman, due to physiology, did not immediately determine that she was pregnant, or made a mistake when calculating the gestational age (sometimes it happens that a pregnant woman continues to have menstruation for several months after fertilization), or she did not immediately tell this news to her lover or loved ones, therefore, the decision to interrupt is made at a later date. It is for such cases that there is a second group of indications for abortion - social. This group of reasons should also include extremely unpleasant situations when the husband or father of the unborn baby suddenly dies in a pregnant woman, when this pregnancy is the result of rape, or when the expectant mother is in "places not so remote." Deprivation or restriction of parental rights, as well as disability of the first and second groups, can also serve as a serious reason for carrying out artificial termination of pregnancy at a later date. In each case, a special commission of doctors at the place of observation of the pregnant woman is considering the issue.
It should be noted that, despite the presence of a significant social or medical indication for a late abortion, in the presence of acute inflammatory diseases of the female genital organs, acute inflammatory processes and acute infectious diseases, such a surgical intervention is not permissible.
Examination before abortion.
Before the operation to terminate pregnancy, an ultrasound scan of the fetus and uterus is prescribed, the blood group and Rh factor are determined, a blood test for HIV, syphilis, hepatitis, hemostasiogram, biochemical blood test, urine, smears from the urethra, cervical canal and vagina are determined, antibodies are determined to hepatitis C, X-ray examination of the chest organs, as well as an examination by a therapist and other specialists, if necessary.
In the case of existing social or medical reasons for termination of pregnancy, the woman is issued a certified conclusion stating the full clinical diagnosis with the signatures of specialists and the seal of the institution. If a woman is diagnosed with mental and venereal diseases, the documents are transferred to the obstetric and gynecological institution. In the absence of medical contraindications, the woman is given a referral to a medical and prophylactic institution, where they indicate the duration of pregnancy, the results of the examination, the conclusion of the commission (diagnosis) and social indications.
Since late abortion is associated with many risks, this operation is performed using painkillers in a hospital setting and only by specialists with special training. At the end of the surgery, an ultrasound scan is performed to accurately assess the result (check whether all parts of the fetus and placenta have been removed).
Late pregnancy termination techniques.
Taking into account the duration of pregnancy, the doctor selects the appropriate method of abortion. The smallest number of complications is given by termination of pregnancy at a period of no more than 21-22 weeks, and in general, abortion is possible up to 27 weeks.
Dilation of the cervix and fetal extraction are performed between 12-20 weeks of pregnancy. A vacuum aspirator is introduced into the uterus, through which the fetus and fetal membrane are extracted in parts. With this technique, there is a high risk of injury to the uterine wall, which results in severe bleeding, often resulting in death.
Another technique used for termination of pregnancy at 20-28 weeks is vaginal administration of fluids (one of the methods of artificial childbirth). Having expanded the cervix, a small amount of fetal fluid is sucked out of the fetal bladder using special instruments, after which the same volume of a highly concentrated solution of salts and glucose is injected into the uterus. As a result, the fetus dies, and after a day or a half, the woman begins to have contractions, and the dead fetus is rejected by the body (a kind of miscarriage occurs). On average, such an abortion occurs within thirty hours.
In rare cases, kelp sticks are injected into the cervical canal to induce labor. If in this case the contractions do not start, special substances are introduced to stimulate labor (prostaglandins, oxytocin, lubricants).
Very rarely, but if there are medical contraindications with a simultaneous medical or social indication for a late abortion, a small cesarean section is performed. During such an operation, surgeons open the anterior abdominal wall and the anterior wall of the uterus, then the fetus and surrounding tissues are removed from the uterus, and the uterine wall is scraped out. As a result of using this technique, the fetus may be alive, but no resuscitation actions are applied to it, and it dies.
Complications after late abortion.
- Incomplete cleansing of the uterine cavity from fragments and parts of the fetus with the addition of an infection.
- Placental polyp.
- Hematometer.
- Ruptured cervix.
- Perforation of the uterus.
- Diseases of a purulent-inflammatory course.
The relationship between the boss and the subordinate becomes much more complicated when the second, according to the medical report, cannot fulfill his official duties. Can they be fired for health reasons and what is the procedure for dismissal for health reasons, so as not to violate?
An employer, when dismissing employees in connection with an illness that interferes with work at the enterprise, must rely on the regulatory framework.
Violation of the Labor Code of the Russian Federation can lead to disastrous consequences. There are several articles of the Labor Code of the Russian Federation that are suitable for termination of labor relations for health indicators. Moreover, the initiative to quit can come from both the management and the employee himself:
- Clause 5 - the subordinate cannot work anymore due to illness - the management will need to submit documents from the medical institution confirming that the person is not able to work;
- Clause 8 - due to illness, the subordinate cannot agree with the new working conditions proposed by the employer and due to the inability to stay further in the previous workplace, he is forced to resign for health reasons;
- Paragraph 3 (A) of Article 83 of the Labor Code of the Russian Federation - the dismissal of an employee for health reasons due to the fact that this fact does not allow him to fully perform his work.
In addition to the Labor Code (and not all of its articles regulating this area of labor legal relations have been touched on above), the employer must also rely on other norms of modern legislation. These include:
- Article 5 of the Administrative Code;
- The Constitution of the Russian Federation;
- The laws on the protection of workers' rights and their health;
- Judgment by the Supreme Court in 2004.
In cases of non-compliance with the provisions of regulatory legal acts, an employer who fires an employee due to health problems may be held liable.
Refusal to transfer to another job due to illness
How if, on the basis of a medical report, he can no longer continue to work in the same place where he could no longer be? In this case, dismissal for medical reasons is possible only in the following cases:
- the employee did not agree to be transferred to another proposed job that was medically appropriate for him;
- the employer cannot offer a subordinate anything that would suit him in accordance with his position.
This provision of the law is applied in cases where the need for a translation is temporary or permanent (in the case of a temporary option, a translation is considered for more than four months). The proposed new position may correspond to the previous one in terms of employee qualifications and remuneration. Or it could be worse (lower position, lower salary, etc.). In this case, legislation primarily looks at the safety of human health and life, and not at prestige and material well-being.
The procedure for transferring from one position to another must be recorded in writing.
The subordinate should be presented with a document with a proposal to move to a more suitable workplace for him. In this document, a person leaves his resolution - whether he agrees or not to the employer's proposal. After the refusal of the subordinate to transfer, an order of dismissal must be issued (it must also be familiarized with it under the signature). An appropriate entry is made in (“what date” was dismissed under Art. 77, Part 8 of the Labor Code of the Russian Federation).
Conclusion of a medical institution
A conclusion from a medical institution is the only basis for terminating an employment contract due to deteriorating health. Moreover, just a certificate from a district therapist will not be enough. Papers are issued:
- KEK - blade expert examination;
- MSEC - Medical and Social Expert Commission.
The conclusion of any of the commissions is indisputable. And even if the person himself does not want to announce the result, the conclusion will be transferred to him for work by the doctors without fail. For example, a person works as an ATP driver on a passenger bus, and he has a brain tumor. A person can die at any moment and at the same time destroy all his passengers, not to mention the random cars that are nearby.
Dismissal procedure
So, dismissal for health reasons, which does not contradict modern laws on the protection of workers' rights, is possible in a number of cases:
- the employees of the medical institution, as a result of the examination, issued a verdict in relation to the dismissed person - completely unfit for work ();
- if health problems are so great that a person cannot work in the same place, and does not want to transfer to another position;
- if poor health can harm the employee himself and his colleagues in the process of performing their job duties (threat to health / life, harm to production).
If the employee, indicating the reason for the presence of a disease that is not compatible with work, does not need to work for two weeks. A wordless statement about the disease will not work. The employee will need to document all his words. For this, it is necessary to obtain the conclusion of the medical commission. When an employee wants to quit, the procedure is standard. In case of termination of the employment contract on the initiative of the employer, the procedure for dismissal has certain features.
Another job offer
After the subordinate has provided the boss with confirmation from the medical organization about his illness, the management will have to make a decision.
If there are positions in the organization according to the staffing table, suitable for the "patient", the manager is obliged to offer a transfer to this job. Even if the subordinate loses his salary. The offer is made in writing. Consent / disagreement must also be in writing.
Refusal of an employee to transfer
Job options for easier work should be prepared by the HR department. The subordinate gets acquainted with the proposed options. If nothing suits him, then the person can be fired under the appropriate article. It is better to receive a refusal from an employee in writing or draw up an act of refusal in the presence of witnesses. Provided that the employee has temporary health problems, and he will be able to start work no later than 4 months later, then there is no need to dismiss such an employee. He can simply be sent to "rest", but at the same time the person retains his workplace.
Vacancy notice / job offer must be made in duplicate. One of them must remain with the employee, the other is handed over to the manager with a mark of consent / disagreement. If there are no suitable vacancies, the “patient” should also be informed about the situation in writing.
This document is drawn up in the organization and registered in accordance with the accepted document flow. The content of the order indicates information about:
- enterprise;
- the head;
- dismissed;
At the end, signatures are put with a transcript of the interested parties.
In the case of temporary suspension from office due to the fact that a person is sick, the order indicates the period of time for which the employee is removed.
Employment book entry
A mandatory record of dismissal is made in the work book and the article of the Labor Code is indicated, in accordance with which. This means that an entry is made in the work book that the person was fired due to poor health.
Dismissal payments
Any dismissal is always accompanied by the payment of funds:
- money earned (salary);
- unaccompanied vacation -;
- other payments due to various categories of employees.
In case of being deprived of work due to illness, an additional allowance is paid - the average salary for two weeks.
Subject to the loss of working capacity during the performance of his official duties, excluding the negligence of the employee himself, the reimbursement of the average earnings from the employer should continue until his full recovery.
Features of the dismissal of military personnel
Dismissal from military service in connection with a detected disease has its own characteristics. The main one is the ability to leave only at the request of the serviceman himself. Restriction on health is not a reason for the dismissal of a serviceman at the request of a higher rank / rank. Upon termination of the contract with a soldier, he is transferred to the reserve. Previously, a soldier must be notified of his rights and capabilities:
- information on the period of time during which documents will be prepared for submission for transfer to the reserve;
- the opportunity to express wishes for the service and future life;
- information on benefits and preferential opportunities for a serviceman in reserve;
- information about the military registration and enlistment office, in which it will be necessary to register, etc.
Payments for military personnel will also differ from payments for civilians:
- monetary allowance - until the end of the fulfillment of military duty;
- allowance - once after retirement - two salaries for those who have served less than twenty years, seven salaries for those who are more;
- bonus for distinctions during the performance of their duties up to 25% of the assigned salary at the discretion of the commander.
If an injury is received at work, compensation will be received in the amount of two million rubles for contract servicemen and one million rubles for conscripts.
Samples of documents
It will be interesting for you
Medical abortion is an artificial termination of pregnancy, which is carried out in a specialized institution by qualified specialists. The choice of the method of artificial termination depends on the duration of pregnancy and is carried out with the written consent of the woman, having previously drawn up the appropriate documentation. Medical abortion is done for a variety of reasons. A woman can terminate a pregnancy of her own free will for up to 12 weeks. For social reasons, abortion is possible up to 22 weeks. For medical reasons, such an interruption is possible at any time.
Indications
A woman decides to terminate her pregnancy for reasons that can adversely affect the birth and further fate of the child and mother (change in her personal life, the absence of the father of the unborn child, financial difficulties, lack of housing). You can carry out an abortion of your own free will up to 12 weeks of pregnancy.
For medical reasons, abortion is performed in two situations:
- diseases in which pregnancy and childbirth can significantly worsen a woman's health and become a threat to life;
- severe fetal malformations.
Termination of pregnancy is carried out at the conclusion of a gynecologist, the head of this institution and specialists of the relevant profile (oncologist, therapist, surgeon). This termination is carried out regardless of the duration of pregnancy after a written application from the woman, considered and signed by a specially created commission for this. For non-medical reasons, the abortion takes place with the participation of a lawyer.
According to social indicators, pregnancy is terminated in the following situations:
- rape;
- disability or death of a husband during pregnancy;
- a woman's stay in places of deprivation of liberty;
- deprivation of parental rights.
The issue of abortion for social reasons is decided by a specially created commission, which gives an opinion with full legal documentation.
An overview of the terms and methods of abortion is presented in the table
Examination before abortion
The tests are taken just before the procedure. Depending on the result of the tests, the appropriate method of performing the operation will be selected, which is suitable for the woman in terms of her health.
Required list of analyzes:
- general blood analysis;
- blood chemistry;
- coagulogram;
- analysis for the Rh factor and determination of the blood group;
- blood test for HIV, syphilis and hepatitis;
- general urine analysis;
- flora smear;
- consultation of a therapist.
Termination methods:
- medical abortion;
- surgical abortion: vacuum aspiration of the ovum and curettage of the uterine cavity;
- termination of pregnancy with drugs;
- small cesarean section.
Surgical method
Surgical or instrumental method is the termination of pregnancy by curettage of the uterine cavity. This method is not safe for a woman's further reproductive performance. However, the surgical method also has undoubted advantages. Initially, it guarantees almost 100% interruption with complete removal of the ovum and membranes. Surgical intervention is carried out only in a specially equipped hospital.
For pain relief, intravenous anesthesia is mainly used, which requires the presence of an anesthesiologist. After the introduction of anesthesia, the cervix is expanded mechanically. Then the gynecologist cleans the uterus with the instrument, removes the inner layer and the embryo with membranes. A medical abortion in this case lasts 15-20 minutes. After the operation, the woman remains for some time in the ward under the supervision of medical personnel. This procedure is included in the list of free services under a health insurance policy.
Vacuum aspiration
Vacuum aspiration, or mini-abortion, is a simple operation performed in many medical clinics. Have a mini-abortion, early, up to 6 weeks from the date of the last menstrual period. Mini-abortion has practically no consequences, but there are cases when the vacuum-aspiration method of abortion may be incomplete, then it is necessary to repeat the operation or to curet the uterine cavity.
Before the procedure, the woman is injected with an anesthetic and antispasmodic for self-opening of the cervix. The procedure is carried out using an instrument that is inserted into the cervix and creates pressure inside with an electric suction. The doctor very carefully outlines the uterine cavity with a tool and through the hole pulls the detached ovum into a special container. The operation time is a few minutes.
Medication method
The medical method is the termination of pregnancy with the help of pills. Pharmacological interruption is carried out up to 6 weeks of gestation. The method consists in the use of drugs to suppress the secretion of hormones in the body and increase the contractile activity of the uterus. The drug method is optimal for nulliparous women.
Interruption by drugs
For a period of 14-22 weeks, the following means are used for an abortion:
- prostaglandins;
- hypertonic solutions.
The use of prostaglandins leads to an increase in the tone of the uterus, which provokes the ripening of the cervix, detachment of the ovum and stimulates artificial childbirth. In the case of using hypertonic solutions, fetal death occurs and labor develops. In all these situations, a dead fetus is born.
Minor cesarean section
The operation is performed for a period of 13-22 weeks and only in cases where other methods are found to be ineffective or unsafe. The procedure is also indicated if a woman decides to undergo surgical sterilization after an abortion. The technique for performing the operation is similar to that of a conventional caesarean section. After the completion of the procedure, antibacterial therapy is performed. In the later stages, agents are used to suppress lactation.
Complications after a medical abortion
The most common complication is the retention of the ovum in the uterus. The main symptom of such a complication is a strong discharge with blood clots, which does not stop for a long time. If the remains of the ovum are detected, it is necessary to urgently contact a specialist and repeat the procedure under stationary conditions.
Please note: if a medical abortion was performed not professionally and with the remnants of parts of the fetus in the uterus, then this can lead to disastrous results. The development of bacteria will immediately begin in the uterus, since the remnants of the fetus are a favorable environment for their reproduction, which contributes to the development of various purulent diseases.
If the following symptoms occur, you should contact your gynecologist:
- heat;
- profuse discharge with blood clots;
- severe pain in the lower abdomen;
- the appearance of an unpleasant odor of discharge;
- dizziness, vomiting, fainting.
What to look for after a medical abortion:
- After an abortion, it is advisable to consult with a gynecologist about the use of contraception.
- Baths or hot showers are not advisable, but daily personal hygiene is essential.
- Compliance with sexual rest, which is required to prevent and prevent infection from entering the uterus. The resumption of sexual relations is recommended no earlier than after 14 days.
- Going to the toilet regularly to empty the bowels and bladder: this has a beneficial effect on the contraction of the uterus.
- Monitor body temperature daily, avoid hypothermia and physical activity.
- Observe the correct diet.
- Pay more attention to yourself.