How to make a medical termination of pregnancy. Medical method of termination of pregnancy - how negative the consequences are. Medical termination of pregnancy - drugs
Despite the fact that medical termination of pregnancy has become popular in modern medicine, a number of sequential steps must be taken for the procedure to be successful. This will minimize the possible consequences and bring the effectiveness of the method closer to the maximum. It is important to remember that an abortion with Mifegin should be performed as early as possible, ideally in the first days of a missed period, after confirmation of the fact of pregnancy. The dosage regimen is calculated by the gynecologist, individually for each woman.
| Stage 1: EXPLORATORY SURVEY |
You call the contact phone number to our medical center and make an appointment at a convenient time for you to see a gynecologist, telling the administrator the reason for contacting: "I want to have a medical abortion." It is advisable not to eat about 2-3 hours before the visit.
Arriving at the medical center, you go for an ultrasound scan to clarify the duration of pregnancy and exclude the main contraindication - an ectopic pregnancy. The latter circumstance is fundamentally important, therefore, the results of an ultrasound scan performed in another medical institution are not accepted by us.
Further, with the results of an ultrasound scan (gestational age and its localization), you go to see a gynecologist. After indicating the presence of an unwanted pregnancy and a desire to terminate it, possible solutions to the problem are discussed at the consultation. In the case of choosing a method of medical abortion, information is provided on the essence of the method, contraindications, possible side effects, complications, symptoms and possible options for the course of this procedure.
Also, at the preliminary consultation, you choose the options:
- by the drug Mifegin (France)
- with Mifepristone (Russia)
For primary pregnant women and according to indications, a list of tests can be recommended to clarify the state of health and exclude contraindications. Then, 2-3 days are given for making a final decision.
| Stage 2: TAKING THE PREPARATION MYPHEGIN (MYFEPRISTON) |
You confirm your desire to terminate the pregnancy with this method. Completing the Patient Informed Consent Sheet for medical abortion with pills. Taking the drug Mifegin (mifepristone) in the presence of a doctor. After that, you will receive all the necessary recommendations, the schedule for taking the support drug and attendance at the control ultrasound. If you have chosen a VIP program, you will additionally give appropriate appointments and recommendations.
If vomiting occurs within 1 hour after taking Mifegin (which is extremely rare), then most likely the desired result will not be achieved and the termination of pregnancy will need to be performed in another way. After taking Mifegin for 36 - 48 hours, the appearance of spastic pain and bloody discharge from the genital tract is expected and possible. If these symptoms appear, you should consult your doctor.
| Stage 3: TAKING SUPPORT PREPARATION |
In 36 - 48 hours after taking Mifegin (mifepristone), support drugs are prescribed - prostaglandins. In most cases, the medical abortion will then take place within the first 12 to 48 hours. Pain sensations and the degree of bleeding can be different in intensity and duration, and with a longer period they are more pronounced. After 1 - 3 days to confirm the fact of the release of the ovum, it is necessary to make the first ultrasound control. If the ovum has not come out by this time, additional support drugs are issued and the date of the next ultrasound control is set.
Women with Rh negative blood should be immunized with a special anti-Rh immunoglobulin in order to prevent Rh-conflict in future pregnancies. It is performed if there are no antibodies to the Rh factor in the blood.
| Stage 4: CONTROL SURVEY |
Bleeding and pain are not indications that the abortion was complete. Therefore, it is necessary to conduct a control study by appropriate methods (ultrasound) 5 and 15 days after taking Mifegin (mifepristone). According to the data of this ultrasound study, the final result is determined. If pregnancy persists, appropriate intervention may be recommended. In case of incomplete termination of pregnancy, it is possible to try to solve the problem by means of a set of conservative measures followed by ultrasound control. In case of a negative result of conservative therapy, an appropriate instrumental intervention should be offered in one of the medical institutions.
The preservation of a woman's reproductive health provides for the sparing conduct of all gynecological manipulations. This also applies to termination of pregnancy. It is known that the earlier the procedure is performed, the less dangerous the complications are. It is optimal to completely abandon this manipulation, but this is not always possible. Therefore, it is recommended to perform an abortion with the help of medications with a short gestation period.
What is the medication method?
Replacing the surgical instrument and vacuum aspirator with hormonal drugs made it possible to develop a method of pharmacological abortion. This is a non-invasive procedure for getting rid of pregnancy in the early stages, which proceeds as a spontaneous one.
Its advantages are associated with the following factors:
- efficiency 98-99%;
- the absence of the possibility of injury to the uterus or cervix when performing surgical procedures;
- low risk of ascending infection;
- there is no danger of getting HIV, hepatitis;
- no risks caused by anesthesia;
- can be used in primary pregnant women, the effect on women's health is minimal;
- low stress level, does not create a traumatic situation.
The procedure does not require a long stay in a hospital. After the patient has taken drugs that cause medical abortion, bleeding can be expected at home. But self-administration of medicines without a doctor is impossible.
Which is better, vacuum abortion or medical abortion?
This is decided individually. But the complications and the degree of interference in the body during vacuum aspiration are much higher.
How is the time for an abortion determined?
The terms for medical abortion are determined by the protocol of the Ministry of Health of the Russian Federation of 10/14/21015. They recorded that it is possible to carry out a violation of gestation up to 63 days, or the 9th week. But in world practice, there are differences in how long this manipulation can be done. In developed countries, the period is determined at 49 days, or 7 weeks of pregnancy.
Why is there such a period for pharmacological interruption?
At the 5th week of pregnancy, the embryo begins to acquire human features, the rudiments of many organs and umbilical cord appear. At 6 weeks, the placenta begins to form, and internal organs continue to develop. At 8 weeks, the embryo is already completely human, it goes into the fetal stage. After this period, the formation of blood vessels of the placenta occurs, therefore, carrying out a medical abortion can cause profuse bleeding.
The following drugs for medical abortion are registered and used in Russia:
- Mifepristone 200 mg.
- Misoprostol 200 mcg.
Pharmacological abortion can be used if the gestational age complies with the permitted protocol. The main condition for the successful completion of the procedure is the day of pregnancy and the presence of an embryo inside the uterus according to the results of ultrasound. After a caesarean section, the drug method is preferable to.
Preparing for the procedure
At the first visit to the gynecologist, you need to conduct a general examination, bimanual examination on the chair and in the mirrors, smears are taken from the vagina. Blood pressure, pulse, and respiratory rate are also measured. Next, the woman is sent for an ultrasound scan to establish the exact day of gestation, the state of the uterus, and the ovum.
Directions are given for blood, urine, glucose, ECG tests. A coagulogram is prescribed if there was a history of problems with the blood coagulation system. Additional examination methods may be needed, the need for which is determined by the doctor.
Execution method
At the next visit to the obstetrician-gynecologist, the patient signs a consent to perform an induced abortion using pharmacological drugs. How a medical abortion proceeds is determined by the clinical protocol.
With a gestation period of up to 63 days, 200 mg of Mifepristone is used, which a woman drinks with a doctor. A doctor's supervision is necessary within 1-2 hours, after which you can go home.
If the period is 49 days, 200 mcg of Misoprostol is taken on the next visit 24-48 hours later. During pregnancy 50-63 days, 800 mcg of the drug is used. This medication should be placed under the tongue, behind the cheek, or deep into the vagina. With the last method of administration, you need to lie down for 30 minutes. The patient should be observed for 3-4 hours. During this period, most people start bleeding. If this does not happen, repeat the Misoprostol 400 mcg tablet to achieve the result.
The signs of an abortion are identical to a spontaneous miscarriage. A woman feels like a cramps in her stomach, menstrual discharge appears.
How long does the bleeding last?
For most women, it lasts 7-9 days. Bloody discharge after the procedure is rarely observed until the next menstruation. If the manipulation is carried out for a period of 3-4 weeks, then bleeding is not much different from menstruation. With an increase in the term, the release of blood increases, sometimes the use of hemostatic therapy may be required.
After 14 days, you need to appear for a control examination. This is necessary to confirm a completed interrupt. If there is an unsuccessful medical abortion, then aspiration from the uterus is prescribed.
Contraindications
The above medications have serious side effects. Despite the high degree of safety, there are certain contraindications to medical abortion:
- gestational age exceeds 63 days;
- diagnosed;
- a large fibroid that changes the internal cavity of the uterus;
- infectious diseases of the genital organs in the acute period;
- anemia with hemoglobin less than 100 g / l;
- porphyria - a disease associated with impaired metabolism of the constituent pigment of hemoglobin;
- blood clotting disorders, as well as taking anticoagulants;
- individual intolerance to one of the drugs;
- insufficiency of the adrenal cortex or long-term use of glucocorticoids;
- diseases of the liver and kidneys, which are accompanied by acute or chronic insufficiency;
- severe diseases of other organs;
- extreme exhaustion;
- smoking when a woman is over 35 years old;
- arterial hypertension;
- bronchial asthma;
- glaucoma;
- diabetes mellitus and other diseases of the endocrine system;
- hormone-active tumors;
- lactation period;
- pregnancy with an established or after taking oral contraceptives.
According to the WHO recommendation, interruption with the use of Mifepristone is possible up to 22 weeks, but the severity of bleeding increases in parallel with the term. In this case, for the duration of the procedure, the patient is hospitalized in a hospital, where there is a deployed operating room and emergency surgical care is possible.
Fibroids threaten the development of bleeding, but if the size of the largest node is up to 4 cm and they do not change the uterine cavity, then you can resort to a pharmacological method.
Anemia is also a relative contraindication. The consequences of medical abortion can manifest itself in a decrease in hemoglobin concentration: bleeding after taking medication exceeds menstrual bleeding in volume and duration.
Violations of hemostasis are important for the volume and duration of blood loss. If, shortly before the manipulation, the woman was treated with anticoagulants, then an increase in blood clotting time will lead to more profuse bleeding. Women who smoke over 35 are at risk of developing thrombosis and diseases of the cardiovascular system. Therefore, in order to exclude complications, a therapist is consulted.
The use of oral contraceptives for a long time before the onset of pregnancy also affects the hemostatic system. But this contraindication is relative. If, according to the results of the coagulogram, no pathological abnormalities are found, then this method of interruption can be used.
If pregnancy occurs against the background of the installed IUD, then it is removed before the procedure. Further tactics do not differ from the standards.
Genital infection is a medical condition that requires appropriate therapy and should not be delayed. Medical abortion does not promote ascending infection, and acute infection can be treated at the same time.
Mifepristone and Misoprostol pass into breast milk. If it becomes necessary to interrupt with hepatitis B, then you need to express milk up to 5 days after taking Misoprostol. At this time, the child is transferred to artificial feeding.
Bronchial asthma, high blood pressure and glaucoma are diseases that respond to prostaglandins. Therefore, misoprostol is contraindicated for these pathologies.
In addition, the contraindications for each drug should be taken into account. For the most part, they coincide with the above. Only the careful use of Misoprostol in patients with epilepsy, atherosclerosis of the cerebral vessels, and ischemic heart disease can be supplemented.
Possible complications
Despite the small number of complications, it is possible to determine the dangers of medical abortion. In 85% of cases, adverse reactions in the form of abdominal pain and bleeding are moderate, no special treatment is required.
In other cases, manipulation can lead to the following complications:
- severe pain syndrome;
- profuse bleeding;
- temperature;
- incomplete abortion;
- progressive pregnancy.
Lower abdominal pain is observed during the period of expulsion of abortion products. Its intensity can be different, but the individual threshold of tolerance also matters. To reduce pain, Analgin, Drotaverin are used. Ibuprofen is indicated in the WHO guidelines for pain relief. If the chest hurts after an abortion, this may be due to a high level, which increases with the progression of pregnancy. This symptom goes away on its own.
Bleeding is considered significant if two pads have to be changed in an hour, and this condition is observed for at least 2 hours. In this case, vacuum aspiration of the contents of the uterus is shown in order to stop it. In severe cases, surgical cleaning is performed.
In 2-5% of cases, the medical abortion is incomplete. Then it is also necessary to perform vacuum aspiration or curettage of the uterine cavity. Less than 1% of cases result in progression of pregnancy. If a woman insists on abortion, then invasive methods are used. Those who changed their mind should be informed about the possible teratogenic effect of drugs on the fetus. But there is not enough data to confirm this fact.
Taking medications can cause a slight increase in temperature, but it lasts no more than 2 hours. If the fever persists for 4 or more hours or occurs one day after taking Misoprostol, this indicates the development of an infectious process. A woman with these symptoms should see a doctor.
Infectious complications are not common in pharmacological abortion. But there is a group of people who have an increased risk of infectious complications:
- established by smear;
- patients with a genital infection up to 12 months ago, but there is no laboratory confirmation of its cure;
- diagnosed patients;
- women with a large number of sexual partners or low socioeconomic status.
Other complications in the form of dyspeptic symptoms can be a sign of pregnancy itself. In case of allergic reactions, treatment with antihistamines is necessary.
Recovery period
After taking Mifepristone and Misoprostol, there is no disruption in the menstrual cycle. But when the period begins and how long it will last after a medical abortion is difficult to predict. The timing of the procedure matters; after an earlier interruption, the restoration of the cycle is faster.
The first menstrual period may start in 30-50 days. But medabort does not affect the onset, therefore, in the first cycle, a new fertilization is possible. To avoid this, immediately after the procedure, the doctor prescribes combined oral contraceptives. It can be such means as Yarina, Regulon, Rigevidon, Novinet, Lindnet, Jess. The selection of a medicinal product takes place individually.
Protects against unwanted pregnancies in 99% of cases. A positive effect is the regulation and restoration of the menstrual cycle. The minimum period for such contraception is 3 months, but you need to wait until the body is fully restored to decide when to get pregnant. Usually this period is at least 6 months.
If pregnancy occurs earlier, then it threatens with complications such as:
- threat of interruption;
- ectopic pregnancy;
- anemia in a woman.
The doctors' advice on how to restore the body after a medical abortion is as follows:
- start taking oral contraceptives early;
- avoid overheating and hypothermia in the first month after the procedure;
- do not visit the sauna, pool, do not swim in open water;
- do not take a hot bath, take a shower instead;
- monitor your health, during the season of colds, avoid crowds so as not to get infected;
- nutrition should be balanced, with sufficient protein and vitamins;
- completely give up alcohol, exclude smoking;
- at first, physical activity should be limited. Those who are intensely involved in sports or fitness need to give up visiting the gym for a while;
- will limit stressful situations and emotional stress.
Sexual life after medical abortion is possible after the end of the first menstrual period. After an artificial miscarriage, the uterus is an extensive wound surface with a breeding ground for microorganisms. Sexual contact is always a risk of infection. In addition, active frictions can cause discomfort or lead to renewed bleeding.
Physiotherapy has a positive effect on the recovery process. The choice of a specific method of exposure must be agreed with the attending physician, because this method of treatment also has contraindications.
If the restoration of the menstrual cycle has not occurred within 2 months, you must consult a doctor for an examination and search for the causes of hormonal failure. Discomfort in the mammary glands, which have begun to prepare for lactation, may also disturb. Therefore, in some cases, a consultation with a mammologist is recommended.
Despite its many positive aspects, medabortion is not an ideal method. Any interference with the internal environment can lead to unpleasant consequences. To avoid them, it is necessary to approach the issues and family planning correctly, and not to solve the problem after it arises.
Termination of pregnancy (abortion) is a surgical or medical method of removing a fertilized egg from the uterus. Moscow clinics offer several methods of abortion: vacuum aspiration, curettage, medical abortion.
Early abortion
On the 4th day after fertilization, the ovum enters the uterine cavity through the cervix. In the first week of delayed menstruation (13-15 days of pregnancy), the fertilized egg does not have a close connection with the mucous membrane of the reproductive organ, therefore, an early abortion (5-10 days after a delay in menstruation) passes quickly and without significant consequences for the patient.Early termination of pregnancy does not entail hormonal disruptions or the development of neoplasms on the mucous surfaces of the reproductive system. At the discretion of the patient, an early abortion can be performed using vacuum regulation or drug therapy.
Medical abortion
The pharmacist's behavior is possible up to 6 weeks of pregnancy (less than 40 days of delay). Medical abortion is the least traumatic method of abortion. Pharmabort does not provoke ruptures and other mechanical injuries, excludes the appearance of inflammatory processes in the uterine cavity, as well as complications after anesthesia.Surgical termination of pregnancy
There are two types of surgical abortion: curettage (8-12 weeks of gestation) and vacuum regulation (4-6 weeks of pregnancy). A classic abortion is performed under general anesthesia with the opening of the cervix and the extraction of the fetus using a gynecological curette. Such surgical correction is carried out blindly, therefore there is a danger of incomplete cleansing of the uterine cavity, injury to the soft tissues of the genital tract, cervix, uterus itself, and bleeding. The manipulation takes 35-60 minutes. Within 6-7 hours after a medical abortion, the patient must be in the hospital.Vacuum aspiration (mini-abortion) is performed under local or general anesthesia. The principle of manipulation is to remove the fertilized egg using a vacuum tube (electric pump) inserted through the vagina and cervix. A mini abortion does not cause significant blood loss or internal trauma. The entire vacuum aspiration procedure is performed for 4-7 minutes, after which the patient is under the supervision of a specialist for 30-40 minutes and can soon go home on his own.
Where are abortions carried out in Moscow?
In the database of the information portal Zoon you will find the addresses of gynecology and reproductive health centers, hospitals of state clinics and other medical institutions in Moscow. The site also contains questionnaires of obstetricians-gynecologists, surgeons and other specialized specialists. The rating of doctors, patient reviews and the cost of services of certain doctors will help you make the right choice.Before an abortion, you will need to go through a number of procedures and pass tests to make sure there are no contraindications to medical abortion:
- First, an ultrasound is done to exclude an ectopic pregnancy.
- You need to pass a smear for flora.
- Determination of blood group and Rh factor.
- Analysis of urine.
- Blood test for HIV infection, syphilis, hepatitis B and C.
When a woman needs to terminate her pregnancy early, one of the most gentle methods is medical abortion.
If necessary, appoint consultations of other specialists.
Often in clinics, express analyzes are done in one day and, in the absence of contraindications, they immediately carry out the procedure for medical abortion, since it is limited in time.
How long does it take to have a medical abortion?
This type of abortion should be carried out no later than 2 weeks after the delay, that is, 6 weeks of pregnancy. The optimal period is 3-4 weeks of uterine pregnancy. This is due to the fact that after 6 weeks the ovum is already firmly adhered to the wall of the uterus; during a medical abortion, the likelihood of maintaining pregnancy is high.
How does medical abortion work?
The essence of medical abortion is that a woman takes drugs under the mandatory supervision of a doctor, which provoke rejection and miscarriage of the ovum, followed by cleansing of the uterus.
For medical abortion, mifepristone drugs are used. The dosage is determined by the doctor.
The woman takes mifepristone at the doctor's office and remains in the clinic for about 2 hours. This is necessary so that in the event of a reaction to the drug, doctors can urgently provide medical assistance to the woman.
The doctor can then schedule a visit in 1–2 days, or hand out the drug of the active ingredient misoprostol. Misoprostol is taken on an empty stomach or after meals (at least 2 hours). The drug causes an active contraction of the uterus, bleeding will begin after a medical abortion.
A woman may experience pain, then pain relievers can be taken. The type and dosage of pain reliever will be determined by your doctor. If vomiting occurs or the bleeding is extremely severe, urgent medical attention is needed.
Seeing a doctor after a medical abortion
It is necessary to visit a doctor 10-14 days after a medical abortion. The doctor will evaluate the condition of the uterus by ultrasound in order to check the effectiveness of the procedure. If the abortion was complete, the doctor will recommend a method of contraception and tell you how long it will take for a woman to plan a pregnancy.
If the pregnancy persists, you will have to use a different method of abortion. If particles of the ovum remain, they must be removed to avoid complications, in particular the development of polyps.
Despite the availability and seeming safety of medical abortion, it is strictly forbidden to carry out the procedure on your own. Only a doctor will be able to assess the condition of the woman's body, the possibility of carrying out the procedure and carry out proper medical control over the condition of the woman during and after an abortion.
Dragalina asks:
What is medical abortion?
Medical abortion or pharmaceutical abortion, as the name suggests, is a non-surgical termination of pregnancy. This is a relatively new method of abortion that can only be performed in the early (up to 6 weeks) stages of pregnancy.
With medical abortion, the death of the embryo and its subsequent expulsion from the uterine cavity is ensured by taking special medications.
Today, the most popular is the medical termination of pregnancy using the steroid mifepristone and the prostaglandin analog misoprostol, which are packaged in one package.
Preparations for medical abortion are not available in the public domain, since termination of pregnancy, regardless of the method chosen, poses a danger to the life and health of a woman.
So medical abortion is carried out under strict medical supervision after a standard examination, which makes it possible to exclude conditions in which this method of termination of pregnancy is contraindicated.
Contraindications to medical abortion
There are contraindications to abortion common to all abortion methods, such as:- acute infectious diseases;
- acute and subacute inflammatory processes of the female genital area;
- acute inflammation in the body, regardless of localization;
- ectopic pregnancy.
In addition, medical abortion has its own contraindications, such as:
- intolerance to one of the medications (this is one of the reasons that medications are taken under the supervision of a doctor);
- porphyria (a fairly rare hereditary disease characterized by impaired pigment metabolism);
- the presence of a scar on the uterus;
- chronic adrenal insufficiency;
- severe disturbances in the activity of the liver and kidneys;
- severe cardiovascular disease;
- risk factors for the development of atherosclerosis (age over 35 and smoking);
- inflammatory diseases of the gastrointestinal tract (gastritis, duodenitis, enterocolitis) with a tendency to chronically recurrent course;
- severe bronchial asthma or obstructive bronchitis;
- a bleeding disorder and / or anemia (medical abortion often causes significant blood loss, so doctors recommend that women with anemia choose another method of terminating pregnancy);
- the use of glucocorticoids (including for bronchial asthma);
- long-term use of hormonal contraceptives, discontinued shortly before pregnancy;
- breastfeeding (drugs pass into breast milk, so breastfeeding will have to be stopped for 14 days after taking them).
How is a medical abortion performed?
Medical abortion is performed on an outpatient basis in two stages. First, the woman takes 600 mg (three tablets) of mifepristone in the presence of a doctor. After admission, the patient is under the supervision of the medical staff for 2-4 hours, then, in the absence of a pathological reaction to the drug (which is extremely rare), goes home.Mifepristone causes the death of the embryo and prepares the uterus for its expulsion (softening of the cervix begins, the tone of the uterus and its sensitivity to prostaglandins increase, the growth of the endothelium stops, changes occur in it as before the onset of menstrual bleeding).
36-48 hours after taking mifepristone, the woman should return to the outpatient clinic and, in the presence of a doctor, take misoprostol, which starts the process of expulsion of the ovum. As well as at the first visit, after taking the drug, a woman should be under the supervision of doctors for at least 2 hours.
After 36-48 hours after taking misoprostol, a woman should undergo a control ultrasound examination, and then, after 8-14 days, appear for a gynecological examination and undergo another ultrasound examination to finally make sure that the abortion is effective and that there are no complications.
Such careful monitoring allows you to avoid serious complications in the development of hematomas (accumulation of blood in the uterine cavity) or incomplete expulsion of the ovum, as well as to timely detect the remaining pregnancy.
In a small number of cases (about 3-10%), pregnancy is terminated after taking mifepristone; in most women, the release of the ovum occurs on average 6-7 hours after taking misoprostol.
The duration of the abortion from the first pill intake to the complete cessation of bleeding is from 3 to 10 days (on average 6-7 days).
Early complications of medical abortion: what to do to avoid trouble
Bleeding
The most dangerous early complication of medical abortion is severe uterine bleeding, which often has to be stopped by curettage (scraping) of the uterus. In rare cases, blood transfusions are used (0.1% of all cases of medical abortion).This complication is observed in 0.3-2.6% of cases, with an increase in pregnancy, the likelihood of its development increases.
It should be noted that medical abortion, as a rule, proceeds with rather heavy bleeding, so you should not be afraid of spotting. Bleeding can begin in the clinic or on the way home, so you need to stock up on sanitary pads ahead of time. It is better to ask someone close to you to be accompanied.
A doctor should be consulted if the bleeding is so severe that you have to change 2 sanitary pads per hour, or if it is accompanied by signs of acute blood loss, such as:
- dizziness, tinnitus, increasing weakness;
- increased heart rate (100 beats / min and above);
- lowering blood pressure (100/60 mm Hg and below);
- pallor of the skin, cold sweat.
Hematometer
A hematometer is an accumulation of blood in the uterine cavity and occurs in 2-4% of cases of medical abortion.This complication poses a danger in relation to the development of infection (blood is an excellent breeding ground for microorganisms).
In addition, with prolonged resolution of hematometers, even in the absence of infection, the development of an adhesive process in the uterine cavity is possible, which in the future will have an extremely adverse effect on reproductive function.
For the timely detection of hematomas, it is necessary to strictly follow the doctor's instructions and appear for a control ultrasound scan 36-48 hours after taking misoprostol.
In addition, you should seek medical attention if you have a combination of the following symptoms:
- abrupt stop of bleeding;
- increasing pain and a feeling of heaviness in the abdomen;
- temperature increase.
Incomplete removal of the ovum (incomplete abortion)
Incomplete removal of the ovum occurs on average in 3-5% of cases of medical abortion. The likelihood of such a complication is higher in nulliparous women, especially in primary pregnant women.In order to timely recognize an incomplete abortion, it is necessary to appear in a timely manner for a control ultrasound scan (36-48 hours after taking misoprostol), and after one to two weeks undergo a gynecological examination and another ultrasound scan.
In case of incomplete abortion, vacuum aspiration (mini-abortion) or curettage of the uterus (curettage) is performed. If you do not take action in a timely manner, the remnants of the ovum become infected, and purulent inflammation develops - endometritis, which can be complicated by purulent inflammation of the uterine appendages, often leading to infertility, or even sepsis (blood poisoning).
Signs of incomplete abortion usually appear two to three weeks after the termination of the pregnancy:
- prolonged bleeding (more than two weeks after the expulsion of the ovum);
- pulling pains in the lower abdomen;
- an increase in temperature (indicates the development of an infection).
Preservation of pregnancy
Preservation of pregnancy with medical abortion is extremely rare (less than 1% of cases), the likelihood increases with an increase in the duration of pregnancy.In such cases, doctors recommend terminating the pregnancy with vacuum aspiration. While maintaining pregnancy, there is a high risk of giving birth to a child with gross malformations, which can develop both as a result of exposure to medications and as a result of hypoxia during tonic contraction of the uterus.
In order to timely recognize the remaining pregnancy, it is necessary to strictly follow the instructions: one to two weeks after the medical abortion, appear for a gynecological examination and undergo an ultrasound scan.
Infectious complications
Infectious complications with medical abortion are much less common than with surgical abortion.Nevertheless, the story of American women who died after undergoing medical abortion gained worldwide fame. Studies have shown that the cause of their death was not the direct effect of medications, but such a serious infectious complication as toxic shock.
To prevent the development of infectious complications, you should undergo a bacterioscopic examination before performing a medical abortion. If an infectious and inflammatory process is detected during the study, preliminary treatment is necessary.
A characteristic sign of the development of infectious inflammation is the appearance of fever. However, it should be borne in mind that often during medical abortion, there is a short-term slight increase in temperature, accompanied by chills - this is an unpleasant, but not life-threatening side effect of drugs.
A doctor should be consulted if you have symptoms such as:
- the temperature rises above subfebrile (above 38 degrees Celsius) and lasts for more than 4 hours;
- fever develops 6-8 hours or more after taking misoprostol.
With the development of infectious complications, antibiotic therapy is prescribed. Depending on the indications of the tests, it can be carried out in a hospital or outpatient.
Coping with medical abortion: unpleasant side effects and how to deal with them
In about 30-35% of women, medical abortion is completely painless or causes minor discomfort.The rest develop severe pain syndrome. Pain during medical abortion can be very intense - pulling or cramping. Pain is often accompanied by nausea, vomiting, and diarrhea (diarrhea).
Pain syndrome is more pronounced in nulliparous, especially in primipregnant women. As a rule, women with algodismenorrhea (painful periods) are more likely to experience pain with medical abortion than those with painless menstrual bleeding.
It should be noted right away that the strength and severity of the pain syndrome in no way correlates with the risk of complications after abortion. Therefore, you should tune in to possible discomfort, and console yourself that it will soon pass.
It is important to know that pain cannot be relieved with drugs containing acetylsalicylic acid or other non-steroidal anti-inflammatory drugs. So, taking such drugs familiar to many as baralgin, spazmalgon, tempalgin, diclofenac, citramone, ketans, paracetamol is categorically contraindicated, since they block the abortive effect of the prostaglandin misoprostol.
Standard non-drug methods of pain relief are recommended, which are used for painful menstruation: dry heat, rest, copious hot drinks. With a strong pain syndrome, you can take a "pure" antispasmodic (No-shpa).
To the attention of smoking ladies: Smoking more than 10 cigarettes per day also reduces the effects of misoprostol.
Long-term complications of medical abortion. How to get out of a difficult situation with the least losses
The late complications of medical abortion are not well understood. However, judging by the available data, medical abortion today is the safest form of termination of pregnancy, since it is carried out at the earliest possible date and is not associated with a surgical intervention that additionally injures the cervix and the inner surface of the uterus.Nevertheless, any termination of pregnancy is a severe stress for the whole organism, and even with the safest form of abortion, late complications often arise, such as:
- dysbiosis of the vagina and gastrointestinal tract;
- breast problems;
- psychological problems.
For the prevention and correction of hormonal imbalance, all women after medical termination of pregnancy are advised to take combined oral contraceptives for 6 to 12 months.
Dysbacteriosis after termination of pregnancy develops as a reaction of the body to stress and is associated with a decrease in immunity, hormonal imbalance, and nervous exhaustion.
To prevent this complication, special drugs are used, taken orally (for the prevention of intestinal dysbiosis) and intravaginally (for the prevention of vaginal dysbiosis). In case of development of candidiasis, specific antifungal therapy is prescribed.
Termination of pregnancy at any of its stages is a predisposing factor for the development of breast dysplasia. Young and young nulliparous women are especially susceptible to this complication. To prevent problems with the mammary gland, you should visit a mammologist and be under his supervision for a year after the termination of pregnancy.
Many women, after a successful medical abortion, feel relief, but often there is an opposite reaction: some patients feel emptiness, loss of strength and loss of meaning in existence. If severe symptoms of depression develop, you should seek the help of a psychologist.
Benefits of medical abortion:
- the possibility of using at the earliest stages of pregnancy;
- minimal trauma to the uterus;
- lower risk of infectious complications in comparison with surgical abortion;
- eliminates the need for manipulations, which also carry a certain amount of risk (the risk of complications when using drugs for anesthesia, the risk of contracting HIV, syphilis or hepatitis, etc.);
- termination of pregnancy occurs "at home" and is perceived by many women as normal menstrual bleeding.
Disadvantages of medical abortion:
- sufficiently strong and prolonged bleeding;
- severe and prolonged pain syndrome often develops, which cannot be removed with the usual drugs;
- the process of termination of pregnancy is prolonged in time, therefore it is worse tolerated;