Therapeutic abortion: the list is held, reviews

Before the 12th week of pregnancy, a woman has the right to decide whether she wants to give birth to a child conceived. After the deadline interruption make with the proviso that there is a medical or social indications. Therapeutic abortion is carried out at any stage in the health care facilities that have permission to interrupt the later stages.

Indications for abortion

Even in the presence of medical indications for abortion doctors can do it only with the patient's consent. Interruption is recommended if there is:

• health problems of the mother;
• testimony from a child in the womb;
• problems with the pregnancy.

Absolute indication for abortion at any stage of a developing pregnancy. If the baby died in utero, then it must be removed from the uterus as soon as possible. This is to prevent complications and save lives and health of the mother.

By the indications for abortion, which are related to the fetus and include:

• malformations incompatible with life (lack of brain or other organs);
• the threat of having a child with a disability caused by malformations or genetic defects (such as Down's Syndrome, Arnold Chiari malformation).

In severe malformations of the child may die before the end of pregnancy or within a few hours after birth.

The list of medical indications for which abortion is recommended because of the health problems in the mother, is extensive. This procedure is carried out at:

• heart diseases, in which there is severe heart failure;
• bacterial endocarditis;
• aplastic anemia, leukemia and other serious blood diseases;
• complex form of hypertension;
• renal disease leading to serious kidney failure;
• severe respiratory failure provoked by the lung pathology;
• tuberculosis in active form;
• endocrine disturbances, hindering the healthy nurturing of the child (diabetes in decompensation stage, thyrotoxicosis in a severe form);
• advanced stage of clinical symptoms of AIDS;
• oncologic diseases in which used chemotherapy or irradiation organs located in the pelvis;
• pathologies of the digestive tract, preventing the carrying of a healthy child (eg, parenchymal damage liver, in which it ceases to perform its function of detoxification, and the mother and child poisoned);
• malignant lesions of eyes, corneal or optic nerve disease;
• serious mental pathologies;
• diseases of the nervous system in severe (multiple sclerosis, polyneuritis with progressive);
• abdominal operations in history, because of which the gestation and birth of a child is life-threatening;
• severe hereditary diseases identified in one parent (hemophilia, schizophrenia, diseases of eye, causing blindness).

But in each case, take into account the individual characteristics of the disease, collect medical consultation to assess the patient's health status. It is better that the diagnosis was made at an early period, while it is possible to conduct medical termination of pregnancy for medical reasons.

Comment! Thanks to the progress, the list of diseases for which it is recommended an abortion, is steadily declining. Until a few decades ago diabetes was an absolute contraindication to pregnancy, and now a woman with such a diagnosis can carry and give birth to a healthy baby.

Appoint therapeutic abortion and the women who identify violations of pregnancy:

• ectopic implantation of the fertilized egg;
• heavy early or late toxicosis (with the proviso that they do not respond to treatment and threaten the mother's life).

In identifying ectopic pregnancy is necessary to have an abortion in early pregnancy. This condition threatens the patient's life. But to interrupt the conduct laparoscopic surgery, rather than a standard abortion because the fetus is not in the uterus, most often it is attached to the fallopian tube.

Termination of pregnancy is indicated for:

• Effects of Maternal infectious agents causing fetal lesions (rubella virus, varicella-zoster virus);
• taking medicines that have teratogenic effects on the child;
• the influence of mutagenic factors - radiation, chemicals.

If these factors are identified in the first weeks, the doctor may recommend a medical abortion may be needed. Although some clinics do interrupt medicines and in the II trimester.

Legal aspects of medical abortion. indications

Up to 12 weeks of pregnancy an abortion can make every woman even in the absence of medical indications. This right is enshrined in Article 56 of the Federal Law "On the basis of public health protection." The same article states that the termination of pregnancy for medical reasons is performed on any stage.

In accordance with the legislation of abortion has to do a certified obstetrician-gynecologist at the health facility where which has a license to carry out these manipulations. Otherwise, abortion (except spontaneous) is classified as a criminal abortion. For its implementation provides for administrative and criminal liability.

Forced to have an abortion, even when there are medical indications for interruption is prohibited. The exception is only for disabled adult women who are not able to express their will. In this case, by a court decision, which was adopted at the request of the official representative of the patient, doctors can make a forced abortion.

Preparing for pregnancy termination of honey. indications

The process of preparation for the termination of pregnancy depends on the state of women's health, life, which will have an abortion, and the selected method. Before the interruption recommend:

• undergo a pelvic exam, to make Pap;
• do an ultrasound to confirm intrauterine pregnancy, clarify the term;
• pass general blood, urine;
• donate blood for HIV, RW, viral hepatitis, hCG, making coagulation;
• to make an electrocardiogram.

When carrying out an abortion in the early stages of special training is required. Although in cases where the plan to conduct surgical abortion (dilation and curettage), according to the WHO guidelines prestage cervix necessary. This reduces the risk of trauma during the abortion, but in the CIS countries, this recommendation is not fulfilled.

The patient is advised not to eat before the operation to empty the bladder and bowels. On the eve of surgery do a cleansing enema.

Warning! Prior medical termination must ensure no contraindications to the use of drugs which are used for tablet abortion.

If you are planning to do an abortion for medical reasons in 14 weeks later, the patient requires long preparation. It is performed in a hospital. You need to prepare the cervix, to achieve its softening and opening.

How is the termination of pregnancy for medical reasons

The method of abortion depends on the duration of pregnancy and women's health. Medically terminate a pregnancy at term of more than 12 weeks may be such methods:

• Use of prostaglandins for the stimulation of uterine contractions and the expulsion of the fetus (sometimes in combination with the administration of saline solution);
• small caesarean section;
• dilation and evacuation (analog curettage).

The first method allows you to bring abortion to the flow of labor. Soften and expand the neck by using tampons laminaria Tserviprosta Prepidil or gel.

To activate uterine ability to use Prostin 15 M and make early amniotomy. So prepare to artificial birth in the early stages, this is the preferred option of termination of pregnancy for patients who are in the II trimester of pregnancy. Under the action of prostaglandins during days 75-90% occurs in miscarriage.

Practiced as mifepristone and misoprostol for interrupts. At the same time the patient is inserted into the cervix kelp to reveal the cervical canal.

One of the methods of abortion for medical reasons is to conduct a small cesarean section. It is conducted in the period between 13 and 22 weeks of pregnancy, if you want to remove the fetus from the uterus and at the same time to sterilize a woman. Also an indication for this operation are:

• severe scarring of the neck, under which it can not independently open;
• tumors of the pelvic organs.

For up to 16 weeks of pregnancy are often prescribed a surgical abortion for medical reasons. Initially, the surgeon expands the cervical canal with the help of special tools (do this after the preliminary preparation of the cervix), and then deletes all the contents of the uterus. Fertilized egg is pulled out tongs, then the inner cavity curette.

If necessary for medical termination of pregnancy at a later period of more than 22 weeks gestation, the physician can use a hypertonic solution of sodium chloride or urea. The required amount of solution is calculated based on the period of pregnancy.

The gynecologist pre-selects from membranes bit amniotic fluid - their number should correspond to the volume of a hypertonic solution which will be administered. This procedure provokes necrosis placenta, chorion and amnion. As a result, the fetus dies within 17-21 hours after administration of the solution. After that, the doctors begin to stimulate labor. After the saline abortion, there is a high risk of uterine bleeding opening.

Comment! Currently, the "salt casting" is practically not used. Sometimes the fetus dies and is born alive, but apparently it looks as if it doused with boiling water.

Possible complications after medical abortion for indications

Any of the methods of abortion in late pregnancy is dangerous to the life and health of the patient. Therefore, even if there are medical indications doctors try to have an abortion as early as possible.

All negative effects are divided into instant and long-term. Immediately after such an abortion complications can arise for medical reasons:

• perforation of the uterine wall (during the surgical curettage);
• hypotension uterine bleeding;
• cervical rupture;
• incomplete removal of membranes or fruit pieces.

After surgery women can have the appearance of such complications:

• inflammatory disease of the reproductive system;
• hemometra;
• placental polyp.

Among the long-term consequences of abortion for medical reasons is called:

• violation of the regularity of the menstrual cycle;
• inflammation of the uterus, appendages;
• adhesive disease development (may cause disturbances and infertility tubal patency);
• formation of adhesions in the uterine cavity;
• damage to the endometrium;
• cicatricial changes of the cervical canal leading to cervical incompetence;
• complicated pregnancy in the future, including the threat of interruption and spontaneous abortions.

Intervention in the body, even for medical reasons have a negative effect on the condition of the heart, blood vessels, nervous system and endocrine organs. Repeated interruptions increase the risk of hormonal imbalance and are precipitating factor in the development of hormone-dependent tumors.

conclusion

Therapeutic abortion can be carried out only in institutions qualified obstetrician-gynecologist. Prescribe it in cases where the mother diagnosed diseases in which pregnancy and childbirth are contraindicated. Also recommend abortion if the likelihood of a healthy baby bear low. For medical abortions carried out for women, if the child reveals severe malformations or genetic diseases.

Reviews for the termination of pregnancy for medical reasons