Terms of medical termination of pregnancy until what week. Medical termination of pregnancy in the early stages: indications, drugs, threats, consequences

Medical abortion for early dates- this is the easiest and painless way among those existing in modern medical practice. According to the standards of Russian legislation, a woman has the right to refuse pregnancy if the gestational age is not more than 12 weeks. However, medical interruption is carried out only in the very early stages, up to and including 6 weeks.

What is medical abortion

By definition, abortion is any interruption of a pregnancy through medical or surgical intervention. Termination of pregnancy with the help of medications is possible only in the early period of gestation, when the fetal egg is just beginning to take shape and look for a place of attachment and development.

Termination of pregnancy with medication is the easiest way, since in this case there is no surgical intervention in the female body. All the work is done by drugs - they destroy and reject the fetal egg. However, such a procedure is a serious malfunction of the whole organism, so a mandatory consultation with a gynecologist is necessary before it is carried out.

How does it happen

Termination of pregnancy with the help of medications can be one- or two-stage. To determine the tactics and method of carrying out this procedure, it is necessary to consult with a gynecologist.

Ways of conducting:

1. For one step. When deciding to interrupt in one stage, the woman takes a drug that blocks the activity of progesterones. Because of this, the endometrium stops growing, and the body begins to increase the production of oxytocin. This element leads to an increase in the contractility of the uterus, as a result of which the ovum is detached from the wall and comes out.
2. For two stages. This method is necessary in case of prolonged attachment of the fetal egg to the uterine walls. The first stage takes place, as with a one-stage interruption - the same drugs are used. Two days after taking the first medication, you must take the second - with a high content of prostaglandins. Their action increases the activity of uterine contractions, compresses the myometrium and increases tone.

To carry out the procedure correctly and safely medical abortion, you need to follow certain instructions:

1. Contact a gynecologist. A specialist can be visited at a polyclinic at the place of residence, or you can choose the required specialist in a private center, according to reviews. If you choose a private specialist, you must make sure that the center and the doctor have the right to conduct a specialized appointment. This can be done by reviewing the licenses and certificates.
2. The primary examination for planning medical abortion is an ultrasound examination of the pelvic organs. This procedure will show the location of the fetal egg in the uterus or appendages, the approximate timing of pregnancy and the condition of the organs in general.
3. The next step is laboratory testing. It is necessary to pass clinical and biochemical blood and urine tests so that the doctor assesses the general condition of the body. In public clinics, the results are ready the next day, in private clinics it is possible to conduct an express analysis in a couple of hours.
4. Followed by a consultation. The gynecologist will tell you how the medical termination of pregnancy will take place, how the drug works, possible symptoms and manifestations. It is necessary to fill out a special form - an informed consent that the entire procedure is carried out consciously, all the necessary recommendations and instructions are explained.
5. After filling in all the necessary documents, the woman accepts special preparation which will be used to terminate the pregnancy. The first two hours will need to be spent under the supervision of medical staff, to exclude side effects and complications. After 2 hours it will be possible to go home, it is recommended to spend this day in a calm atmosphere, it is best to observe bed rest.
6. With a two-stage interruption after two days, you need to take the drug again, for this you should again contact the selected clinic.
7. The standard symptoms of medical termination of pregnancy are pulling pains in the lower abdomen, periodically intensifying. Bloody discharge should come out gradually, throughout the day, small clots are allowed.
8. When the whole process of termination of pregnancy is completed, abundant menstrual-like discharge appears. The duration of such discharges should not exceed two weeks, on average they last 10 days. After their completion, it is necessary to undergo an examination again - ultrasound of the pelvic organs and clinical tests. With a low content of hemoglobin in the blood, it is necessary to prescribe iron supplements to restore it. With residual elements of the fetal egg in the uterine cavity, the woman is sent for a vacuum aspiration procedure.
9. If the pain takes on a strong cramping character, you can take antispasmodic drugs to reduce them. The drugs of choice are no-shpa and drotaverine, since their action is the most acceptable in this situation. It is worth noting that taking certain medications slows down and worsens the effect of the drug for abortion, so you need to tell the gynecologist about the treatment being carried out.
10. A completely normal course of the menstrual cycle is restored one month after the successful medical termination of pregnancy.

When contacting a polyclinic or a private center, you should find out about psychological support services. A preventive conversation with a psychologist is necessary in order to return to a full life.

In the case when the pad fills up very quickly on the day of the medical abortion blood secretions, you should immediately seek medical help to eliminate acute bleeding. Otherwise, there is an increased risk of a health hazard.

Benefits of medical interruption

Terms of medical termination of pregnancy limited to 6 weeks. However, this type of intervention has a number of advantages that distinguish it from other types of intervention.

• early use;
• Has minor effects on the female body;
• Complications occur only in 5% of cases;
• There is no need for a stationary stay;
• A minimum of examinations before the procedure.

If you comply with the necessary requirements for health reasons, examinations and the implementation of the recommendations of the gynecologist, the risk of complications is reduced to zero.

How long can you do

The question is How long is medical abortion considered possible, defined by Russian law. The standard term for an abortion is up to 12 weeks inclusive. However, termination of pregnancy with the help of a drug is possible only at the very beginning - up to 8 weeks.

If the pregnancy is unwanted or, according to some indicators, it must be terminated, then, depending on the period, different kinds abortion:

1. Abortion through the action of a drug. It is carried out at the earliest possible date, up to 8 weeks of the course of the gestation period. However, the more time passes from the moment of conception, the greater the likelihood of an unsuccessful outcome of the interruption.
2. Interruption with vacuum aspiration. This method is the most acceptable in the conditions of modern medicine, since it practically does not affect the state of health and completely removes fragments of the fetal egg from the uterus.
3. Abortion by surgery. The most unsafe way to get rid of an unwanted pregnancy. For medical reasons, it is possible to carry out such an intervention until the end of the twentieth week. Such an intervention has a detrimental effect on the mental and physical health of a woman, therefore, this method is resorted to only when absolutely necessary.

There is a way to calculate the optimal time to terminate a pregnancy with a medication. To do this, determine the period from 42 to 49 days after the start of menstruation. This period, in terms of gestational age, will be 4 to 5 weeks. This is the ideal period for terminating a pregnancy, for two reasons:

• It can be determined that the pregnancy does not flow according to the ectopic type;
• The fertilized egg has not yet fixed on the uterine wall and can be easily brought out.

The possibilities of abortion with the help of a medical preparation are not unlimited, therefore, after the eighth week of pregnancy, it is better to resort to other methods of interruption.

The cost of medical abortion

Cost of medical abortion will directly depend on the place where this interruption is carried out.

In a private center, a comprehensive service is calculated depending on the range of tests and examinations that must be completed before starting the interruption process.

What are the contraindications

All contraindications, in which abortion becomes impossible, are conditionally divided into two groups - general and private.

General contraindications:

• Acute infectious process or exacerbation of a chronic one;
• The course or exacerbation of inflammation of any localization, especially the organs of the genitourinary system;
• If an ectopic pregnancy is diagnosed.

In order for the abortion to end successfully, all these conditions must be eliminated. As for an ectopic pregnancy, only surgical treatment is indicated in this case.

Particular contraindications apply only to the type of medical interruption:

1. An allergic reaction to the substances that make up the selected drug for abortion. This contraindication can be eliminated by offering another drug with a safer composition.
2. Renal or liver failure, in acute or chronic course.
3. Pathologies of the cardiovascular system.
4. Decreased level of hemoglobin in the blood. With medical abortion, a large amount of blood is lost, which, against the background of an already existing anemia, can lead to serious complications.
5. Lactation - all drugs pass into breast milk.
6. Against the background of improper intake of oral contraceptive pills.
7. Exacerbation of diseases of the digestive system.
8. Cicatricial changes on the walls of the uterus.

If such violations occur, other options should be considered.

Possible Complications

Any intervention in the natural course of the normal process in the body does not remain without consequences. You need to know that even with a low-traumatic medical termination of pregnancy, complications may occur:

1. Continuation of the gestation period. There is a risk of high resistance of the woman's body to the drug, in which case the pregnancy continues.
2. Sharp cramping pains in the lower abdomen.
3. Acute bleeding from the uterus.
4. Vomit. Such a symptom can negate the effect of the drug due to its early removal from the body.
5. Failure of the hormonal system.
6. Exacerbation of chronic processes or the occurrence of acute ones in the organs and systems of the body.
7. Violation in the work of the organs of the genital area, improper work as a result of stress against the background of abortion.
8. Prolonged recovery of the menstrual cycle.

If such complications occur, it is necessary to consult a gynecologist and undergo additional examinations.

What to do after the procedure

Medical abortion method involves periodic monitoring by a gynecologist, taking care of your health and fulfilling all prescriptions.

A second visit to the gynecologist is necessary on the third and fifteenth day after the medical abortion. The purpose of these visits is to establish the normal course of the recovery process and conduct ultrasound of the pelvic organs for dynamic monitoring.

Women who are faced with an unwanted pregnancy often wonder how long it is possible to have an abortion, until what month the procedure is safe for health. Termination of pregnancy in any case entails some complications and the need for a recovery period. Everything happens individually and only after visiting the antenatal clinic.

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Description of the procedure

Abortion is forced termination of pregnancy through medical intervention. Translated from Latin, this word means "miscarriage."

According to the mechanism of manifestation, they distinguish:

1. Spontaneous, which occurs for a number of reasons most often in the first trimester without the initiative of a woman. Some encounter it even before they know they are carrying a child.
2. Artificial. This class includes all other types of abortions that involve third-party intervention at the initiative of the mother.

Causes of spontaneous miscarriage are very different:

• wrong way of life;
• weakness of the immune system;
• previous abortions;
• the use of hormonal contraceptives;
• smoking;
• sexual infections.

Regardless of the timing of an abortion, it is important to remember that this is an important step that requires a lot of responsibility. After a miscarriage, serious complications can follow, from cervical fibroids to failure to carry subsequent pregnancies and infertility in general. It is necessary to weigh all the pros and cons in advance.

Interruption methods

Abortions are legal in Russia, made before 22 weeks. At the same time, it is important at what time the abortion is done, since up to 12 weeks this happens at the request of the woman, from 12 to 22 - under certain circumstances.

These include cases where:

• the pregnancy was the result of rape;
• there are medical indications;
• A woman is declared incompetent after the death of her husband.

The answer to the question of how long a pregnancy can be terminated depends on the method chosen:

Medical

For medical termination of pregnancy, the first trimester is most favorable. The optimal period for an abortion is 45 days or 6 weeks.

Abortion is done with drug Mifepristone. The tool for several hours blocks the release of the hormone progesterone, which is responsible for preserving the fetus. As a result, a miscarriage occurs.

The advantages are:

1. there is no recovery period or stay in the hospital;
2. minimal risk of complications;
3. no damage to the cervix, as in the surgical method;
4. high efficiency;
5. the possibility of successful conception in the future;
6. such a method is psychologically easier perceived by women.

Medical termination of pregnancy occurs two hours after taking the drug and is accompanied by bloody uterine discharge. They can last for two weeks and be profuse. Also, the discharge is often accompanied by pain in the lower abdomen, this indicates a contraction of the uterus.

Important! If a copious discharge continue to be after two weeks, and the pain does not go away, you need to see a doctor or call an ambulance.

Three days after the medical interruption, you should begin to protect yourself, since conception is possible during this period.

Women who are in the early stages of gestation and do not want to keep the child are increasingly resorting to medication.

This method is much safer and more effective than surgery. Especially if before C-section, and the suture on the uterus has not yet healed to the end.

Plus, when using tablets, you do not need to be under the supervision of a doctor for a long time or use anesthesia.

Many people ask the question: how long can abortion pills be used. The effect of the tablets is the higher the earlier a woman decided to use them . The maximum term for abortion using pills is 6 weeks or 42 days from the first day of the last menstruation.

Important! As soon as a woman finds out that she is pregnant and decides to interrupt this process, one should not delay taking abortion pills.

If more than 6 weeks have passed since conception, and the doctor decides to terminate with pills, then the procedure is carried out in a hospital under supervision.

Miscarriage occurs under the influence of the following drugs:

Despite the fact that abortion pills are recognized as the safest means, there are a number of contraindications to their use:

1. malignant and benign uterine formations;
2. diseases of the gastrointestinal tract or kidneys;
3. high pressure;
4. poor blood clotting;
5. epilepsy.

Abortion pills have a lot of advantages:

• psychologically easy procedure
• takes little time
• does not cause complications.

However, it is very important to undergo an ultrasound examination 10 days after taking the pills to make sure of the result.

vacuum abortion

Vacuum abortion (or mini-abortion)- this is getting rid of the fetal egg by sucking it through a special vacuum nozzle

This method is less dangerous than instrumental, since damage to the uterus or the occurrence of infections is excluded.

Sometimes disputes arise as to how many weeks a vacuum abortion can be done, since sometimes it is carried out in the period up to 12 weeks.

Vacuum abortion is allowed for up to 6 weeks, subject to the normal development of the fetus. If the pregnancy is frozen, then it is possible to use a mini-abortion up to 12 weeks inclusive.

At too early a time, it is also not recommended to do it, since the fetal egg is still difficult to distinguish. Therefore, a woman who decides on a mini-abortion and is interested in how long this procedure is done should determine the type of pregnancy.

Late dates

Late abortion poses a health risk future mother's life. But there are situations when such a method is inevitable.

It is important to remember how long a pregnancy can be terminated. This period is 22 weeks. After 12 weeks, it is considered that this is already an abortion in the later stages, since the child has formed the main organs and systems.

The decision to terminate can only be made by a doctor for medical reasons:

• detection or severe genetic diseases;
• the mother has an infection or cancer.

It is important to remember that late abortion is very dangerous, so the decision is made not by one doctor, but by a council.

Process duration

Sometimes women are interested not only in the question of how long the whole procedure will take.

The later a woman decides to get rid of the fetus, the more dangerous the consequences for her health will be. It is important to remember how long a pregnancy can be terminated by different methods so that a long wait does not result in surgical intervention.

Useful video: how the abortion procedure works

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Medical abortion is prescribed only in the early stages, up to 49 - 63 days of pregnancy. But for a guaranteed good result, it is more effective to carry out this procedure for up to 28 days (4 weeks). At this stage of development, the fetal egg is still weakly connected to the uterus, so abortion is easier and the risk of hormonal failure is reduced. The effectiveness of the pharmaceutical board reaches 96%.

How long can a pregnancy be terminated?

The main advantage of this type of abortion is the absence of traumatic surgical intervention, which avoids many complications, the most dangerous of which are uterine perforation, secondary infertility and infection of internal organs. During a medical abortion, patients usually do not need anesthesia, since the pain is about the same as during menstruation. And the psychological trauma from a medical abortion is not so pronounced.

Before conducting a medical abortion, it is necessary to take tests for the content of antibodies to HIV and RW in the blood, as well as a smear for the presence of pathogenic flora.

There is no need to stay in the hospital for the procedure. At the gynecologist's appointment, the woman receives pills and goes home. Then it will be necessary to come to the appointment two or three more times, so that the doctor is convinced that the abortion was successful. And in case of complications, he could prescribe additional drugs.

But can all women have a pharmacological abortion? Of course, like any medical intervention, medical abortion has its absolute and relative contraindications.

absolute contraindications, when not to have a medical abortion are:

- intolerance to drugs used for medical abortion, allergic reactions to any of the drugs used, noted earlier.

- Many people ask how long it is possible to terminate the pregnancy, in case of choosing a medical abortion, this period is 6-7 weeks.

Diseases of the internal organs, in particular problems in the work of the adrenal glands, since the drug used in the pharmacotherapy violates the action of corticosteroid hormones. For the same reason, a severe form of bronchial asthma is a contraindication to the procedure, since drugs based on these hormones are used to treat it.

- suspicion of ectopic pregnancy. When referring a woman to a medical abortion, the doctor must make sure that the fetal egg is in the uterine cavity, so the procedure for an ectopic pregnancy is not only useless, but also poses a threat to the life of the woman, in which case a surgical operation is indicated.

• severe anemia, hemophilia and other pathologies of blood clotting, since abortion is associated with large blood loss.
• porphyria, a hereditary disease that causes disruption of the enzymes that affect the production of hemoglobin, with this disease, large blood losses are highly undesirable.
• uterine fibroids with nodules large sizes, as this disease creates a risk of heavy bleeding.
• inflammatory and infectious diseases of the female genital area, including venereal diseases.

There are also relative contraindications to medical abortion, in the presence of these diseases, caution should be exercised when using drugs that cause abortion.

Such contraindications include breastfeeding, since the substances taken by a woman during pharmacotherapy affect the composition breast milk Therefore, before the procedure, it is necessary to express milk, and do not breastfeed until the drugs are completely removed from the body. Although excretion is fast, a break in feeding can adversely affect milk production.

The procedure is also prescribed with caution in the presence of scars on the uterus after cesarean section, in this case, the pharmacist is carried out exclusively in the hospital and in the early stages up to 4 weeks.

A relative contraindication is pregnancy that occurred while taking hormonal drugs contraception or in the presence of an intrauterine device. In these cases, pharmabort is not recommended.

The patient's smoking is not in itself a contraindication to medical abortion, but in women over 35 years of age, this bad habit causes disruption of the blood vessels and the hematopoietic system, which is a relative contraindication.

Medical abortion, although it is considered a method of abortion without serious consequences, however, like any other medical manipulation, it can cause complications and side effects.

In some cases, uterine contractions are very strong, the woman feels contractions, as during childbirth. To reduce pain, you should take a painkiller that your doctor will advise. Symptoms similar to poisoning may appear, such as vomiting and diarrhea. If a woman vomited less than 2 hours after taking the drug, the procedure may not be effective. Very rarely, medical abortion is accompanied by fever, headaches, and a rash similar to an allergic one.

The most serious complication of a pharmaceutical abortion is an incomplete abortion, when either the fetus continues to develop, or a dead fetal egg or its particles remain in the uterus. In the first case, even if a woman changes her mind about having an abortion, leaving the pregnancy is very risky, since the risk of developing pathologies in the fetus is too high.

Severe and prolonged bleeding is also a serious complication. In all the cases described, it is necessary to resort to a surgical method of treatment.

Medical abortion does not affect a woman's fertility and she can get pregnant again almost immediately. Therefore, it is extremely important, when resuming sexual activity, to carefully protect yourself.

Women should remember that absolutely safe methods of abortion do not exist, in any case, gross interference with natural processes does not pass without a trace for the female body.

If a woman decides to terminate her pregnancy, she should contact a gynecologist as soon as possible. The risk of complications depends on when the abortion is done.

Pregnant patients who seek to get rid of their baby are worried about how long this can be done. Ideally, an abortion is done at 6-12 weeks of pregnancy. In this case, termination of pregnancy will be considered early.

Early abortion methods include:

• Farmabort. It is carried out with the help of medications that provoke contractions, fetal death, and its rejection. The technique is effective only in the first trimester, at a later date the fetus is protected by the placenta, which takes on the entire pharmacological attack. The fetus in this case does not die, but the harm done to it will not be comparable with normal development.
• Mini abortion. Abortion by vacuum technique - modern method termination of pregnancy in the first trimester before the 13th week.

In some cases, termination of pregnancy can be performed at a later date. Then the doctor should start from the law, which spells out the permitted terms for abortion. Late interruption techniques are high risk unpleasant consequences for woman. These include:

• Artificial childbirth. Doctors resort to them in case of fetal death at a later date. The patient is injected with certain drugs that stimulate the onset of labor, and the cervix is ​​opened manually or with the help of a medical instrument.
• Salt abortion. The essence of the technique is to pump out the amniotic fluid, instead of which a special concentrated solution is introduced. Two days later, the fetus dies. Further tactics of the doctor are similar to artificial childbirth.
• Small caesarean section. The procedure is performed through a small incision in the peritoneum or through the vagina. This method is used only in the most extreme cases.

The legislative framework

According to the Ministry of Health, about 3 million women a year agree to an abortion procedure. In state medical institutions, abortion is free of charge. 30% of women experience complications, and 10% of patients become infertile. On the legal side, there are 3 types of abortion:

• At the woman's request. Termination of pregnancy in this case should be carried out during the first trimester. The latest is 12 weeks. The smaller the size of the fetal egg, the easier the procedure will be.
• For social reasons. Abortion is carried out before the term of 22 weeks. Abortion is allowed only in case of fertilization due to rape. Until 2003, the death of a father, having many children, poor living conditions, etc., were among the social causes.
• For medical reasons. Medical factors include fetal anomalies that are incompatible with his life, serious illnesses that threaten the health or life of a woman.

The ethical side of the issue

AT modern society There are 2 categories of people - opponents and those who are neutral about abortion. Each side has its own arguments. People who are neutral about the decision to have an abortion, that is, do not condemn such women, put forward the following arguments:

• every woman has the right to decide for herself whether she wants to become a mother and take responsibility for the child;
• it is better to terminate a pregnancy than to bring an unwanted child into the world, dooming him to suffering in the future.

There are undoubtedly many more opponents of abortion in our society. They justify their position with the following theses:

• man exists from the moment of conception;
• abortion is the killing of an innocent child;
• no one can ask to give him life and no one has the right to take it away;
• the child should be given the right to life, and then transferred to a childless couple.

Types, features and timing of abortion

Abortion is a difficult decision that scares women with a high risk of complications. With information about techniques and deadlines, a woman can re-evaluate the decision and choose a method with minimal risk to her health.

To date, there are three main ways to get rid of a child. For the last 20-30 years, doctors have resorted only to surgical curettage - the most traumatic method. Modern gynecologists usually terminate pregnancies medically and with the help of vacuum aspiration.

Medical method (pharmaceutical)

This method of abortion is carried out for a period of 5-6 weeks (we recommend reading: early abortion pills: names of drugs and indications for abortion). For the safest possible pharmacological abortion, the patient must undergo all the necessary preparatory procedures, do tests and ultrasound. Medical termination of pregnancy does not mean that it is safe. Among the disadvantages of a medabort are:

• incomplete abortion. If elements of the fetal egg remain in the uterine cavity, they will have to be surgically scraped.
• A number of contraindications. Medical abortive method is not suitable for all patients. Contraindications to its implementation: pathologies of the gastrointestinal tract, neoplasms in the uterus, age up to 18 and after 35 years, taking oral contraceptives, anti-inflammatory and steroid drugs.
• Serious complications. Conducting a pharmaceutical abortion can provoke the following consequences: bleeding, pain, discomfort in the lower part of the abdominal cavity, problems with the digestive tract.

Vacuum aspiration (mini-abortion)

Vacuum aspiration is an early mini-abortion. Patients who decide to take such a step are concerned about an important question: how long can it be done? Since vacuum aspiration is an early abortion, it should not be performed later than 2 months of pregnancy.

Doctors perform an abortion under anesthesia, which does not have the usual unpleasant consequences (clouding and pain in the head, etc.). Vacuum aspiration includes several stages:

• stretching the muscles of the cervix by means of special metal dilators in the form of rods or with the help of kelp;
• the introduction of anesthesia to the patient;
• installation in the uterus of tubes connected to an apparatus that exerts negative pressure on the fetal egg;
• attachment to the tube of a pump that grinds the body of the embryo, and a syringe in order to suck the fetal egg out.

If the doctor failed to completely pull the embryo out of the uterine cavity, he additionally resorts to scraping with a rounded knife. After the operation, the patient may be disturbed by the following unpleasant symptoms associated with uterine contraction: pain, discharge, similar to menstruation. Some women in the postoperative period, the doctor additionally prescribes antibiotic therapy.

This method of abortion has many advantages, chief among which is high efficiency. The likelihood that the pregnancy will continue after a mini-abortion is reduced to almost zero. The disadvantages of this method include a high risk of infection, especially in patients with poor smears.

Surgical curettage

Surgical curettage is the most dangerous of the above methods of abortion, which was the main one in most state gynecological departments 10-20 years ago. Surgical curettage is performed by expanding the cervical canal with a special tool and scraping the fetal egg from the uterine cavity using a curette, that is, a rounded knife. The procedure is performed under general anesthesia. Its duration usually does not exceed half an hour. The next 2 days the patient should be under the supervision of medical staff.

The deadline for surgical abortion is 12 weeks. Doctors resort to curettage in case of a threat to the life of a pregnant patient or pathologies of fetal development. Since surgical curettage entails 2 times more unpleasant health consequences, gynecologists insist on other methods of abortion in the normal course of pregnancy without complications.

Contraindications

• Large uterine fibroids (many nodes or a node larger than 4 cm and deforms the uterine cavity, there is a risk of bleeding);
• Allergic reaction to drugs included in the abortion scheme;
• Suspicion of an ectopic pregnancy;
• Anemia, in which the hemoglobin level is less than 100 g / l;
• Hormonally dependent tumors;
• Hepatic, renal, adrenal insufficiency and some severe extragenital diseases (hereditary porphyria, severe bronchial asthma, glaucoma);
• Smoking over the age of 35 + long-term use of COCs and pregnancy caused by COCs (the risk of thrombosis increases, drug interruption can be used only after an additional study of the coagulating properties of the blood).

If pregnancy occurs against the background of an intrauterine device, the IUD should first be removed, and then it is also possible to apply medical termination of pregnancy.

When using a drug regimen, you can not breastfeed, so this method of abortion is not suitable for a nursing mother.

Vacuum aspiration is an alternative to medical abortion.

Pills for abortion in the early stages: action

1. Taking pills is carried out under medical supervision in case side effect or a strong reaction of the body to a similar miscarriage. The pill is drunk on an empty stomach, then the effect of a complete interruption is guaranteed. Otherwise, it is possible to save a pathological pregnancy.
2. The onset of action of the drug is characterized by the opening of bleeding. It may be thick spotting, which is similar to menstruation. And a variant of abundant blood loss is possible, in which a medical presence and intervention is necessary.
3. If after a while the bleeding does not start, then the doctor prescribes the intake of prostaglandins. These substances tone the uterus and stimulate its contractile action. As a result, the fetus dies.

Taking pills on your own is bad for a woman's health, there is a risk of emergency hospitalization. Often, an adverse reaction of medical abortion is the opening of uterine bleeding, nausea, severe vomiting, a sharp deterioration in well-being.

The recovery of the female body after an abortion takes about 30 days, and the menstrual cycle can return to normal by the 50th day after the termination of pregnancy. After an abortion, a woman may experience abdominal pain, headache, fever, vaginal discharge with blood. With such symptoms, you need to urgently consult a doctor.

For the recovery period, a woman should refrain from drinking alcohol, intense training, going to the bathhouse, solarium and sauna, sexual intercourse, and protect the body from prolonged exposure to a cold room. For bloody discharge, only sanitary pads can be used.

Medical abortion (6 to 12 weeks or 13 to 24 weeks after last period).

This surgical abortion is performed during the second trimester of pregnancy. Up to 12 weeks, you can have a routine or surgical abortion. It feels like it will be the same as a mini-abortion, but instead of a tube, a special instrument is inserted into the uterus, with which the fetal egg is removed. Here, the same rule applies very clearly - the longer the period, the more difficult the operation, the more complications there may be.

Because the developing child doubles in size between the 11th and 12th weeks of pregnancy, his body is too large to be crushed by suction and pass through the tube. In this case, the cervix should be opened wider than in the 1st trimester abortion. Therefore, kelp is introduced a day or two before the abortion itself. After the cervix is ​​opened, the doctor removes parts of the baby's body with forceps. In order to easily remove the skull of a child, it is first ground with tongs.

Only these three methods of abortion are permissible and are not considered “criminal abortion” in our country, with the exception of abortion according to the indications of a doctor at a later date.

How is a medical abortion performed?

A pregnant woman takes abortive pills once in the presence of a doctor. The dose to be drunk at a time is 600 mg. mifepristone (3 tablets of 200 mg.). After that, the patient is under the supervision of medical personnel for 2 hours, then she is allowed to go home.

Mifepristone provokes fetal death, stimulates the growth of the endometrium and restores its sensitivity to oxytocin (a hormone that promotes contractile activity of the uterus). 36 to 48 hours after taking the abortion pills, the woman takes oral misoprostol 600 micrograms (a prostaglandin). The uterus begins to contract vigorously and the fetus is pushed out of the uterine cavity.

1-2 weeks after a medical abortion, a woman should come for an examination to a gynecologist and do a control ultrasound so that the doctor can make sure that the fetal egg is completely out of the uterus.

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.

Pain in the lower abdomen is observed during the expulsion of the products of abortion. Its intensity can be different, but the individual tolerance threshold also matters. To reduce the pain syndrome, Analgin, Drotaverin are used. The World Health Organization (WHO) recommends Ibuprofen for pain relief. If the chest hurts after an abortion, this may be the result high level progesterone, which rises 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 indicated in order to stop it. AT severe cases surgical cleaning.

In 2-5% of cases, the abortion is incomplete. Then it is also necessary to perform vacuum aspiration or curettage of the uterine cavity. Less than 1% of cases end with progression of pregnancy. If a woman insists on an abortion, then invasive methods are used. Those who have 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 drugs can cause a slight increase in temperature, but it lasts no more than 2 hours. If the fever lasts 4 or more hours or occurs a 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 typical for pharmacological abortion. But there is a group of people who have an increased risk of infectious complications:

• bacterial vaginosis, established by smear;
• patients with a sexually transmitted infection up to 12 months ago, but there is no laboratory confirmation of its cure;
• patients diagnosed with chlamydia;
• women with many sexual partners or low socioeconomic status.

Other complications in the form of dyspeptic symptoms may be a sign of pregnancy itself. Allergic reactions require treatment with antihistamines.

What needs to be done for medical abortion?

1. If there is a delay and pregnancy is suspected, contact a gynecologist. The doctor can independently adjust the time period: until what time is a medical termination of pregnancy due to the individual characteristics of the body.
2. If a woman wants to terminate the pregnancy with medication, then she is prescribed a complete examination. This will allow you to accurately select the medication, as well as determine its effect on the body, avoid contraindications and side effects.
3. A woman undergoes an ultrasound examination of the pelvic organs, a fetal egg is observed.
4. Gynecological examination and taking smears on the flora in the vagina.
5. Testing for genital infections.
6. Blood tests for the detection of viruses, infections, HIV and others.
7. Determination of blood group and Rh.
8. With good performance, a woman can sign all the relevant documents and receive the necessary pills, as prescribed by a doctor, that terminate a pregnancy in the early stages.

Medical termination of pregnancy: the terms of this procedure are quite short, and therefore all the necessary tests must be done over a small number of days.

Names of abortion pills and where to buy them?

The names of abortion pills are different: Mifolian (China), Mifeprex (Russia), Mifegin (France), Pencrofton (Russia), but the active ingredient in all pills is the same - mifepristone.

A pregnant woman does not need to know the name of the abortion pills, since they cannot be bought over the counter. They are not sold in pharmacies even with prescriptions. You can get these medications only from a gynecologist, after an examination (examination and ultrasound) and they are taken by a woman in his presence.

Execution Method

When visiting the obstetrician-gynecologist again, the patient signs a consent to perform an artificial abortion using pharmacological preparations. How medical abortion works 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. Within 1-2 hours, a doctor's supervision is necessary, after which you can go home.

If the period is 49 days, on the next visit after 24-48 hours, take 200 micrograms of misoprostol. 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 in the vagina. With the last method of administration, it is necessary to lie down for 30 minutes. The patient should be observed for 3-4 hours. During this period, most begin to bleed. If this does not happen, the Misoprostol 400 mcg tablet is repeated to achieve the result.

Signs of abortion are identical to spontaneous miscarriage. A woman feels a cramping pain in her stomach, menstrual-like discharge appears.

How long does the bleeding last?

In most women, it is expressed and lasts 7-9 days. Blood 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 period, the release of blood increases, sometimes the use of hemostatic therapy may be required.

After 14 days, you need to come for a follow-up examination. This is necessary to confirm the completed interruption. If there was an unsuccessful medical abortion, then aspiration from the uterus is prescribed.

Think what a sin you are committing by agreeing to an abortion!

Mini-abortion or Vacuum abortion (for up to 5-7 weeks, i.e. within 6-14 weeks after the last menstruation)

Mini abortion - vacuum aspiration, termination of pregnancy at an early stage. This surgical abortion is performed at an early stage of pregnancy (termination of pregnancy before 5-7 weeks).

The operation is done under anesthesia. In medical centers, anesthesia is used, which does not leave consequences in the form of a prolonged headache, nausea, etc. That is, for you it will look like this: lay down on a chair, put a catheter in a vein, fell asleep, woke up not pregnant anymore. During the operation to terminate the pregnancy, the doctor inserts a special tube connected to the device into the uterus. After turning on the device, a negative pressure is created in the tube, due to which the fetal egg is removed from the uterus.

Before the operation, the muscles of the cervix are stretched with metal dilators until the opening is wide enough to allow the abortion instruments to pass into the uterus. The doctor attaches a special syringe to the tube (it is inserted into the uterus) and the intrauterine child is sucked out.

In fact, during a vacuum abortion, the doctor opens the cervix with metal dilators or kelp (thin sticks that are inserted hours before the procedure itself); inserts a tube into the uterus and attaches it to the pump. The pump grinds the baby's body into pieces and sucks them out of the uterus. If the fetus could not be completely removed, a subsequent curettage is performed. In this case, the doctor may use a curette (rounded knife) to scrape parts of the baby's body out of the uterus.

Immediately after the abortion, there may be slight pain in the lower abdomen associated with uterine contractions, then for several days you will have a small discharge similar to menstruation. Sometimes a doctor prescribes antibiotics after an abortion. Physical inconvenience is minimal, but in this case much depends on the skill of the doctor. So choose a doctor you trust. This method is more reliable in terms of the chances that the pregnancy will definitely terminate. Cases where pregnancy continued to develop after a mini-abortion are extremely rare. Ultrasound is used to increase reliability during abortion. But, since there is interference, there is also the possibility of injury. If the smear before the abortion was bad, and the treatment was not carried out or was insufficient, infection is possible.

Despite the fact that a mini-abortion is performed earlier than an ordinary abortion, a mini-abortion is a means of killing a conceived child - a human life.

The physical, moral and emotional consequences of a mini-abortion are no less complex and dangerous than the complications of a surgical abortion. From the very moment of conception, there is a living, little man inside you, with its own individual set of DNA. With an already defined eye color, hair color and gender of your child. Don't be fooled by the words that you have a bunch of cells inside you. It is not true.

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 dated 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 term is 49 days, or 7 weeks of pregnancy.

Why is such a period defined for pharmacological interruption?

At the 5th week of pregnancy, the embryo begins to acquire human features, the rudiments of many organs, the umbilical cord, appear. At week 6, the placenta begins to form, the internal organs continue to develop. At week 8, the embryo is already quite human in appearance, it passes into the fetal stage. After this period, the formation of placental vessels occurs, so medical abortion can cause heavy bleeding.

In Russia, the following drugs for medical abortion are registered and used:

1. Mifepristone 200 mg.
2. Misoprostol 200 mcg.

Pharmacological abortion during a missed pregnancy can be used if the gestational age corresponds to 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 medical method is preferable to other methods.

Preparation for the procedure

At the first visit to the gynecologist, you need to conduct a general examination, a bimanual examination on the chair and in the mirrors, swabs are taken from the vagina. Also measured arterial pressure, pulse, respiratory rate. Next, the woman is sent for an ultrasound scan to determine the exact day of gestation, the condition of the uterus, the fetal egg.

Referrals for blood, urine, glucose, ECG tests are given. A coagulogram is prescribed if there was a history of problems with the blood coagulation system. May be needed additional methods examinations, the need for which is determined by the doctor.

Benefits of Medical Abortion

Termination of pregnancy with abortion pills is a relatively safe method, since there is no surgical intervention in the woman's body. Therefore, medical abortion has advantages over other abortion methods:

• no need to apply anesthesia;
• the cervix and uterine mucosa are not injured;
• there is no risk of infection of the genital organs;
• accompanied by moderate pain syndrome;
• the likelihood of infertility due to abortion is minimized.

Abortive pills are the best method of terminating pregnancy in nulliparous women, since in the future they do not affect the reproductive function of the genital organs, and a month after the procedure, the menstrual cycle is restored.

Medical abortion does not require special preparation, a gynecologist's examination and an ultrasound examination (ultrasound) are sufficient. The effectiveness of abortive pills for up to 6 weeks is 95 - 98%.

How is a medical abortion performed?

The medical abortion procedure includes four visits to the gynecologist.

The abortion itself occurs in two stages: the first dose of the drug and after a day or two - the second dose. Bleeding occurs in the second stage and begins within 3-4 hours after taking the pill.

After two weeks, a follow-up appointment with a gynecologist is required.

Gynecologist visits:

• 1 visit: consultation and referral for tests;
• 2nd visit: taking the drug;
• 3rd visit, after 1-2 days: repeated administration of the drug;
• 4 visit, not earlier than in 14 days: control

Standard pre-abortion tests

• general analysis of blood and urine,
• blood group and rhesus,
• smears for purity and oncocytology,
• HIV testing,
• hepatitis B and C and syphilis.

First gynecological appointment

At the first appointment with a gynecologist regarding an unwanted pregnancy, a woman receives advice on available methods of interruption, receives referrals for examination and psychological counseling.

Before the start of the procedure, an ultrasound examination is mandatory, which serves as the basis for the appointment of an abortion and a method for excluding ectopic pregnancy.

If an ectopic pregnancy is suspected, the patient is prescribed a blood test for hCG twice with an interval of several days (the growth of the pregnancy hormone in a few days differs in the normal course of pregnancy and in an ectopic or missed pregnancy).

If the examination revealed an inflammatory type of smear or bacvaginosis, then medical abortion is carried out in the usual way with the simultaneous administration of antibacterial drugs as prescribed by the doctor.

Abortion requires the appointment of antibacterial drugs:

• In patients without risk factors for infection, examined for the presence of chlamydia: for the prevention of inflammatory complications, once a day of the procedure.
• In patients with identified chlamydial or other infection, as well as in the presence of risk factors for the addition of inflammatory complications (with bactaginosis earlier in the smear): a course for 7-10 days.

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Second reception

The patient comes to the second appointment with the gynecologist with decision about the abortion and signs an informed consent for medical interruption.

The patient is given 1 dose of drugs: first, the drug mifepristone, which has an antiprogesterone effect, is used. Progesterone is a pregnancy hormone, and when it is blocked by the drug, a signal to interrupt and prepare the cervix for a miscarriage occurs.

Against the background of the use of 1 tablet for 1 day, there are no special changes in the woman's well-being. There may be a slight pulling pain in the lower abdomen, scant blood smearing, and sometimes nausea.

Important! In an Rh-negative mother and an Rh-positive partner, an injection of a dose of anti-Rh immunoglobulin is also recommended to prevent Rh incompatibility with the child in the next desired pregnancy.

Third visit to the gynecologist

At the third appointment with the gynecologist, after 24-48 hours, the patient is allowed to take the second part of the pills, which directly cause uterine contractions and miscarriage through the prepared dilated cervix. At different times, the doses of drugs and the method of administration differ (tablets can be prescribed to drink inside, put under the tongue, enter vaginally).

In 95% of patients, spotting begins within three to four hours after taking the drugs.

Almost always, women have symptoms that the doctor warns about in advance:

Cramping pains in the lower abdomen, which each woman suffers differently, depending on the pain threshold. For the purpose of pain relief, the patient can take a tablet of no-shpa, baralgin or ibuprofen. A miscarriage will occur after a few hours from the start of contractions.

Abundant bleeding during miscarriage (larger and stronger than normal menstruation). True bleeding is rare, in 0.2-1% of cases. A woman should be alerted by such a volume of blood loss, at which two sanitary pads of the maximum size are completely saturated with blood within an hour, and this is repeated during the second hour. In this case, the patient must call an ambulance, which will take her to the gynecological hospital. In the hospital with the development of bleeding, vacuum aspiration of the uterine cavity is performed.

An increase in temperature to 38.5 (common, is a common side reaction to the interruption tablet). You should go to the hospital if the temperature rise lasts more than 4 hours, with chills.

Diarrhea (observed in more than half of cases, is also side effect drugs).

Usually bleeding stops completely after 7-9 days. The longer the gestation period, the more abundant the bleeding. In some cases, brown spotting remains until the next menstruation, which can be considered the norm.

Fourth reception

4 reception at the gynecologist - control. The patient is examined on a gynecological chair, a control ultrasound of the pelvic organs is evaluated. Ultrasound is recommended to be performed 2 weeks after the miscarriage. By this time, the cavity and size of the uterus are reduced. Within 2 weeks after the abortion, the patient can take herbal preparations for uterine contraction: uterine collection, water pepper infusion.

Late term abortion

After 12 weeks, optional abortions are prohibited in our country. They do it only for medical and social reasons: a court decision to restrict parental rights, pregnancy as a result of rape; the death of a husband during a woman's pregnancy. They terminate the pregnancy in the later stages, either artificially inducing childbirth, or making a small caesarean section. That is, there will be childbirth, but there will be no child. So, you understand, it is better not to bring it to this.

This medical abortion is performed:

From 20 weeks after the last menstrual cycle. The procedure for terminating a pregnancy in the later stages takes 3 days. During the first two days, the cervix is ​​dilated and the woman is given anti-spasmodic drugs. On the third day, the woman takes a medication that induces childbirth. After labor has begun, the doctor will do an ultrasound to locate the baby's legs. Grasping the legs with forceps, the doctor pulls the child out, leaving only the head inside. In this case, parts of the child's body can come off the body itself and stretch through the vaginal canal. The rest of the body is pinched and pulled outward. The baby's head is pinched and crushed in order to pass through the vaginal canal. The placenta and the remaining parts are sucked out of the uterus.

Previously, salt abortion or salt pouring was used, but this method turned out to be insufficiently effective, as well as Homeopathy (efficiency no more than 20%), Acupuncture (up to 40% effect with a slight delay and depends on the qualifications of the specialist), Magnetic induction (“magnetic cap” with in the absence of contraindications, it is effective in 50% of cases with a delay of no more than 3-5 days)

Possible consequences

• uterine bleeding, requiring instrumental emptying of the uterus in a hospital (vacuum aspiration of the uterine cavity) and the use of means that reduce the uterus;
• incomplete abortion (the remains of the fetal egg are also removed using vacuum aspiration of the uterine cavity in a hospital);
• infectious complications (the risk of their development is less than 1% of cases);
• progression of pregnancy in a situation where there was no rejection of the fetal egg.

With the ineffectiveness of medical abortion and the progression of pregnancy, the patient is offered to terminate the pregnancy by vacuum aspiration.

There are no large studies on the teratogenic effects of drugs for medical abortion on the fetus, but 14 cases of fetal malformations after the use of this regimen are known. If the patient suddenly changes her mind and decides to carry a progressive pregnancy, she should be warned about these known cases.

Contraindications to the use of abortion pills

In the instructions for Misoprostol and Mifepristone, registered in the Russian Federation, their use for medical termination of pregnancy on an outpatient basis indicates a time limit for use of 42 days without menstruation.

In this regard, the period of 63 days of absence of menstruation is accepted as a normative one. Preparations for terminating pregnancy in the later stages can be used only in the conditions of a stationary gynecological department with the possibility of providing medical care in the required amount.

Absolute contraindications are:

1. Individual intolerance to one of the drugs or their auxiliary components.
2. The possibility of an ectopic pregnancy.
3. Long-term use of glucocorticoid drugs due to certain comorbidities, and/or chronic adrenal insufficiency.
4. Chronic renal or hepatic insufficiency.
5. Violation of pigment metabolism, accompanied by increased level in the blood of porphyrins (hereditary porphyria).
6. Severe concomitant extragenital pathology, as well as the presence of glaucoma, arterial hypertension, chronic obstructive pulmonary disease, severe bronchial asthma.
7. Hormone-dependent tumor formations, as well as impaired functioning of the endocrine glands, including diabetes mellitus.
8. Exhaustion.

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Relative contraindications:

1. Absence of menstruation (with confirmed pregnancy) for more than 63 days. The need for misoprostol and mifepristone in longer pregnancy requires hospitalization in the gynecological department.
2. The presence of uterine fibroids of significant size, which is a risk factor for bleeding. The use of drugs is possible with the size of the dominant myomatous node up to 4 cm and the absence of deformation of the uterine cavity by myomatous nodes.
3. The initial content of hemoglobin in the blood is less than 100 g / l, which increases the risk of even more pronounced anemia due to possible blood loss.
4. Blood clotting disorders, including taking anticoagulants and non-steroidal anti-inflammatory drugs, which dramatically increases the risk of blood loss.
5. Acute inflammatory processes of the female genital area (despite the fact that medical abortion does not increase the risk of developing an ascending infection, however, the simultaneous use of antibacterial agents is desirable).
6. Smoking women over 35 years of age, as they are at risk for cardiovascular disease. Prior to the appointment of the above drugs, it is necessary to conduct an examination by a therapist.
7. Period breastfeeding. It must be canceled for 7 days from the day you took mifepristone and 5 days from the day you took misoprostol.
8. The development of pregnancy against the background of the use of an intrauterine contraceptive. The IUD must be removed before taking mifepristone and misoprostol.
9. Long-term use of oral hormonal contraceptives, which increase the risk of bleeding disorders. Although this contraindication is relative, nevertheless, a preliminary study of the coagulogram is necessary.

The implementation of an abortion in the early stages using these drugs is characterized by longer bleeding and, often, a longer pain syndrome, compared with surgical abortion.

It is practically impossible to buy pills for medical termination of pregnancy in pharmacies, especially without a prescription. They should be used only under the supervision of a gynecologist, and are issued mainly to specialized private medical institutions or gynecological inpatient departments that have official permission to perform abortions and have the ability to carry out not only infusion and transfusion therapy, but also provide emergency gynecological and surgical care or , in extreme cases, the emergency delivery of a woman to the appropriate medical institutions.

There are a number of contraindications for medical interruption. The absolute ones, when it is forbidden to do the procedure, include the following:

• ectopic course of pregnancy;
• gestational age more than 9 obstetric weeks;
• the presence of scars on the uterus;
• allergic reactions to the drugs used;
• the presence of neoplasms and inflammatory processes in the organs of the reproductive system;
• severe diseases of the heart and blood vessels, kidneys, liver.

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There are also relative contraindications to pharmabort, in the presence of which the patient may be refused the procedure (the issue is decided by the doctor):

• age less than 18 and more than 35 years;
• violation of the menstrual cycle;
• poor blood test (low hemoglobin, clotting problems);
• smoking within the last five years;
• epilepsy;
• long-term use of drugs with antithrombotic action.

One of the main causes of many gynecological diseases and infertility is abortion. Particularly high risk of complications and injuries of the genital organs are characterized by abortion, which is accompanied by instrumental dilation of the cervix, vacuum aspiration and, especially, curettage.

Termination of pregnancy with pills in the early stages of gestation avoids mechanical trauma to the cervix and uterine body, significantly reduces the risk of bleeding and acute and chronic inflammatory processes, which often complicate surgical abortions.

Abortive pills, like any drug, have contraindications for use:

• suspected ectopic pregnancy;
• pregnancy for more than 6 weeks;
• pregnancy not confirmed by clinical studies;
• pregnancy that occurred in the presence of an intrauterine device or after the termination of hormonal contraception;
• inflammatory diseases of the genital organs;
• the presence of a scar on the uterus after the operation;
• uterine fibroids;
• anemia;
• blood clotting disorder;
• inflammatory diseases of the gastrointestinal tract;

Advantages of vacuum abortion For decades, the only way to get rid of the unborn child was curettage,

Indications for abortion If a woman cannot or does not want to keep a child. She has

Medical abortion seems to be such a simple procedure that it is completely incomprehensible what a doctor is needed for. Can't you just buy pills and take them according to the instructions? Why is it necessary to go to the clinic, take tests? This is a fairly common question that needs to be answered seriously.

A bit of history

Researchers have long dreamed of creating the perfect product for safely terminating a pregnancy. After all, women often died from abortions - curettage of the uterus with an acute curette is dangerous with many risks: perforation of the uterus with an intestinal injury or Bladder, bleeding, purulent-septic complications.

The concept of the “pregnancy pill” was wonderful: a doctor writes a prescription, a patient buys a medicine at a pharmacy and calmly terminates an unwanted pregnancy at home, without being subjected to any intervention.

In the 1970s, a large-scale research program was launched in France, dedicated to the study of hormonal and antihormonal drugs. Already in 1980, mifepristone was synthesized, which worked as an antiprogesterone that terminated pregnancy.

How it works?

Mifepristone blocks the action of progesterone at the receptor level. Deprived of a beneficial effect, the endometrium ceases to feel pregnant and is rejected along with the fetal egg.

After the invention of mifepristone, they thought more and added new drug using prostaglandins (misoprostol). Prostaglandins help soften the cervix and stimulate contractions that facilitate the expulsion of the fetal egg.

In 1988, the method was approved by the WHO, and France became the first country to obtain a license for the use of mifepristone in combination with prostaglandin for abortion in early pregnancy. The method came to Russia in 1999, the US FDA allowed medical abortions in 2000.

It would seem that the dream of a safe abortion has come true? But, alas, life shattered these fantasies.

The pill also kills

The first case occurred in France in April 1991. A woman died as a result of a medical abortion. As it turned out, she had contraindications to the use of the drug: smoking, high blood pressure and heart disease. But the drug turned out to be dangerous for those who, at first glance, had no contraindications.

In September 2001, a Canadian woman died of septic shock 8 days after taking mifepristone. The reason was infection of the uterus, most likely due to the remaining parts of the embryo in it. Another woman suffered a severe heart attack but survived.

septic shock caused by Clostridium sordellii, turned out to be an infrequent, but almost 100% fatal complication of medical abortion. The disease develops almost at lightning speed and has an erased course. By 2013, US regulators (FDA) collected information on 15 such cases.

On September 12, 2001, a 38-year-old US woman died 5 days after taking mifepristone. In the clinic where the medical abortion was performed, they did not see a fetal egg on a preliminary ultrasound, but decided that it was not scary, because the gestational age was still small.

At home, the patient developed severe abdominal pain and bleeding. The woman called the clinic several times, where she was assured that everything was “okay, that’s how it should be.” When the patient was brought to the clinic and operated on, it turned out that the pregnancy was ectopic. The rupture of the tube caused profuse intra-abdominal bleeding and peritonitis.

Ectopic pregnancy is a contraindication for medical abortion. In ultra-small terms of pregnancy, the doctor should be patient and wait for the opportunity to see the fetal egg in the uterine cavity. A couple of years ago, a case was analyzed in our country when a patient had a combination of uterine and ectopic pregnancy. A medical abortion almost killed a woman. Only close medical supervision and timely assistance saved the patient.

In 2003, 18-year-old Holy Patterson died after taking mifepristone in the United States. Death was due to an incomplete abortion. Fragments of the embryo, lingering in the uterine cavity, led to septic shock and the death of a young woman. That same year, 16-year-old Rebecca Tell Berg from Sweden died of a hemorrhage.

8 days after a medical abortion, carried out in a specialized clinic and strictly according to the instructions, her body was found in the shower. The investigators concluded that the doctors acted correctly, but the patient did not seek help in a timely manner.

In 2004, the FDA reported 17 life-threatening situations associated with medical abortion. In 8% of cases, bleeding lasted about 1 month, in 72 cases a blood transfusion was required. Seven patients developed life-threatening sepsis. Fortunately, then everyone was saved.

That is why in most countries of the world, including Russia, the United States and the European Union, medical abortion is performed only by doctors. Not nurses, not physician assistants, not midwives. Only highly qualified specialists.

Why do you need a doctor

The doctor must accurately assess the duration of pregnancy, reliably exclude ectopic pregnancy, provide emergency surgical intervention in case of heavy bleeding or incomplete abortion, be able to hospitalize the patient in a specialized hospital, where they can perform abdominal surgery or blood transfusion.

The doctor performing the medical interruption procedure should thoroughly advise the patient on the sequence of actions, possible unwanted effects, and make sure that the woman understands everything. Of course, several kilograms of informed consents are signed during the consultation process. The patient must read all papers in the presence of a doctor.

The physician should examine the patient's initial health status, take into account contraindications and conditions requiring caution, ascertain the risk of drug interactions, and select a drug interruption scheme that best suits the situation. Finally, the physician must discuss with the patient possible methods contraception so that you can start using contraception as soon as possible and never again have an unwanted pregnancy.

In our country, pills for medical abortion cannot be bought in a pharmacy even with a doctor's prescription. These drugs are only available to hospitals.

"Mifepristone" is intended only for use in medical facilities, its sale in pharmacies is strictly prohibited.

Moreover, since December 2017, the licensing of clinics that conduct abortions has been tightened. All this is done in order to minimize the risks of surgical and non-surgical termination of an unwanted pregnancy.

Oksana Bogdashevskaya

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