Medical abortion - artificial termination of pregnancy

In Ukraine, abortions are not prohibited. The possibility of termination of pregnancy is defined in the Civil Code of Ukraine (Article 281) and in the Law of Ukraine "Fundamentals of Ukrainian legislation on health" (Article 50). Artificial termination of pregnancy, which does not exceed 12 weeks, can be carried out at the request of a woman. From 12 to 22 weeks. Pregnancy, medical abortion can be carried out only if there are indications established by law (Decree of Cabinet of Ministers No. 144 of 15.02.06 g).

For patients who undergo an abortion surgery, pre-abortion and noselaabortnoe consultation on the specific features of a specific method of medical abortion and possible consequences.

Counseling is carried out on a voluntary basis. The issue is especially acute for HIV-infected women. For this population, information is provided on the available options for preventing mother-to-child transmission of HIV, as well as the possible specific risk of infection of the fetus and the newborn.

The following information is provided in consultation with the medical abortion procedure:

• what actions will be performed during the interruption of pregnancy;
• what inconveniences may arise during and after abortion;
• what anesthetics and methods can be used before the termination of pregnancy (it must be remembered that frequent use of pain medication reduces the effectiveness of anesthesia during medical abortion);
• what risk of complications may occur with this method of medical abortion;
• through what period of time a woman can return to her habitual way of life and resume sexual relations;
• necessity and frequency of postabortion monitoring in order to reduce the risk of complications;
• contraceptives that a woman can use after an abortion.

[1], [2], [3], [4], [5]

Methods of medical abortion

1. The method of using mifepristone, misoprostol and prepidia

A patient in the presence of a doctor takes 200 mg (1 tablet) of mifepristone orally. 22-26 hours after receiving mifepristone, the doctor injects 3 g of gel, which contains dinoprostone (0.5 mg), to an endocervical pregnant woman.

After the next 22-26 hours the patient takes 800 μg (4 tablets) in the presence of a doctor: 2 tablets - orally and 2 - intravaginally.

2. In the case of a stagnant pregnancy in the late term, only misoprostol should be used - 2 tablets orally, 2 tablets intravaginally. 3.
3. The technique of intraamnial administration of dinoprost. By transabdominal amniocentesis (puncture of the bladder) remove at least 1 ml of amniotic fluid. In this case, it is necessary to check the absence of impurity of blood in the amniotic fluid (there should be no color).

After this, 40 mg (8 ml) of a sterile solution of dinoprost are injected very slowly into the bladder. The first 5 mg (1 ml) is administered within 5 minutes, the rest dose in the next 5-10 minutes.

In case of strict observance of the noted technique, the probability of occurrence of anaphylaxis, arterial hypertension, bronchospasm, and vomiting decreases. 4.

4. The method of intracervical injection of a gel with dinoprostom followed by induction of uterine contractile activity by intravenous administration of a solution of dinoprostone.

To prepare the cervix, every 3 hours of endocervical treatment, 3 g of gel are injected, which contains dinoprost (0.5 mg), before the opening of the cervical canal by Geghar No. 12 dilator.

Induction of contractile activity of the uterus is carried out by intravenous drip injection of 0.75 mg of dinoprost in the form of a sterile solution (0.75 mg in 500 ml of isotonic sodium chloride solution). The bottle with the solution is shaken off to ensure uniformity. The initial infusion rate, which is maintained for the first 30 minutes, is 0.25 μg / min, after which the rate of administration is either the same or increased to 50 μg / min in each individual case (6-8 to 35-40 drops , / min). The average infusion rate is from 20 to 25 cap / min, the infusion time is about 3.5-4 hours. 5.

5. The technique of intraamnial administration of hypertonic solution. Amniocentesis is performed by transabdominal, transvaginal or transcervical access. The location of the puncture is determined depending on the location of the placenta and the height of the standing part of the fetus, which is specified by ultrasound.

Anesthesia is performed by a local method. The skin of the anterior abdominal wall is treated with 5% alcohol solution of iodine or another antiseptic. After infiltration anesthesia (10.0 ml of 0.25-0.5% solution of novocaine), a puncture of the anterior abdominal wall or vaginal vault, the wall of the uterus and membranes with a thick needle 10-12 cm in length is made.

The amniotic fluid is evacuated (150-250 ml depending on the gestation period), then a 20% solution of sodium chloride is slowly introduced into the amnion cavity in an amount of 30-50 ml less volume of the distal amniotic fluid. The latent period from the instillation of the solution to the appearance of fights ranges from 17 to 21 hours. Spontaneous abortion occurs, usually after 24-26 hours.

In order to facilitate the process of expanding the cervical canal against the background of the application of all the above methods, it is possible to use sticks of laminaria in the amount of 6 to 20.

After the expulsion of the fetal egg, the curettage of the walls of the uterine cavity is necessary.

After the artificial termination of pregnancy in the period from 12 to 22 weeks. In the case of the establishment of congenital defects of fetal development, incompatible with life, the autopsy of the fetus is mandatory. The result of pathoanatomical research is stitched in the "Medical chart of the inpatient patient" and records the extract in the epicrisis.

Methods of medical medical abortion

Medical abortion can be conducted in an accredited health care institution of any form of property and departmental subordination, in which emergency medical care is possible.

Medical abortion is carried out exclusively in the conditions of a gynecological or day hospital by an obstetrician-gynecologist.

Drug induced abortion is performed at the request of a woman in pregnancy until 49 days from the first day of the last menstruation.

Medical abortion is performed in the absence of medical contraindications.

Contraindications to medical abortion:

• lack of reliable data on the presence of pregnancy;
• suspicion of ectopic pregnancy;
• the gestation period is more than 49 days from the first day of the last menstruation;
• allergy, hypersensitivity to mifepristone or misoprostol;
• adrenal insufficiency;
• long-term glucocorticoid therapy;
• defeat of coronary or cerebral vessels;
• kidney failure;
• severe liver damage and liver failure;
• porphyry;
• a violation of the hemostatic system (including the previous treatment with anticoagulants);
• uterine leiomyoma;
• scars on the uterus;
• breastfeeding of a child;
• the age of a woman over 35 years;
• active tobacco smoking (more than 10 cigarettes a day);
• severe form of bronchial asthma;
• cardiovascular diseases.

Medical abortion: use of mifepristone and misoprostol

A patient in the presence of a doctor takes 200 mg (1 tablet) of mifepristone.

After 36-48 hours after taking mifepristone, the pregnant woman in the presence of the doctor takes 2 tablets (400 mcg) or 800 mcg of misoprostol intravaginally and is hospitalized all day before the termination of pregnancy, which usually occurs within 3-6 hours.

On the 7th-10th day, the obstetrician-gynecologist inspects the patient and records in the form No. 025 / o "Medical card of an outpatient patient", approved by order M3 of Ukraine No. 302 of 27.12.99.

Mandatory ultrasound is performed to confirm the absence of a fetal egg in the uterine cavity.

In the case of incomplete removal of the fetal egg, clotting, diagnostic scraping of the uterine cavity is carried out followed by the direction of the material obtained for histological examination.

Medical abortion by vacuum aspiration method

Vacuum aspiration is the safest surgical method of abortion. The method of vacuum aspiration is used instead of the method of curettage of the uterine cavity - the traumatic and the most dangerous to the health of a woman.

Medical abortion by vacuum aspiration is carried out in day clinics of women's clinics and gynecological departments of public health institutions by an obstetrician-gynecologist.

Vacuum aspiration of the uterine cavity is performed in the period of pregnancy not more than 8 weeks.

The women's consultation entrenches a gynecological hospital for the hospitalization of women with complications after the artificial termination of pregnancy and ensures their timely delivery by sanitary transport.

Medical anesthesia is performed in all cases of performing an abortion operation by a surgical method. To do this, use three types of medicines - alone or in combination: analgesics, tranquilizers, anesthetics. The question of the method of anesthetizing the operation is decided individually. 

Medical abortion under general anesthesia (anesthesia) is impractical, as this increases the clinical risk; Anesthesia is used only in difficult cases, according to the indications.

Non-narcotic analgesics - non-steroidal anti-inflammatory drugs - help to reduce pain.

When performing vacuum aspiration, the uterine cavity for anesthesia is used:

1. local anesthesia;
2. analgesia;
3. easy sedation.

Technique of manual vacuum aspiration

In the case of manual vacuum aspiration, the necessary negative pressure is created with a 60 ml plastic aspirator, which is manually activated. Most models of such reusable aspirators provided they are washed and disinfected or sterilized.

In the term of pregnancy up to 2 weeks. The vacuum aspiration operation is carried out in accordance with the rules of aseptic and antiseptic, without expansion of the cervical canal, by inserting into the uterine cavity a plastic cannula 4-6 mm in diameter for vacuum aspiration connected by a special syringe for manual vacuum aspiration.

In the term of pregnancy 6-8 weeks. Before the introduction of the cannula, dilatation of the cervix is carried out by the expander Geghar No. 8.

The method of electrovacuum aspiration of the uterine cavity

In the period of pregnancy up to 20 days of menstruation delay, the operation of electrovacuum aspiration of the uterus (EVA) is performed in accordance with the rules of aseptic and antiseptic, without enlarging the cervical canal by inserting into the uterus cavity a plastic or metal cannula 4-6 mm in diameter connected to the apparatus for aborting the pregnancy. In the term of pregnancy 6-8 weeks. Before the introduction of the cannula, dilatation of the cervix is carried out by the expander Geghar No. 8.

The EVA uses an electric vacuum pump. Aspiration is carried out at a negative pressure up to 0.8-1.0 atm.

Curettage of the uterine cavity after vacuum aspiration is not routinely performed. In the absence of confidence in the removal of the fetal egg, the aspirate is sent for histological examination.

The procedure for performing a medical abortion operation within a period of up to 12 weeks. Method of curettage of the uterine cavity

Medical abortion in the period up to 12 weeks by the method of curettage of the uterine cavity is performed in the gynecological department of an accredited health care institution by an obstetrician-gynecologist. 

Examination of the patient before the artificial termination of pregnancy in a period of up to 12 weeks using the method of curegistration of the uterine cavity is carried out in accordance with the "Norms of providing medical care to the female population in the specialty" Obstetrics and Gynecology "in outpatient clinics" approved by order M3 of Ukraine N2 503 from December 28, 2002

If necessary, the list of methods for examining the patient may increase in accordance with the medical indications found in the patient.

For each woman who entered for an artificial termination of pregnancy, the "Medical card for the termination of pregnancy" is filled (form 003-1 / 0). The consultative conclusion of the specialist and the survey data are saved in the card.

Information on the conduct of medical abortion is recorded in the "Record of surgical interventions in the hospital" (form 008/0), the form of which was approved by the order of M3 of Ukraine No. 184 of July 26, 1994. The cervix is prepared compulsorily in women under the age of 18 , in primitive women, if the gestation period is 10 weeks or more, in women who have abnormalities in the development of the cervix, in women with surgery and cervical intervention in the anamnesis.

Preparation of the cervix for surgical abortion can be carried out by such methods:

• vaginal administration of 400 μg of misoprostol 3-4 hours before surgery;
• peroralty reception of 400 mcg misoprostol 3-4 hours before the procedure of abortion;
• oral administration of 200 mg of mifepristone 36 hours prior to surgery.

Medical abortion is carried out with obligatory anesthesia (it is developed individually).

To reduce pain, the period of time between the administration of an analgesic medication and the performance of an operation should not exceed 2 minutes.

Dilation of the cervix is carried out by mechanical method with the help of expander Gegar or a complex of sticks of laminaria for 6-16 hours.

After dilation of the cervix with a metal curette, the uterine cavity is scraped.

The procedure and methods of performing a medical abortion operation, the term of which is from 12 to 22 weeks.

Artificial termination of pregnancy, the term of which is from 12 to 22 weeks, is performed in the gynecological department of a healthcare institution of the third level providing stationary obstetric-gynecological and neonatal care, according to order M3 of Ukraine No. 620 dated 29.12.03.

Medical abortion, the term of which is from 12 to 22 weeks, is performed by a doctor an obstetrician-gynecologist of the first or highest qualification category.

What can happen after a medical abortion?

Each woman should be informed that the next ovulation occurs after 2 weeks. After an abortion, which can lead to the next unwanted pregnancy, provided that the means of preventing it are not used.

After a medical abortion, a woman receives information regarding the prevention of unwanted pregnancies with the provision of the location of health care facilities for family planning.

The doctor is obliged to explain to the patient in an accessible form the state of her health, as well as to tell about the harmful effect of artificial termination of pregnancy on health, including the existence of a risk to life.

Medical abortion causes irreparable harm to a woman's health, reproductive health of both family members. The harmful effect on health is explained by the forced intervention in the hormonal state of a woman, and the interruption of pregnancy is an extreme stress for the hormonal and nervous systems of the body. Even the absence at first sight of tangible complications immediately after a medical abortion can cause miscarriage (spontaneous abortion and premature birth), as well as infertility, especially if the first pregnancy is interrupted.

A significant test for the body of a woman are inflammatory complications; they can arise immediately after a medical abortion and have an acute course, as well as a latent chronic course that causes hormonal dysfunction: the latter, in turn, can cause benign and malignant tumors of the reproductive organs in the future.

Surgical intervention during medical abortion is accompanied by trauma to the tissues of the cervix and the body of the uterus. Technical features of medical abortion is that it is performed without visual control, so complications occur quite often and a pregnant woman who resorts to medical abortion should know about this for the purpose of personal responsibility for the decision.

Unfortunately, after a medical abortion, long-term complications often occur, sometimes unexpected for the woman herself, with serious consequences, the treatment of which can be long-term and expensive, with a low degree of effectiveness.

Every pregnant woman should remember that medical abortion can aggravate the psychological climate in the family, as evidenced by scientific and sociological research. Even short-term complications after abortion have a negative impact on sexual relations and are associated with the disorder of the functions of the reproductive organs. And complications such as miscarriage and infertility become factors of social tension in the family and divorce.

Another serious warning for a woman who has decided to make a medical abortion is the interruption of the concept of intrauterine life, regardless of the period of pregnancy. Ukraine has ratified the World Convention on the Rights of the Child, one of the requirements of which is the right to life of the child. This must be remembered!

In exceptional cases, according to the List of grounds (hereinafter - the List), in the presence of which an artificial termination of pregnancy, the term of which is from 12 to 22 weeks, is possible. According to the Resolution of the Cabinet of Ministers of Ukraine No. 144 of 15.02.06, abortion can be carried out in the period up to 22 weeks. Pregnancy with informed consent of the patient or her legal representatives, in case of a minor and incapacitated.

In the event that pregnant circumstances of a medical nature that are not noted in the List, but in which the prolongation of pregnancy and childbirth pose a threat to her health or life (urgent conditions), the termination of pregnancy is carried out on the basis of the conclusion of the doctor's consultation.

Medical abortion in pregnancy after 12 weeks. (up to 22 weeks) in the presence of non-medical grounds noted in the List (the age of a pregnant woman under 15 and over 45 years of age, pregnancy as a result of rape or the occurrence of disability during this pregnancy) are carried out at the request of the pregnant woman or her legal representatives (in case of a minor, incapacity of the person) and the submitted documents, which confirm these circumstances.

In urgent cases, in the presence of a real threat to the life of an individual, medical assistance is provided without the consent of the natural person or parents (adoptive parents), guardian, guardian.

Parents (adoptive parents), guardian, guardian and man (with the consent of a woman) have the right to receive information about the state of health of the fetus or ward.

Medical workers and other persons do not have the right to disclose information about the state of health and the methods of treatment, except for cases provided for by law. When using information that constitutes a medical secret, in the educational process, scientific and experimental work, including in the case of its publication in the specialized literature, anonymity of the patient should be ensured.

In connection with the operation of medical abortion at the request of a woman, a disability sheet is issued for 3 days, taking into account the day of the operation. In the event of complications during the operation or in the postabortion period, the disability sheet is issued for the entire period of temporary incapacity for work.

An individual who is on inpatient treatment in a health care institution has the right to be admitted to him by other medical professionals, family members, a guardian, a trustee, a notary and a lawyer.

A woman after a medical abortion must follow the recommendations of doctors who can prevent complications in after a medical abortion. In accordance with the current legislation, the doctor is not responsible for the patient's health in the event of failure to comply with his recommendations and appointments.

On a follow-up visit, the doctor must appear 7 days or earlier if there are complaints of bleeding, pain, or fever.

After medical abortion, the timely use of contraceptive methods is of great importance in preventing unwanted pregnancies. Today in Ukraine there is a network of centers, offices, family planning points, the main task of which is to enable the spouses to give birth to the coveted children, adhering to the interval between births with the least harm to health.

Visiting family planning clinics or receiving advice on these issues should be indicative of a general culture of the population.

Every woman should require sufficient attention to herself when appointing a contraceptive specialist on the basis of an individual approach.

After providing information on all existing methods and means of preventing pregnancy, the doctor must prescribe a contraceptive in accordance with the woman's desire, the age and health of her and the man (partner), their reproductive plans, and their material capacities. This approach increases its effectiveness

The modern range of methods and means of contraception makes it possible for every woman or spouse to use the most optimal of them and not to violate the rights of the unborn child.