Medication abortion

Medical abortion, or pharmacological abortion, is a method of artificial termination of pregnancy in the early stages. Medical termination of pregnancy is based on the pharmacological effects of special drugs and does not require surgical intervention. Compared to surgical techniques (curettage) or vacuum aspiration, medical abortion causes fewer complications, but, like any medical manipulation, it is not completely devoid of them. Medical abortion should be carried out only under the supervision of a doctor after appropriate informational and psychological preparation.

When deciding to terminate a pregnancy, a woman goes to a medical institution, where a certain procedure must be followed. The medical abortion procedure requires some preparation, including filling out medical documentation. It is important for a woman to know how the interaction between a doctor and a patient is regulated during pharmacological abortion.

According to Article 56 of Federal Law No. 323 “On the Fundamentals of Citizens’ Health”, any woman has the right to independently decide whether to become a mother or not ^[1].

It can terminate an unwanted pregnancy. Before performing an abortion, a medical professional should inform the patient in detail about the method of the procedure and all the potential risks associated with it. Before the procedure, a woman signs an official document on her voluntary consent to an artificial termination of pregnancy.

All abortion procedures, even if it is not a surgical intervention, should be carried out only in medical institutions that have the appropriate license to provide this medical service.

Gynecologists, obstetrician-gynecologists and gynecological surgeons with a higher medical education have the right to terminate a pregnancy. The organization of medical care in case of termination of pregnancy is carried out in accordance with order 572n of 2012 “On approval of the Procedure for the provision of medical care in the field of obstetrics and gynecology” ^[2].

People who carry out such manipulations without a specialized medical education will be criminally liable for this in accordance with Art. 123 of the Criminal Code of the Russian Federation, and abortion procedures performed outside a medical institution are classified as criminal abortions ^[3].

When can this procedure be done?

In Russia, medical abortion can be performed up to 63 days from the first day of the last menstruation (up to 9 weeks) if a uterine pregnancy is detected.

Mechanisms of action of drugs used for medical abortion

For medical abortion, two drugs with different mechanisms of action are used. The first remedy is a synthetic steroid hormone that blocks the action of progesterone at the level of receptors located in the endometrium and myometrium. By binding to receptors, the drug blocks the action of progesterone, which stimulates the growth of the endometrium (the inner layer of the uterus, where the fetal egg is attached). In this case, the rejection of the decidua (the functional layer of the endometrium changed during pregnancy) occurs and the contractility of the myometrium increases. Clinically, this is manifested by menstrual-like discharge and spastic pain in the abdomen. 36-48 hours after taking the first drug, the woman takes a prostaglandin analogue. Synthetic prostaglandin causes contraction of the smooth muscles of the myometrium and promotes the expansion of the cervix. This facilitates the removal of the contents of the uterine cavity.

Противопоказания

Contraindications to pharmacological abortion are quite numerous, since they concern not only gynecological aspects of women’s health.

The main contraindications are ectopic (ectopic) pregnancy, pregnancy that occurred after the use of hormonal contraceptive methods or against the background of an installed intrauterine contraceptive (the so-called spiral), polycystic ovaries, myomatous nodes that deform the uterine cavity, acute inflammation of the vagina or internal genital organs. Contraindications to medical abortion include the presence of hormone-dependent tumors of the uterus and ovaries.

Medical abortion is contraindicated in women with the following diseases: severe endocrine disorders, severe cardiovascular pathology, anemia, severe liver and kidney disease, high blood pressure, bronchial asthma, and so on. Pharmacological termination of pregnancy is not indicated when taking certain drugs: corticosteroids, anticoagulants. Smoking is one of the reasons why a doctor may not recommend medical abortion for a woman.

Procedure algorithm

After the woman goes to the gynecologist and informs him of her intentions to terminate the pregnancy, the doctor gives her time to think. In the case of medical abortion, this period is at least 48 hours. The doctor cannot perform the abortion procedure at the time of the request, so the promise of some private medical organizations to perform an abortion on the day of the request is illegal. Before performing a medical abortion, there are a number of activities that the doctor must do. First of all, it is necessary to diagnose pregnancy and its duration. Ultrasound examination allows you to make sure that the fetal egg is located in the uterine cavity and there is no other pathology of the pelvic organs, in which medical abortion can lead to complications. The doctor examines the woman for infections, takes a swab from the vagina for the flora, and conducts clinical and laboratory examinations. Next, the doctor collects an anamnesis, and if the woman has any concomitant diseases, he directs her for a consultation with a specialized specialist. After the examination, in the absence of contraindications, the gynecologist prescribes drugs that cause rejection of the inner layer of the uterus, and then contraction of the smooth muscles of the myometrium with the expansion of the cervix to expel the fetal egg. The dosage and methods of administration of drugs depend on the duration of pregnancy (up to 7 weeks or 7-9 weeks). After the first dose of drugs, the patient must be under the supervision of a doctor for at least two hours. After 36-48 hours, the woman should undergo ultrasound control, and after 8-14 days, come for a gynecological examination and a second ultrasound examination to make sure that the fetal tissues have completely left the uterine cavity. The doctor conducts a gynecological examination and assesses the condition of the internal genital organs (cervix, size and consistency of the uterus, condition of the appendages, pain during a gynecological examination). In some cases, to be completely sure of the effectiveness of medical abortion, the doctor recommends determining the level of the beta subunit of human chorionic gonadotropin (beta-hCG), which is a marker of pregnancy. Normally, one day after taking the drugs, the level of beta-hCG decreases by about 50%, and 2 weeks after the start of the abortion, the level of beta-hCG decreases even more significantly.

The doctor controls the general condition of the woman, the nature and intensity of bleeding, the presence of hyperthermia. After the abortion procedure, contraception and rehabilitation measures are necessarily discussed ^[4].

Side effects and possible complications of medical abortion

The symptoms of medical abortion are similar to those of spontaneous abortion. The duration of bleeding in all patients is individual: from a week to 20 or more days. In some cases, spotting continues until the next menstrual period. As a rule, bleeding is not too heavy, but it is usually more abundant than normal menstruation. The process of detachment of the fetal egg may be accompanied by pain, about which the woman should also be warned. Cramping pain in the lower abdomen due to contraction of the myometrium. Sometimes the use of painkillers or antispasmodics is required. Possible increase in body temperature. The procedure for pharmacological termination of pregnancy may be accompanied by some changes in a woman’s well-being: dizziness, weakness, headache.

In some cases, a woman is worried about nausea, vomiting and other disorders of the gastrointestinal tract. As a rule, such side effects can be caused by prostaglandins prescribed by a doctor. They go away on their own, but in some cases, the use of antiemetic drugs is also acceptable. Diarrhea is relatively common, but it is short-lived and usually does not require medication. Sometimes, due to spasm of the cervix, a significant accumulation of blood clots (hematometer) occurs in the uterine cavity, which can be eliminated with the help of medications prescribed by a doctor.

Complications of medical abortion include incomplete abortion and progressive pregnancy. Despite the fact that medical abortion is a fairly effective method, in a small percentage of cases it is still possible to continue the pregnancy. The presence of remnants of the ovum and ongoing pregnancy are indications for intrauterine surgery.

When to seek medical help

Immediate medical attention is required in case of severe bleeding. Heavy bleeding is considered if two sanitary pads of the maximum size are completely saturated with blood within an hour and this continues for two hours in a row or more. Taking drugs sometimes causes a slight increase in temperature, but it lasts no more than 2 hours. If a high temperature (38 ° C and above) lasts more than 4 hours, this indicates the development of an infectious-inflammatory process. In this case, the woman should consult a doctor. With medical abortion, pain is possible, the severity of which depends on the characteristics of the woman’s body, her emotional state and the threshold of pain sensitivity. If the pain in the abdomen is so severe that it requires pain relief, the doctor recommends antispasmodics and analgesics. It is strongly not recommended to take painkillers on your own. Possible allergic reactions also require immediate medical attention. ^[5].

Recommendations after medical abortion

• avoid overheating and hypothermia in the first month after the procedure;
• do not visit the sauna, swimming pool, do not swim in open water;
• do not take a hot bath, take a shower instead;
• temporarily limit physical activity;
• completely give up alcohol, eliminate smoking;
• limit stressful situations and emotional overstrain ^[6].

Contraception after pharmacological termination of pregnancy

After medical termination of pregnancy, the use of any modern method of contraception is allowed. You should start to protect yourself from subsequent conception immediately, since ovulation (the release of a mature egg) can occur as early as day 11, that is, before the first menstrual bleeding. This means that within about 2 weeks after the abortion, the next pregnancy may occur. It is allowed to start taking contraceptive pills in conjunction with synthetic prostaglandin used to terminate pregnancy. Barrier methods of contraception can be started immediately after the resumption of sexual activity. Sex life after medical abortion is possible after the end of the first menstruation. The choice of a method of contraception is helped by a gynecologist in accordance with generally accepted recommendations.

All methods of protection against unwanted pregnancy have their advantages and disadvantages and should be considered depending on the state of health of the woman, the duration of their use, planning a subsequent pregnancy. The minimum period for such contraception is 3 months. The recommended period for planning a subsequent pregnancy is usually at least 6 months. ^{[7] [8]}.

Medical abortion is allowed on an outpatient basis: in antenatal clinics, private clinics. But this does not mean complete safety for a woman’s health. It is worth mentioning that the immature reproductive system of young women is most vulnerable to abortion, especially if this is the first pregnancy. Of course, a woman should be able to terminate an unwanted pregnancy in the safest way, but even the most gentle way to terminate a pregnancy is a significant psychological and hormonal stress. Use contraception to avoid situations in which an abortion becomes necessary.

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