Surgical abortion

Surgical abortion, today, remains the most reliable way to terminate a pregnancy. During this operation, the contents of the uterus are physically removed or scraped along with the fetal egg, which makes further development of the embryo impossible.

Despite the 100% guarantee of interrupting the gestation of the fetus, doctors prescribe this method of getting rid of it to women only in cases where other methods of interruption are ineffective or inappropriate. Surgical abortion is a complex operation that can cause complications and negative consequences for a woman for the rest of her life.

What is a surgical abortion, how is it different from other methods of abortion

Surgical abortion is a method of dilatation and curettage of the uterus. Dilatation implies a mechanical expansion of the cervical canal, and curettage is the process of removing or scraping the inner mucous layer of the uterus with a fetal egg.

According to the World Health Organization, this type of abortion is one of the most dangerous for the patient. The procedure itself requires the introduction of a woman into a state of medical sleep, so an anesthesiologist is necessarily involved in it. In terms of the likelihood of complications, surgical abortion also ranks first among other types of abortion.

It is believed that the implementation of the procedure is relevant only from the 6th to the 12th week of pregnancy, however, for example, in Russia, surgical abortion is often prescribed at the earliest possible date – from the third week. In the presence of some indications, termination of pregnancy is performed inclusively up to 22 weeks. Before the sixth week of pregnancy, doctors recommend turning to less traumatic ways to get rid of the fetus – a mini-abortion or medical interruption.

A mini-abortion is also called a vacuum aspiration procedure. This type of intervention is carried out using a special device – vacuum suction. The nozzle of the apparatus, inserted into the uterine cavity, creates a negative pressure in it, due to which the fetal egg is separated from the walls of the organ, and then enters the vacuum suction catheter.

Medical or pharmaceutical abortion occurs in a slightly different way – without surgical intervention. It is used only in early pregnancy, up to 6 weeks. In the presence of a doctor, the patient takes a one-time drug that provokes fetal death. The substance of the drug acts on progesterone receptors, inhibiting the action of progesterone. Without the normal production of this hormone, the growth of the endometrium stops, in addition, the myometrium begins to contract intensively.

The next stage of the pharmacist is the adoption of a medical device, which is a catalyst for strengthening uterine contractions. In this case, the organ simply pushes the fetal egg out of its cavity.

Thus, surgical abortion requires more preparedness of the patient, higher qualification of the doctor. It is allowed to be carried out up to and including the 22nd week of pregnancy, while other types of interruption are effective up to a maximum of the sixth.

Indications for surgical abortion

An abortion operation is performed in exceptional cases when a woman cannot or does not want to bear a fetus and give birth to a child.

Every year, all over the world, opponents of abortion raise the issue of legislative prohibitions on the possibility of having an abortion without appropriate medical indications, only at the request of the woman herself. The ethics of abortion are discussed by doctors, church representatives, scientists and public figures. Nevertheless, today in most civilized countries there are no prohibitions on abortion at the legislative level. Therefore, the main indication for its appointment is the reluctance of a woman to become a mother for any reason, for example:

• if the child was conceived in the process of rape;
• if the father of the child refuses to participate in his maintenance and upbringing;
• if the pregnant woman is in prison;
• for any other economic or social reasons.

In addition, among the indications for abortion, there are a number of objective factors that make the bearing of the fetus and the birth of a child undesirable or impossible:

• diabetes mellitus, cancer, heart disease, liver or kidney disease in a pregnant woman;
• alcohol or drug addiction;
• the presence of dangerous viruses in a woman that can be transmitted to the fetus or cause malformations of its development: rubella, hepatitis, herpes viruses, HIV;
• fetal malformations detected on ultrasound;
• death of the fetus in the early stages of its stay in the womb;
• risk of miscarriage.

Contraindications: in what cases an abortion is not performed

There are conditions and factors in which the already dangerous procedure of surgical termination of pregnancy can become a real threat not only to health, but also to the life of the patient. So, this type of abortion is not performed:

• in the presence of purulent foci localized in any part of the body;
• in acute inflammatory processes of the genital organs;
• if the patient has a sexually transmitted disease;
• in violation of blood clotting;
• if less than six months have passed since the last abortion;
• if you are allergic to anesthesia.

How to act to get an abortion

The surgical method of abortion is prescribed on the recommendation of a gynecologist, so the first thing a woman needs to do is to consult a doctor. This may be a gynecologist at the antenatal clinic at the place of residence, a doctor at a local clinic, or a doctor at a private clinic.

Already on the day of treatment, the doctor conducts a visual examination of the patient, and can refer the woman for tests and transvaginal ultrasound of the pelvic organs to confirm her pregnancy status.

If a pregnancy is detected for up to 12 weeks, and the woman has expressed a desire to terminate it, the gynecologist gives her a referral for some tests:

• PCR for hepatitis, HIV:
• analysis for antibodies to syphilis;
• general biochemical blood test;
• smear from the vagina on the flora;
• Rh factor and blood group.

In addition, the doctor will refer the patient for fluorography and electrocardiography.

Provided that the results of all examinations and analyzes are within the normal range, the physician determines the date when the operation will be performed, and warns that for this it will be necessary to spend some time in the hospital of a medical institution.

In some cases, unfortunately, a woman is faced with an unprofessional attitude of a gynecologist – sometimes doctors allow themselves to be condemned or try to morally put pressure on the patient in order to force her to change her mind. There are medical workers who, in violation of the law, generally refuse to perform an operation on a pregnant woman because of personal beliefs. Such situations are common mainly in Eastern European countries. Therefore, in addition to physical and medical preparation, a woman needs to prepare and mentally, perhaps, come to an appointment with relatives.

Preparation and features of the operation

By the date appointed by the doctor, the woman, having collected the necessary things for several days of stay in the hospital, appears at the doctor. The gynecologist again conducts a general examination and interview of the patient, after which he determines her to the ward – general or single. Since surgical abortion is practically not performed without anesthesia, an anesthesiologist talks with a woman before the operation begins – he finds out if she has chronic diseases and allergic reactions.

One of the most pressing questions that arise in women is whether it is painful to have an abortion with a surgical method, and what type of anesthesia is better to choose. The process of opening the cervical canal through the introduction of medical devices there, and the curettage of the uterus itself with a sharp curette, are very painful, therefore, if possible, it is better to choose general anesthesia.

When performing an abortion with local anesthesia, 2-3 injections of anesthetic are carried out into the cervix. After the substance takes effect, and the patient falls into a state of half-asleep, the physician, using a special tube, expands the cervical canal, and inserts a plastic tube into it – an aspiration device. With its help, under the influence of air pressure, the uterine mucosa is scraped, and its excavation along with the fetal egg.

Immediately after the end of the procedure, the doctor performs an ultrasound examination of the uterine cavity to make sure that the abortion was successful and that all elements were removed.

If the abortion is performed under general anesthesia, after the patient is placed on the couch, an anesthetic is injected into her intravenously. In just a few minutes, she falls asleep, and the doctor begins the operation. While anesthesia is in effect, also with the help of a special tool, it expands the cervical canal, after which it inserts an aspiration device into the uterus and scrapes the internal contents of the uterus. The next stage is an ultrasound to evaluate the effectiveness of the operation.

How long does the operation take? In total, the process itself with any type of anesthesia takes up to 20 minutes. If a woman was in a state of drug-induced sleep, she will come to her senses for some time after the end of the anesthesia – usually her health and consciousness clear up on the day of the operation, after a few hours.

Surgical abortion at short terms

It is less traumatic for the patient to terminate the pregnancy at terms from 6 to 12 weeks, for example, at 8 weeks. The embryo in this case is still very small, and is an unformed clot of cells – a zygote. For scraping, a special vacuum apparatus is used – the fetal egg is literally sucked out of the uterine cavity, after which it is cleaned. The body of the embryo is destroyed under the action of vacuum, so it freely passes through the cavities of the tube of the apparatus.

Features of the operation at a later date

In cases where it is necessary to terminate the pregnancy at 12-22 weeks, the aspiration apparatus cannot cope with a larger and more developed body of the fetus. In addition, the cervical canal has to be expanded to a large size. The extraction of the fetus occurs after its surgical destruction – the doctor divides the fetus into parts with special tongs, after which he pulls out large pieces of the fetal body with them, and sucks out smaller parts with vacuum suction. The procedure also ends with curettage of the uterus.

It should be noted that an abortion at such a late date can only be performed in exceptional cases, since it is very dangerous for the patient.

What happens after the procedure

When the process of curettage of the uterine cavity is completed, and the woman comes to her senses after the action of anesthesia, she will feel pain in the lower abdomen. The patient is transported on a gurney to the ward, where she is advised to lie still for the next few hours.

In some cases, pain has the form of severe spasms or contractions – then the woman is injected with an antispasmodic to alleviate her condition.

On the same day, or the next day, the patient is allowed to go home. The doctor explains to her the procedure for rehabilitation after the operation, talks about what kind of discharge, how and how much can go after an abortion, what you need to pay attention to, in what cases you should come for an examination.

Pain after the procedure can last from one to several days. If they become so strong that it is difficult for a woman to endure them, you should take an antispasmodic and consult a gynecologist.

Bloody discharge after an abortion, similar to menstruation, usually occurs in women within 1-2 days. They do not always begin immediately after scraping – sometimes they can go for 3-5 days.

It is especially important to monitor your own well-being – if in the days following the operation there is a rise in temperature, weakness and constant abdominal pain that does not go away, but only intensifies, this may indicate an unsuccessful or incomplete abortion. In this case, it is imperative to visit a doctor as soon as possible.

Prolonged spotting (more than 5-7 days) is also an alarming symptom. Prolonged discharge of blood after the procedure may be a sign of the presence of a placental polyp in the uterus, which must be removed.

The absence of discharge can be a bad sign – perhaps the blood has accumulated in the uterus, and because of its spasm, it cannot come out.

In any case, on the 10-14th day after the abortion, the patient again undergoes an ultrasound examination, which makes it possible to assess the condition of the uterus and the completeness of the abortion.

One of the aspects of recovery after the curettage procedure is taking antibiotics for 5-7 days, as well as prescribing antifungal drugs. Such measures are taken to prevent the development of inflammatory infectious processes or candidiasis.

Possible complications: why surgical abortion is dangerous

Surgical intervention of this nature, of course, carries some threat to the woman. Among the most common complications of curettage:

• endometritis: inflammatory processes of the walls or cavity of the uterus, dangerous in that they can cause suppuration, and even death;
• bleeding: occur with an unskilled abortion, or with a violation of blood clotting;
• infertility: it develops against the background of the fact that the inner lining of the uterus, which has undergone curettage, is gradually covered with scar tissue, and the following embryos are not able to attach to the walls;
• damage to the cervix, if the doctor performed the expansion incorrectly and carelessly;
• incomplete abortion: in this case, the embryo continues to develop, although it is guaranteed to have defects and pathologies;
• perforation of the uterine wall: violation of its integrity;
• Rh sensitization is a complication that affects women with a negative Rh blood factor: they can develop antibodies to the cells of the fetus, which causes its rejection.

The rehabilitation process: changes in the menstrual cycle, intimate life and contraception

Under the condition of a normal hormonal background in a woman, the first full menstruation after surgical curettage begins in 28-35 days. The discharge that the patient notices before this time does not belong to the menstrual cycle, they are not so long and plentiful. Some women note that after the procedure, characteristic pain during the first menstruation after an abortion is felt more strongly than usual.

At the time of rehabilitation, a woman is prescribed not only a course of antibiotics and an ultrasound scan, but also a visit to a mammologist-oncologist in order to exclude the appearance of neoplasms in the breast. In addition, the patient is recommended to take a course of multivitamin preparations. Often, the doctor determines the need for hormonal therapy – in such cases, hormonal contraceptives or special hormonal preparations are prescribed.

As for intimate life, after an abortion, a woman should abstain from sex for 2-3 weeks. Before the onset of complete healing of the uterus, it is an extensive wound surface open to any microorganisms. It is known that during sexual intercourse the probability of bacteria and pathogenic flora entering the internal genital organs is very high, even if a condom is used.

Another reason why doctors advise avoiding sexual intercourse for the first time after an abortion is the likelihood of pregnancy. The abortion procedure that a woman has undergone does not exclude the possibility of becoming pregnant at the next sexual contact.

The onset of pregnancy for an organism that has not yet had time to fully recover after the scraping procedure is a great stress, therefore, the conception of a child should be planned no earlier than six months after the operation.

During all this time, partners need to be very careful about the issue of contraception: it is allowed to use condoms, oral contraceptives, spermicidal suppositories and lubricants, or a combination of several of the proposed methods.

Abortion after caesarean section: medical indications

In the case when a woman, for physiological reasons, cannot give birth to a child during natural childbirth, she may be prescribed a caesarean section – an operation during which the anterior wall of the abdominal cavity and the wall of the uterus are cut, after which the doctor removes the child.

As a result of the operation, a scar appears on the woman’s uterus at the site of the incision.

Until the scar is finally formed, it takes 3-4 years. Doctors strongly do not recommend planning a conception during this period, however, it is not always possible to avoid an unwanted pregnancy.

A woman faces a difficult choice: to carry out a surgical abortion, which is highly undesirable, given the condition of the uterus, or to bear a fetus in a uterus that has an inferior scar.

In this case, it is imperative to contact a qualified gynecologist who will assess the condition of the uterine wall and the scar on it.

When deciding to keep the child, a woman must understand that an unformed scar in the process of bearing a fetus can lead to uterine rupture.

However, if the patient decides to keep the baby, no physician will perform an abortion without her consent.

Thus, the decision to have an abortion after a caesarean section is the responsibility of the pregnant woman herself – the doctor can only recommend that she terminate the pregnancy.

Surgical abortion is a type of abortion surgery that can be carried out no later than 22 weeks of pregnancy. Despite the fact that this type of abortion is considered the most difficult and dangerous, it is carried out most often, compared with vacuum or medical abortion.

The operation consists in the physical removal of the embryo from the uterine cavity, after which its inner shell is scraped off with a special tool.