The safest way to carry out an abortion is with medical abortion. It is practically safe for the health and emotional state of a woman. For its implementation, drugs are used that provoke the expulsion of the ovum outward.

What is medical abortion?

The term "pharmabort" is used to denote the artificial termination of the onset of pregnancy with the use of medications. The method completely excludes surgical intervention. During this procedure, the patient takes pills in the presence of a doctor. Under the influence of the components of this drug, the death of the embryo occurs. This is where the first stage of medical abortion ends.

After a certain time, the woman takes another drug. Its components provoke an increase in the contractile activity of the uterine myometrium. As a result, the rejected ovum is expelled outside, an abortion occurs. This procedure has a number of advantages over other methods (scraping,):

• no trauma to the uterus;
• fast restoration of the menstrual cycle;
• low risk of complications;
• does not require anesthesia.

Medical termination of pregnancy - timing

Answering the woman's question, up to what period of medical termination of pregnancy can be carried out, doctors call 6-7 weeks. Pharmabort can be carried out no later than 42–49 days from the moment when the first day of the last menstruation was celebrated. At the same time, the effectiveness of this procedure decreases over time, and the likelihood of complications increases.

Doctors call the optimal time for a medical abortion up to 4 weeks. The fertilized egg does not have time to securely anchor in the uterine wall, so it is rejected and exits better and faster. In addition, the hormonal background has not yet been fully established, the restructuring of the body has not been completed, so it will be easier for him to return to the previous state, before pregnancy.

Medical termination of pregnancy - contraindications

The main indication for such termination of pregnancy is the desire of the woman herself. However, not all pregnant women and not all cases can undergo medical abortion. In addition to the time frames indicated above, there are other contraindications to the implementation of medabort:

• a history of allergic reactions to medications;
• liver failure;
• adrenal insufficiency;
• pathological bleeding;
• active inflammatory process in a woman's body;
• pulmonary tuberculosis;
• suspicion of;
• oncological processes;
• lactation process;
• implementation of corticosteroid therapy;
• disorders of the blood coagulation system.

How is medical termination of pregnancy carried out?

Talking about how the pharmaceutical abortion goes, the doctor explains the stages of the procedure. Previously, a woman needs to undergo a small examination, which is assigned on the day of treatment:

• Ultrasound of the uterus;
• smear for microflora;
• a blood test for syphilis.

After receiving the results, the exact time is assigned when the medical abortion will be performed, the terms of which are indicated above. At the next visit, the doctor again talks with the woman, clarifies the seriousness of her intentions, whether she has changed her mind. Then the patient is given a drug, which she drinks in the presence of a doctor. Under the action of the drug, the growth of the endometrium stops, and the muscle layer begins to contract. The woman is monitored for 2-3 hours, after which she leaves the clinic.

The patient is given a pill of another drug that stimulates the contractions of the uterus. Take it 36–48 hours later, as directed by your doctor. Under the action of the drug, the dead embryo is expelled outward. Only then is the medical abortion considered complete. The woman fixes spotting.

Medical termination of pregnancy - drugs

A woman, even if she wishes, cannot carry out a pharmaceutical abortion on her own - tablets for its implementation are not sold in the pharmacy network. Carrying out medical abortion, drugs are used with a high content of hormones, therefore they are issued by a doctor in a medical facility. To carry out medical termination of pregnancy, the following groups of drugs are used:

1. Antigestagens - suppress the action of natural gestagens at the receptor level. The representative of this group is Mifepristone, Mifegin. For pharmacist use 600 mg of the drug.
2. Prostaglandins - enhance the contractility of the uterine myometrium. Most often from this group they use Mirolyut. 400 mg is prescribed. It is taken 36–48 hours after the antigestagen.

How to understand that the pharmaceutical abortion went well?

Complications are possible with any medical procedure, therefore, women often ask doctors about how to understand that the medabort has failed. In order to exclude possible violations, after 14 days, the woman should visit the clinic and undergo a control ultrasound. The doctor must make sure that the fertilized egg, its remains have completely left the uterine cavity. Examine the organ itself, determining the size. In a woman, the doctor clarifies the nature of the discharge, the presence and severity of the pain syndrome. Often, after a pharmaceutical abortion, the test is positive - this is due to an altered hormonal background.

Periods after pharmacist

Normally, menstruation after a pharmaceutical abortion comes in 28-30 days. Taking abortive drugs practically does not affect the hormonal background of a woman, so menstruation is not disturbed. However, in some cases, there is a change in the volume of secretions: they can be scarce or excessively abundant. So, a small amount of discharge after medical termination of pregnancy can be due to:

1. Small opening of the cervix during abortion - fragments of the fetus cannot normally come out, accumulating in the uterine cavity.
2. Incomplete abortion - the ovum is not completely rejected and the fetus continues to develop.

Bleeding is observed within 2-3 days after the pharmacist. Normally, it lasts up to 10-14 days. The fertilized egg is separated in parts, so the discharge lasts a long time. Their volume exceeds the number of menstrual periods. You need to be careful about the volume, making sure that they do not go into. Signs of this complication are:

• a large amount of blood secreted from the vagina - in half an hour the sanitary napkin ("maxi") is completely saturated;
• pain in the lower abdomen;
• dizziness;
• blanching of the skin;
• an increase in the number of heartbeats;
• lowering blood pressure.

Sex after pharmacist

After the pharmacist has been carried out, what cannot be done and what rules to follow - the doctor explains to the woman. At the same time, special attention is paid to intimate life. Doctors do not recommend having sexual intercourse to women until the spotting stops. Otherwise, there is a high risk of infection of the reproductive system. On average, the period of abstinence should be 2-3 weeks from the date of the abortion.

Pregnancy after pharmacist

A properly performed pharmaceutical abortion does not affect fertility. after such an abortion is possible after a month, in the next menstrual cycle. Given this fact, doctors strongly recommend contraception. Often women regret what they have done and want to get pregnant again. In addition, there are cases when the interruption was carried out for medical reasons, so the woman wants to quickly get pregnant again.

The reproductive system needs time to recover, so you need to refrain from planning pregnancy for 6 months from the moment the medical termination of pregnancy was carried out. During this period, doctors recommend using. In this case, it is better to give preference to mechanical (condom), since the use of hormonal agents can affect the hormonal background.

Preparation includes a smear on flora and intravaginal ultrasound to establish the duration of pregnancy and the location of the ovum. It also clarifies whether a woman has chronic diseases that can become contraindications for drug interruption. Before the procedure, do not eat anything salty and fatty, smoked, after a drug abortion, you cannot take a bath or go to the pool until everything is over. Do not eat 3 hours before interruption and less than 2 hours after.

The effectiveness of medical abortion

Medical termination of pregnancy manifests itself as more painful than usual periods. The interruption efficiency is 95%. The advantage of medical abortion is that it does not require general anesthesia. You just get a pill and drink it in front of a doctor. After 72 hours, you go back to the clinic where you are given a pill to contract the uterus. A day later, profuse bleeding begins.

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Terms of medical abortion

Terms of medical termination of pregnancy: 5-6 weeks. A medicinal abortion is done after a full gynecological examination. Side effects: nausea, headache. Contraindicated in heart defects with severe heart failure, tuberculosis, hypertension and fibroids, obesity and diabetes.

How is medical termination of pregnancy carried out?

Medical termination of pregnancy begins with a preliminary conversation between the woman and the doctor. She is informed about possible contraindications and the complications and the very essence of the method. Next, they take blood tests for HIV, hepatitis, Rh factor and a smear on the flora and do an ultrasound to clarify the time. The woman signs the consent.

As for the pain, it all depends on the period: the longer the pregnancy, the more intense the pain.

After a drug abortion, contraception is selected for the woman. Conception can occur immediately, so you need to start protecting yourself immediately.

Stages

In any case, a woman goes through the following stages of medical termination of pregnancy:

• A woman calls the clinic and makes an appointment with the doctor, indicating that she wants to have an abortion drug... Food is not accepted for 3 hours.
• At the reception, the doctor does an ultrasound.
• You are warned about possible complications of the procedure and contraindications to it, they conduct an introductory conversation.
• Together with the gynecologist, you choose one of the drugs made in France or Russia.
• Tests may also be ordered if you have not done them shortly before interruption. Results are ready in 1 day.
• The drug is taken with a doctor.
• Pain and discharge similar to menstruation appear within 72 hours.
• After the onset of pain and bleeding, prostaglandins are taken. Within 5 days, the ovum comes out entirely.
• The next stage is control ultrasound.

Remember, the vagina is home to bacteria. This is why swabs are done before a medical abortion. When the cervix opens, bacteria can enter the uterus. Unfortunately, sometimes fatal toxic shock occurs, but this is stubbornly silent.

Choose a clinic whose doctors have been performing drug abortion for a long time. This will help keep complications to a minimum.

Abortion pills

Tablets for medical abortion: Mifepristone, Mifegin, Mifeprex, Mifolian, RU-486. The active substance of all these drugs is Mifepristone. This is a complex molecule that has a complex effect on the female body, which is configured to maintain pregnancy. If you had an irregular menstrual cycle before taking the pills, the problem may worsen.

Medical abortion is carried out with drugs that include Mifepristone: Mifegin, Mifeprex, Mifolian, RU-486. Specialists always carefully prepare a woman for taking these drugs. The doctor discusses with the patient anamnesis, all diseases that she had or has.

Mifepristone

Mifepristone blocks receptors for a hormone that maintains pregnancy.

Medical termination of pregnancy with mifepristone is better tolerated than surgery. Before the procedure, you confirm that you are aware that in the future, you may need a surgical abortion due to incomplete removal of the ovum. After taking mifepristone, on the 2nd day you come back to the clinic and take another drug that expels the embryo within 1 hour. Bloody discharge lasts 10 days, after which you come for a control ultrasound. In isolated cases, after taking the drug, diarrhea, dizziness and nausea are possible.

Mifepristone has the following contraindications:

• Pregnancy against the background of the use of an intrauterine device.
• Scar after cesarean section.
• Leiomyoma.
• Failure of the kidneys, liver.
• Blood clotting disorder.
• Anemia.
• Asthma.
• Diseases of the female genital area.

After administration, severe pain in the lower abdomen, dizziness and vomiting may occur. The temperature may rise a lot. Do not take any pain relievers or antipyretics - they can stop the abortion. You can take analgin or no-shpu as a last resort. Better to call the abortion doctor. You will be given emergency numbers where you can get advice. If for some reason you cannot contact this doctor, in case of severe pain, constant vomiting and fever, call an ambulance.

Mifegin

Medical termination of pregnancy with mifegin is an alternative to curettage. An unsuccessful result, incomplete extraction of a fertilized egg is possible in 5% of cases.

Mifegin is a progesterone antagonist. Under its influence, the mucous membrane of the uterus begins to be rejected. Abortion with pills is a serious intervention in the body, it cannot be called completely harmless.

The first visit to the doctor includes an examination on an armchair, a patient consultation, the signing of the appropriate paper - consent to an abortion, an ultrasound scan to confirm the term and the first pill intake. The next visit should take place in 72 hours. During this visit, the fetus is expelled from the uterus by taking prostaglandin. The clinic needs to be under supervision for 1.5 hours. If the pain is very severe, you may be given a no-shpu. Short-term diarrhea is possible.

After 12-16 days, you need to do an ultrasound. If for some reason the pregnancy persists, a regular abortion is performed.

In the intervals between visits, you must not go to the sauna and drink alcohol.

Pencrofton

Medical termination of pregnancy with pencrofton is an alternative to surgical abortion. Benefits of medical abortion with the Russian drug Pencrofton:

• Early termination of pregnancy on the second day after conception (for example, if you have been a victim of violence).
• No risk of contracting hepatitis, as is the case with abortion, if the instruments are poorly sterilized.
• Lower cost.
• Curettage can cause uterine scarring or perforation, life-threatening bleeding. This is not the case with pencrofton.
• Fertility is restored immediately.
• No anesthesia needed.
• No need to go to the hospital.
• The risk of depression after an abortion is reduced.

The drug was developed in 1990. It expels the embryo from the uterus by opening the cervix. Termination of pregnancy with pencrofton is possible up to 7 weeks. It can only be used in clinics. The patient is given 3 tablets once, and she goes home. Then, after 72 hours, she is given a drug that expels the fetus, which has stopped developing during this time. After 16 days, ultrasound and curettage are performed, if necessary (it is rare).

When taking pancrofton, a minimum of side effects is observed, as a rule, these are only nausea and a feeling of weakness, a slight increase in body temperature within 4 hours.

Misoprostol

Medical termination of pregnancy with misoprostol in Kiev can be done in many specialized clinics. Misoprostol is a last-generation abortion drug. As a result of the work of the uterine muscles under its action, the ovum is ejected.

The method eliminates psychogenic trauma and is best suited for young nulliparous girls.

Abortion in 1-15 days occurs in 65-85% of cases. The introduction after 1-3 days of a prostaglandin analogue increases this figure to 88-98%. The same results were obtained using Pencrofton. Thus, the optimal scheme for carrying out the procedure for drug termination of pregnancy today is 600 mg of mifepristone with the introduction of prostaglandins after 36-72 hours.

Duphaston

Duphaston after drug termination of pregnancy is prescribed in the post-abortion period. On day 16, after ultrasound, Dufaston 10 mg is prescribed twice a day for 10 days. Duphaston is an active progestogen. It is used for a variety of gynecological diseases. When taking it, there are no unwanted hormonal disorders. Duphaston does not affect liver cells and blood pressure.

Together with Duphaston, the gynecologist can prescribe multivitamins or special vitamin complexes that are used in stressful situations. Abortion, whether surgical or medical, is stressful for a woman. As a result, not only the nervous system can suffer, but also the heart. Sometimes post-abortion psychosis develops. The first reaction is always relief. But then a woman often experiences remorse, her self-esteem goes down, on this day every year she can cry. Awareness of what happened helps. You can mourn your child. The support of loved ones is very important, but, unfortunately, the husband cannot always understand why his wife suddenly became cold with him. The process of finally getting rid of guilt can be long. Medical termination of pregnancy is usually more tolerated by women and does not affect the state of mind so much.

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The consequences of medical termination of pregnancy

The consequences of medical termination of pregnancy are reduced mainly to nausea, diarrhea and delayed menstruation up to 12 weeks, headache, chills, endometritis. Side effects such as Quincke's edema, uterine rupture and toxic shock are extremely rare. Toxic shock can lead to death.

Pregnancy is not terminated in 3% of cases. Then you have to do scraping. As a result, inflammatory diseases may worsen, adhesions and infertility develop - it does not happen immediately, it happens that a woman becomes pregnant and gives birth, but the inflammation worsens several times and leads to infertility.

During pregnancy, the nervous system is rebuilt. The body is set up to carry a pregnancy. Medical termination of pregnancy artificially stops this process. Therefore, neuroses are so frequent, the so-called. post-abortion syndrome. Rarely, diseases of the thyroid gland are associated with drug abortion, explaining everything by the accident at the Chernobyl nuclear power plant. But in vain. The thyroid gland is involved in the regulation of hormones that support pregnancy, although not as clearly as the ovaries and pituitary gland. It is clear that they go for an abortion because of despair, a sudden collapse of plans. But if you think about it, there is no safe abortion. Most of us have carious teeth, tonsillitis, or rhinitis. These are infectious foci. After an abortion, done in any way, a woman's immune system weakens sharply. Harmful bacteria from the vagina can enter the uterus. The risk of infection from the vagina is especially high, because it is located closest, but theoretically, the bloodstream can get the infection into the uterus from any focus in the body, even a carious tooth.

Of course, these consequences most often occur during surgical abortion. But even with medical abortion, the cervix opens when the ovum is expelled. Infection easily penetrates through these gates.

To minimize the consequences, medical termination of pregnancy should end with rest for your body. A month you can not play sports, no sexual intercourse, take a shower and do not swim in open water, do not go to the sauna, swimming pool, do not take the bathroom earlier than 3 weeks after the drug abortion.

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Harm

The harm of medical abortion is due to the blocking of progesterone receptors. In this case, there is no injury to the uterus, so complications are much less common than with traditional abortion. A frequent complication is incomplete expulsion of the fetus (about 10%). Prolonged uterine bleeding is possible. Cases of toxic shock after taking "pregnancy pills" are known.

Complications

Rarely, but it is still possible to face serious complications after medical termination of pregnancy. First of all, this is the lack of effect from the drug or incomplete abortion. Also, your periods may become irregular or very heavy. Allergy is possible. If any warning signs appear, you should immediately seek advice from the clinic where the abortion was performed.

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Allocations

Discharge after medical termination of pregnancy is usually brownish, bloody, and often bothersome, even if heavy bleeding has already ended. To remove all suspicions, be sure to visit a gynecologist and do an ultrasound scan on the 14-16th day after the abortion. If, after a month and a half after a medical abortion, the discharge does not stop, this indicates that there has been a failure in the hormonal system. To correct this condition, the doctor may prescribe oral contraceptives (mini-drank or combined).

You should also pay attention to the yellow discharge. This may be a sign of purulent inflammation, which has developed due to the fact that you carried a dead child in you for some time. Yellow discharge after a medical abortion may be a sign of Escherichia coli.

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Bleeding

Medical termination of pregnancy is considered the safest method, but this does not mean that it is harmless. Sometimes it happens that after an abortion, profuse bleeding develops. It can lead to life-threatening blood loss. In this case, you need to lie down and call an ambulance, not hiding the fact that you have had a drug abortion. It is considered normal to have a small, not more than menstrual, bleeding until the onset of menstruation after a medical abortion. If you have to change more than one night pad in an hour, seek medical attention.

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Pain

Pain after medical termination of pregnancy in every woman is of varying intensity. They are caused by the contraction of the uterine muscles. How severe the pain will be depends on the pain threshold and the duration of pregnancy. Pain relievers for unbearable pain should be prescribed by a doctor because many of these drugs can inhibit abortion. Pain after drug abortion lasts for two days. Normal pains are considered to be slightly more intense than normal pain during menstruation. Multiple menstrual cycles can also be painful. The gynecologist may prescribe you a course of physiotherapy or gynecological massage if the pain and bleeding are very intense, prolonged. To avoid the development of infection in the uterus, a control ultrasound on day 16 must be done without fail, even if you have no complaints. Abdominal pain, fever, green and cheesy discharge are all signs of infection. Medical termination of pregnancy, done according to all the rules, in three visits, rarely leads to such consequences. 98% of cases of complications in drug abortion are associated with ignoring medical recommendations.

Temperature

The temperature after medical termination of pregnancy usually rises no higher than 37.5 ° C and lasts no more than 4 hours. Temperatures up to 37.2C can be kept for about 10 days. It is associated with increased progesterone levels. Delaying the treatment of a possible infectious process in the uterus leads to infertility. Blood clots and fever, too much bleeding should be the reason for an ultrasound examination of the pelvic organs earlier than the prescribed date (usually 14-16 days after termination). If after an abortion you have a fever and malaise, call your doctor home.

Nausea

Nausea after medical termination of pregnancy is not observed in all women and for a short time. If you vomit within an hour after taking the drug, unfortunately the pills will not work. You will be referred for a vacuum abortion.

If a woman is very worried about pain in the lower abdomen, she may be prescribed no-shpu. Aspirin should not be taken. For nausea, you can take cerucal. It has an antiemetic effect by blocking receptors. The maximum concentration of the drug is reached after 30 minutes. The half-life is 5 hours. The adult dose is 10 mg 3 times a day. Possible side effects: headache, increased fatigue, fear, tachycardia, itching. Contraindications: individual sensitivity, intestinal obstruction, epilepsy.

Recovery after drug termination of pregnancy

Recovery after medical termination of pregnancy should include a number of activities. Abortion is a serious trauma, no matter how it is performed. After a medical abortion, pay special attention to yourself for 2-3 months. Don't lift weights. Ask your family to help you clean. The gynecologist can prescribe you procedures, gynecological massage. Be sure to visit the physiotherapy room if the doctor advised you to. After an abortion, vegetative-vascular dystonia and nervous disorders may progress. Avoid stress and colds - medical termination of pregnancy weakens the body's defenses. From water procedures, only showers are allowed for the first month and a half. Prevent constipation. Change your laundry regularly. The first month, exclude significant power loads, sports. Sex can be done after the first menstrual period after an abortion. Mifepristone is incompatible with alcohol intake. We also recommend getting a mammogram.

Sex

Since 1999, every second woman has done medical termination of pregnancy. Alas, these are statistics. Few women manage without abortion in their lifetime. Bloody discharge then lasts another two weeks. At this time, of course, you need to abstain from sex. The risk of inflammation increases if this recommendation is not followed. The same goes for intimacy during your period.

Pregnancy

It is advisable to plan pregnancy after medical termination of pregnancy no earlier than 3 months later. A pregnancy that occurs earlier has a high risk of complications. In 95% of cases, medical termination of pregnancy does not affect the further possibility of conception, you can get pregnant in the next cycle, so take care of contraception. Immunity is often compromised after a drug abortion, so if you do not restore your body, you may catch some kind of infection during pregnancy. Periods after medical termination of pregnancy Periods after medical termination of pregnancy normally recover immediately. A delay of up to 20 days is considered normal. But for 70% of women, they arrive on time. With severe cramping pains during menstruation after a medical abortion, you need to see a doctor - this happens if the embryo is not completely out.

In Kiev, you can contact the URO-PRO medical center. Medical termination of pregnancy is done at 5-6 weeks. Another visit will be needed in 2 days. Bleeding begins during these days. After 16 days, a control ultrasound is done.

You can also do a pharmaceutical abortion by contacting the Kiev clinic "Demetra" (Poznyaki district). It also conducts colposcopy of the cervix and preventive examinations of women at affordable prices, treatment of STDs, menopause, menstrual disorders. Remember that with the latent course of diseases there are no pronounced symptoms, such as bleeding and pain in the lower abdomen. Regular check-ups help to avoid serious illnesses, incl. oncological. Cancer never occurs on healthy tissue.

The center carries out 300 types of analyzes. Here you can comfortably undergo rehabilitation after a drug abortion, receive psychological help if necessary.

The Atlanta Medical Center is also located on the left bank of the Dnieper in Kiev. Here you can undergo medical termination of pregnancy at early dates (6-7 weeks). The center also treats genital infections, gynecological and venereal diseases, performs gynecological and general massage.

In the clinic "Klinitsi Doroslikh" on Lepse Boulevard in Kiev, you can make a medical termination of pregnancy at an affordable price of 1200 UAH (ultrasound included). You will find understanding here. The gynecologists of the center know that a woman of any age is not 100% insured against unwanted pregnancy, even if she takes contraceptive measures. A medical abortion performed by an experienced gynecologist will not affect your health in any way. The procedure will take place in accordance with all the rules prescribed in the protocol of the pharmaceutical abortion. The clinic for medical abortion uses the long-established, reliable and effective drug Mifepristone. It is well tolerated by women. After the end of bloody discharge, you must undergo a control ultrasound again.

The medical center "Vemar" at ul. N. Bazhana (Kiev). Here they carry out medical abortion at an early stage - up to 42 days from the 1st day of menstruation. The normal size of the uterus, the absence of the embryo on ultrasound and discomfort during the follow-up examination indicate a successful medical abortion. The doctors at the clinic do their best to keep side effects to a minimum. The center's gynecologists also treat colpitis, vaginitis and inflammation of the uterine appendages, polyps and endometriosis. The center's urologist assists in the treatment of kidney and bladder diseases, as well as inflammatory diseases of the prostate and sexual disorders in men.

As you can see, the choice of medical clinics providing medical termination of pregnancy is wide. The method of medical abortion is called by WHO to be the most gentle for women's health.

Medical termination of pregnancy is a chance to preserve your health, like an artificially induced miscarriage, women in many countries of the world know - at least 31st, where this procedure is permitted at the legislative level. It is efficient and affordable.

The timing of medical termination of pregnancy in Russia is limited to six obstetric weeks... This is due to the fact that it is at such an early date that there is the greatest chance of carrying out the procedure without any complications, as painlessly as possible for a woman and effectively.

Advantages of the procedure compared to instrumental abortion

1. Does not require intravenous anesthesia. Thus, many problems associated with its side effects can be avoided. For women, for example, profuse hair loss is a fairly common and significant consequence of anesthesia.

2. Does not require being in stationary conditions. Although some women, on the contrary, want to do a medical abortion in a clinic, as they are afraid that the pain will be too severe, or heavy bleeding will begin.

3. Eliminates trauma to the cavity and cervix. This means that the risk of miscarriage of the next pregnancy does not increase. The risk of infertility is not increased.

4. Psychologically better tolerated by most women. Since you do not need to go to the hospital, it takes a long time to prepare for this procedure, to see the surgical instruments that perform the abortion. All this is very morally difficult.

5. The minimum risk of an inflammatory process in the uterus - endometritis. Since they do not "climb" into the uterus, do not injure, everything goes by the type of menstruation.

It can be said unambiguously that the consequences of medical termination of pregnancy, in comparison with instrumental, are minimal. And it is this type of abortion that is preferred for nulliparous women.

At the doctor's

It is necessary to find a clinic, private or public, that has a license to perform this procedure (now almost everyone has).

At the clinic, you will be examined and an ultrasound of the uterus will be done. This study is considered basic, as it shows that the woman is indeed in the position and the pregnancy is uterine.

Sometimes it happens that a woman comes after receiving a positive pregnancy test result, but the doctor does not find a fertilized egg in her uterus. This happens at a very short gestation period, usually when the delay has not yet begun. Now on sale there are tests with very high sensitivity, showing the correct result not on the first day of the delay, but much earlier - 4-5 days before it starts. The hCG level is very low. To visualize the ovum, its level must reach at least 1000. And the tests show the correct result already at 10 units ... The hCG level doubles every two days. It usually reaches this level already in the first week of the delay. A tableted abortion can be done with a delay of up to 2 weeks. There is time.

If an ultrasound scan showed a fertilized egg in the uterus, the doctor gives a detailed description of how the medical abortion occurs, what you will feel and how to behave. After talking with the doctor, you need to read and sign an information consent, which will contain approximately the following points:

• that the pregnancy is terminated deliberately;
• in case of progression of pregnancy after taking the pills, it is advisable to interrupt it, since there is a great risk to the health of the child;
• information on the course of medical termination of pregnancy has been received in full;
• in the process, complications may arise - bleeding, incomplete miscarriage, sometimes it is required to carry out additional curettage of the uterus or vacuum aspiration;
• exacerbation of chronic infections can be provoked, as a result of which infertility develops;
• the woman undertakes to strictly follow all the doctor's recommendations.

Description of the procedure

Medicines for medical abortion are given by a doctor. The first, "Mifepristone", is taken by a woman in the presence of a doctor. A serious drug that blocks the action of progesterone, a hormone necessary for the development and nutrition of the ovum. This medicine is not sold in pharmacies in the dosage needed to terminate a pregnancy. In order to avoid criminal abortions, as well as to make sure that the drug has worked, the woman should not have vomiting within 2 hours after taking it, the patient is asked to stay at the clinic for this time. And with you is given an information sheet explaining what happens after taking the pills and how to act, the doctor's phone number, by which you can get advice at any time, and the second drug, synthetic prostaglandin. It must be taken at home 36-48 hours after the first one.

And if after "Mifepristone" a woman could have a maximum of bloody discharge from the genital tract, then prostaglandin directly provokes detachment and release of the ovum from the uterus. All this is accompanied by severe cramping pain. The effect appears almost immediately after taking it. So you need to stay at home. After a miscarriage, the pain subsides.

Some women are also worried about nausea, vomiting, diarrhea, chills, fever. These symptoms do not occur in everyone, this is an individual reaction of the body to the medication.

As pain relievers, they recommend "No-shpu", "Baralgin" - that is, drugs from the group of antispasmodics and analgesics. But "Ibuprofen", "Diclofenac", "Aspirin" and other non-steroidal anti-inflammatory drugs should not be taken, as they can weaken the effect of drugs given by the doctor.

Discharge after medical termination of pregnancy is abundant, stronger than during menstruation. Rarely, acute bleeding occurs. This is if the sanitary napkin is completely soaked in an hour, and this continues for 2-3 hours in a row. Then you need to urgently seek help. Usually, doctors prescribe a hemostatic drug.

After a miscarriage, the discharge becomes much more abundant. However, they can persist in small quantities for up to 14 days. Around this time, an ultrasound scan is performed, which should confirm a complete miscarriage. Otherwise, the woman will face vacuum aspiration. Signs of incomplete miscarriage are pain in the uterus and ovaries, fever, prolonged bleeding, unpleasant odor from the vagina, etc. An incomplete abortion leads to endometritis. And that one to infertility, in the absence of treatment.

The menstrual cycle after an artificial miscarriage in most women does not go astray. That is, menstruation after drug termination of pregnancy must be expected at the usual time. And if a woman began to take oral contraceptives, then there will be no problems with calculating the date of the beginning of critical days. They will start 3-7 days after you have taken 21 contraceptive pills. Since few people are planning a pregnancy after drug termination in the near future, this is a wonderful way out. And the cycle will be restored, and there will be no more abortions.

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Despite the abundance of contraceptives, termination of pregnancy remains one of the most popular medical procedures. Therefore, it is so urgent to develop methods that leave the least damage in the woman's body. Pill abortion has been studied since the second half of the last century and in 1988 the first license for this activity was obtained in France. In Russia, early medical abortion began to be practiced only ten years later.

The essence of the procedure

By taking the necessary drugs in a certain sequence in the early stages of pregnancy (up to 6 weeks), an artificial miscarriage is provoked. This is possible while the fetus is not yet sufficiently formed and the ovum is poorly attached to the walls of the uterus.

Advantages of the method

Any abortion has many-sided effects on the body. Changes occur in the genitals, nervous, endocrine, cardiovascular and other systems of the body. How the abortion will be performed depends not only on the woman's desire, but also on the state of her body. But if there are no contraindications, then a medication is offered, the most gentle of the most commonly used.

Comparison of medical and surgical methods of abortion

Indicators / methods	Medication	Surgical
Vacuum aspiration	Curettage
Method efficiency (%)	95-98	95-99	95-97
Surgical intervention	–	+	+
Perforation of the uterus	–	+	+
Cervical injury	–	–	+
Menstrual irregularities	+	+	+
Inflammatory diseases of the genital organs	+	+	+
Hematometer (accumulation of blood in the uterine cavity)	+	+	+
Infertility	–	–	+

Among the main advantages of medical abortion, women highlight the ability to stay at home, use it early in pregnancy, minimal trauma to the uterus, a lower risk of infectious complications, the absence of manipulations that carry a certain share of risk and complications (the effects of anesthesia, hepatitis, HIV, etc.).

Contraindications

If you put together the list of contraindications for abortion in general and specific contraindications for medical abortion, you get an impressive list:

• intolerance to the drugs used;
• inflammation of the genitals or scars on the uterus;
• infectious diseases;
• ectopic pregnancy;
• severe cardiovascular disease;
• severe liver and kidney dysfunction, including chronic adrenal insufficiency;
• smoking and age over 35;
• inflammatory diseases of the gastrointestinal tract with chronic relapses;
• anemia or blood clotting disorder;
• lactation;
• long-term use of hormonal contraceptives stopped before pregnancy;
• severe course of obstructive bronchitis or bronchial asthma with glucocorticoid intake;
• porphyria (an inherited disorder of pigmentation disorders).

Medications Used for Early Abortion

A number of tools have been developed for medical abortion, including:

• "Mifeprex" (contains the active substance mifepristone),
• "Mifolian" (the active substance is mifepristone),
• "Pencrofton" (active substance mifepristone),
• "Mifegin" (micronized mifepristone),
• Misoprostol.

The classic medical abortion remedy is used strictly under medical supervision!

They all contribute to miscarriage. The active substance of the drug initiates the detachment of the ovum from the wall of the uterus and its withdrawal with abundant discharge, similar to menstrual flow. Basically, "Mifepristone" is used on the first day of taking the drug and "Misoprostol" at the next visit to the doctor in 36–48 hours.

The effect of "Misoprostol" is significantly reduced by smoking more than 10 cigarettes per day.

"Mifepristone" breaks the connection of the ovum with the wall of the uterus, slightly increases its tone and opens the cervix, creating conditions for termination of pregnancy. "Misoprostol" increases the activity of the uterus and the egg with the rejected endometrium is removed from the cavity.

Scheme of the

The procedure is performed on an outpatient basis in several stages in the early (up to 6 weeks) stages of pregnancy:

Side effects

A third of women tolerate the procedure with little or no discomfort. Women who have not given birth, especially those who have previously experienced soreness during menstruation, may develop pain syndrome, accompanied by diarrhea, nausea, or vomiting. However, the usual pain relievers cannot be used - the abortive effect of the drugs taken in the outpatient clinic may be blocked.

To reduce pain, alternative therapy methods can be used - rest, dry heat, hot drinks. In extreme cases, "No-shpa" or "Drotaverin" are used. The realization that the chosen method of abortion is the most benign of the existing ones and entails the least consequences, should also serve as support in this short-term period of pain.

Remember that taking most pain pills during the process of fetal rejection may not be the best.

Determination of performance

36–48 hours after the abortion, a control ultrasound is performed to detect cases of hematometers (stagnation of blood in the uterus), and 10–15 days later, a control examination and repeated ultrasound to ensure the effectiveness of the manipulations and the absence of complications.

Possibility of ineffectiveness of the procedure

In 3-5% of cases, the ovum is partially removed. In the first pregnancy, the risk of incomplete abortion is higher. This is recognized on control examinations and ultrasound. The consequences are eliminated by surgical abortion.

With increasing gestational age, the possibility of maintaining pregnancy also increases, but the total number of such cases does not exceed 1%. The remaining pregnancy is detected on examination and ultrasound in 1–2 weeks after the abortion. In such cases, vacuum aspiration is recommended.

Negative consequences

Any termination of pregnancy cannot pass without consequences for the female body, but medication is the most gentle of all, since it is carried out in the early stages and does not provide for surgical intervention that injures the cervix and uterine cavity.

Early

• Stagnation of blood in the uterus (hematometer). They use drugs that enhance the contraction and eliminate the spasm of the cervix, and in the absence of a result, the contents are sucked off by vacuum aspiration. If inflammation develops, aspiration is delayed and antibiotic therapy is given.
• Heavy bleeding during abortion. With excessive blood loss, the likelihood of which increases with increasing gestational age, it is possible to use curettage (curettage) of the uterus.
• Infectious complications are much less common than after surgical termination of pregnancy. To reduce the risk, a bacterioscopic examination is required before the procedure.

Late complications

• decreased immunity;
• hormonal imbalance (most often menstrual irregularities, less often - weight gain);
• psycho-emotional problems;
• dysbiosis of the gastrointestinal tract and vagina (as a rule, it is a consequence of a combination of the above three complications);
• dysplasia of the mammary gland.

The best way to prevent unwanted pregnancy is to use contraceptives. If you happen to resort to interrupting it, then the most gentle method is medication. It has the least consequences in the short term, and there is no need to talk about the long term, since health problems are not only among those who have abortions, and hardly anyone can accurately determine the past catalyst of current diseases.

Despite the availability of various effective contraceptives on the market, abortion remains one of the main methods of birth control and family planning.

Adverse consequences of early drug abortion (bleeding, chronic inflammation, miscarriage of subsequent pregnancies, endometritis, etc.) are very rare.

The pharmacological method, which has been used since 1980 in France and since 1998 in Russia, is the safest and most sparing method compared to traditional curettage, vacuum curettage and vacuum aspiration (mini-abortion).

It will be interesting for you to familiarize yourself with:

How does medical termination of pregnancy occur?

The termination of an unplanned pregnancy with pharmacological agents is achieved by the use of antiprogestins and prostaglandins.

Antiprogestins are synthetic progestational steroids with no hormonal effects. Currently, such proven drugs are used for medical abortion as Mifepristone and its analogues from different manufacturing companies - Pencrofton, Mifegin, Mifeprex, Mifolian, Postinor. All of them are synthetic antigestogenic agents.

The mechanism of their effect is to bind to receptors that normally perceive and respond to the ovarian corpus luteum hormone progesterone, which is the main hormone of pregnancy. As a result:

• the effects of progesterone are blocked;
• the concentration of prostaglandins synthesized by the cells of the decidual (falling off) shell of a fertilized egg increases;
• the sensitivity of the myometrium to the influence of prostaglandins (prostaglandin E1) increases;
• the capillaries of the mother in the decidua are destroyed.

Prostaglandins are produced in the body. They cause uterine contractions and strengthen them, which leads to detachment of the membranes of the fertilized egg from the wall of the uterus, to necrosis (death) of the latter and its removal from the uterine cavity. This is preceded by a softening of the cervix and the expansion of its cervical (cervical) canal. However, in most cases, they are not able to provide sufficient uterine contractility. Therefore, to enhance the effect of natural prostaglandins, that is, to ensure adequate force of uterine contractions and cervical dilatation, their synthetic counterparts are additionally used - Misoprostol, Mirolyut, Saitotek.

Methodology for medical abortion and contraindications to it

When a woman determines the presence of an unwanted pregnancy, it is necessary to consult a gynecologist as early as possible due to the fact that the terms of medical abortion are limited to 42 days (6 weeks), counting from the first day of the last menstrual cycle.

The patient preliminarily receives information from the doctor about the essence of the method of tablet termination of pregnancy, symptoms and options for its course, possible complications and consequences. After carrying out generally accepted examinations and clarifying the duration of pregnancy, a written consent is taken from the woman for an abortion.

The accepted scheme of medical termination of pregnancy is as follows:

1. In the presence of a doctor, the patient takes Mifepristone or one of its analogs at a dose of 600 mg (3 tablets) and is under the supervision of medical personnel for 1-1.5 hours. This is necessary to prevent the occurrence of side effects (nausea, vomiting, allergic reaction, etc.).

   After 2 hours, the plasma content of this drug becomes as high as possible. Within 12 hours after taking it, the tone and contractility of the uterus increase, which after 36-48 hours reach their highest level. During this period, a menstrual reaction occurs (usually after 24 hours), which may be accompanied by painful sensations in the lower abdomen, dizziness and headache, skin rash, weakness, nausea and vomiting, diarrhea, high fever.

   On the recommendation of a doctor, pain can be stopped by taking analgesics (Ketanov, Ketarol) and antispasmodic (No-shpa) drugs. It is not recommended to take acetylsalicylic acid preparations, as they can increase the amount of blood loss.

2. At the next visit to the doctor, which is appointed after 36-48 hours, the woman takes prostaglandin Mirolyut inside at a dose of 200 μg (1 tablet) or 400 μg (at the discretion of the doctor) in order to enhance the contractility of the uterus. The expulsion of the dead ovum with membranes occurs within two hours after taking them or in the coming days, in which there may also be nausea, vomiting, dizziness, cramping pains in the lower abdomen.
3. After 7 and 14 days (as prescribed by the gynecologist), another visit to the clinic is recommended, during which a repeated ultrasound examination of the uterine cavity is carried out in order to establish the fact of a successfully completed abortion. Sometimes blood clots remain in the uterine cavity, which come out on their own or after the appointment of injectable or tablet drugs that enhance its contraction.

Contraindications to medical abortion:

1. Cases of hypersensitivity to Mifepristone, if it has already been used in the past.
2. Exceeding the terms of pregnancy established for the drug method.
3. Pregnancy that has arisen against the background of an intrauterine method of contraception or after the abolition of hormonal contraceptive drugs.
4. Suspected ectopic (ectopic) pregnancy.
5. Breastfeeding (it should be stopped for 2 weeks).
6. Acute inflammation or exacerbation of chronic diseases of the female genital organs.
7. Large uterine fibroids, endometriosis.
8. The presence of a scar on the uterus after a cesarean section and its malformations (saddle, two-horned uterus) are a relative contraindication.
9. Blood clotting disorders and previous treatment with drugs that reduce clotting.
10. Chronic adrenal, renal or hepatic insufficiency, severe anemia and blood diseases, bronchial asthma and chronic obstructive pulmonary disease and other severe somatic diseases.
11. Long-term use of glucocorticosteroid drugs.
12. Age over 35 years with vascular hypertension, coronary heart disease, or in the case of using more than 20 cigarettes in 1 day (relative contraindications). Smoking until the specified age in the absence of concomitant diseases does not lead to negative consequences and is not a contraindication.

Benefits and possible consequences of pharmacological abortion

Despite the fact that it is impossible to completely eliminate the negative consequences of medical abortion, the use of antiprogestins in combination with prostaglandins is the most optimal and highly effective method of early abortion. Its advantages over other methods are:

• relatively physiological effect on the woman's body;
• minimal hormonal and psychological stress;
• no need to use rough instrumental intervention, which significantly reduces the risks of mechanical injury, subsequent inflammatory and adhesions and associated secondary infertility, as well as risks possible complicationsassociated with anesthetic benefits;
• no danger of introducing the immunodeficiency virus (HIV), hepatitis B and C viruses;
• a significant reduction in the risk of developing antibodies to the Rh factor in women with Rh-negative blood group, the development of Rh-conflict in the fetus during repeated pregnancy.

The main negative consequences include:

1. Bleeding.
2. Changes in the cycle and duration of menstruation.
3. Pregnancy.

As a rule, bleeding after medical termination of pregnancy in terms of blood loss is the same as during normal menstruation or slightly exceeds menstrual flow (in 85% of cases). But in 10-11% it is abundant with clots, which occurs most often with incomplete detachment of the ovum or the delay of its parts or blood clots in the uterus. This may require vacuum extraction (removal), instrumental revision followed by curettage of the uterine cavity, hemostatic (hemostatic) therapy, and even blood substitutes transfusion.

Quite often (in 40% of women) there is a menstrual delay after medical termination of pregnancy, which is explained by a change in the psychological state of a woman and, more importantly, by double hormonal changes in the body. It occurs when the egg is fertilized, and then after the termination of pregnancy.

The restoration of menstrual cycles occurs individually for each woman. It is impossible and unnecessary to influence this. A new countdown of the first day of menstruation should be carried out from the moment the bloody discharge appears during an abortion. The next cycle of menstruation may be delayed by 7-10 days, which is considered normal. Minor delays are possible in subsequent months, and the duration of the cycles themselves often increases. The restoration of regular menstruation can take 2 to 7 months.

If the delay in menstruation exceeds the specified periods, this may indicate in favor of the fact that pregnancy after medical abortion has not been eliminated (occurs in 2-4% of women) or has new pregnancy... In these cases, it is necessary to carry out an analysis for the level of human chorionic gonadotropin (hCG) in the blood and an ultrasound examination, followed by a visit to a gynecologist in order to establish the cause of the delay in menstruation. If there is no pregnancy, the use of hormonal contraceptives may be recommended by the doctor for its subsequent prevention.

The effectiveness of the pharmacological method is 98%. Thus, medications used to terminate early pregnancy are completely safe for a woman's body. Subject to all the rules of use, they are usually well tolerated, do not affect the hormonal background and metabolic processes, and also make it possible to almost completely eliminate the risks of infections and associated complications, to reduce the severity of psychological stress, which almost always accompanies the traditional method. Medical abortion is the method of choice when planning future pregnancies, especially for women who have not yet given birth.