We are not going to arrange a holivar between the “right to life” and “right to choose” parties, we will not consider this topic either from an ethical, or from a political, or from a religious point of view. Only with medical. The gynecologist tells how this happens. And no one else.
Surgical abortion (curettage)
This is the most common method in Russia, although WHO, in its 2012 recommendations, called for replacing it with vacuum aspiration everywhere.
Under the current legislation, instrumental abortion without medical indications can be used for up to 12 weeks (technically, it can be used for up to 22 weeks). Before an abortion, the doctor is obliged to prescribe and conduct a series of examinations: a gynecological examination, ultrasound, sampling and smear analysis, as well as tests for HIV, syphilis, hepatitis, a blood test for a group, Rh factor and coagulability.
The procedure is carried out under the supervision of an anesthesiologist, anesthesia is administered intravenously.
The curettage procedure (the correct name is curettage) is preceded by a special treatment of the cervical canal – dilatation: a dilator is introduced, which, gradually swelling, opens the canal. After that, with the help of a curette, the tissues of the fetal egg are destroyed and removed. Sometimes the procedure ends with an additional vacuum aspiration – the doctor must make sure that the contents of the uterus are completely removed.
The operation itself takes no more than half an hour, but subsequently, careful care of the patient is important. She is prescribed drugs to reduce the uterus. It is not recommended to lift weights, take a bath, swim for the first two to three weeks. Sexual life can be resumed no earlier than a month later.
- With surgical abortion, there is a risk of damage to the walls of the uterus. Even with minimal trauma, endometriosis can develop.
- With insufficient qualification of the doctor, germinal elements may remain in the uterus, which will lead to bleeding and inflammation.
- Under non-sterile conditions, it is possible to infect the internal genital organs, which can threaten inflammation of the uterus and its appendages.
- It is also possible hormonal failure, which is fraught with infertility.
- As a result of dilatation, church insufficiency (weakness of the cervix) can develop, which in subsequent pregnancies can cause miscarriage.
In this variant, a vacuum pump is used to extract the contents of the uterine cavity.
Before the operation, the patient undergoes the same examinations and passes the same tests that are prescribed for surgical abortion.
The operation itself takes place in the gynecological chair under local anesthesia. The walls of the vagina are treated with an antiseptic, then an anesthetic is injected into the cervix. A cannula is inserted into the uterus, negative pressure is created inside – as a result, the fetal egg exfoliates and is pulled into a special container.
The procedure can be carried out for up to 12 weeks (in Russia they usually talk about up to six weeks). After an abortion, sexual activity should be avoided for a month.
The risks of vacuum abortion are the same as those of an instrumental one, but (according to WHO data) are 2.5 times less common.
In our country, medical abortion is carried out if the gestational age does not exceed six to seven weeks, although WHO considers it practically safe for up to nine weeks.
The action of the drugs is aimed at blocking the hormone progesterone, which is responsible for the development of pregnancy. In addition, the preparations contain prostaglandins – substances that stimulate muscle contractions in the uterus, as a result, the fetal egg is pushed out of its cavity.
Despite the seeming simplicity of carrying out, medical abortion should take place in the clinic under the strict supervision of a doctor. The whole procedure takes three to four days.
After it is carried out, the doctor is obliged to conduct an ultrasound scan and a gynecological examination: an incomplete abortion is possible, then additional vacuum aspiration will be required.
Medical abortion is considered the least traumatic, since the uterine mucosa is not subjected to mechanical stress.
Other types of abortion
Late abortions (more than 12 weeks) are carried out only for medical or social reasons (for example, if the pregnancy resulted from rape).
After dilating the cervix, the doctor pierces the fetal bladder with a needle and removes a certain amount of fetal fluid, after which a special solution is introduced, from which the fetus dies, the patient begins labor.
Termination of pregnancy in the later stages threatens with great complications and is associated with a risk to the life of the patient. It is also important that when a pregnancy is terminated at a later date, women are more likely to experience depression and mental changes. Often this requires the help and intervention of a psychologist.