Abortion

Abortion (synonym - miscarriage) - interruption of pregnancy before the expiration of 28 weeks, when the fetus is still viable. Abortions can be divided to spontaneous or induced.

Spontaneous abortion

occurs without intervention, against the wishes of the woman. Most often the reasons for it are acute and chronic infections (influenza, sore throat, fever, malaria, tuberculosis, brucellosis, toxoplasmosis, syphilis , and so on), cardiovascular diseases, diseases of liver, kidneys, endocrine disorders, in some cases RH incompatibility between the mother's blood and the blood of the foetus, chronic poisoning (mercury, petrol, nicotine, alcohol, manganese and others). In addition, spontaneous abortion may be caused by diseases of the genital organs (inflammation of the uterus and appendages, tumors), the wrong provisions of the uterus, etc.
Begins spontaneous abortion pulling pain in the lower abdomen and lumbar-sacral region, bleeding different intensity. In the course of spontaneous abortion to distinguish several stages.
Threatening abortion - cramping abdominal pain; bleeding from the genitals minor or absent. The value of the uterus corresponds to the period of pregnancy, the outer cervix the cervix is closed. In this stage, abortion, pregnancy is still possible to save. Treatment - in bed for 2-3 weeks, vitamin E(oily solution) 1 teaspoon 3 times a day. An ice pack is not placed (risk of uterine contractions and detachment of the ovum!).
Started abortion - periodic cramping abdominal pain, back pain, bleeding (partial detachment of the ovum). The value of the uterus corresponds to the period of pregnancy, the outer cervix cervical slightly opened. Pregnancy can be saved. Treatment is the same as when threatened abortion.
Abortion in progress (made abortion) - periodic cramping abdominal pain and lower back, a significant uterine bleeding (detachment of the ovum over a large area, but it is still in the uterus. The value of the uterus corresponds to the period of pregnancy, the outer cervix the cervix is open, and through him are defined part of the ovum. Bleeding threatens a woman's life, if time will not be rendered medical assistance. The treatment, the patient is subject to immediate hospitalization. In the hospital, you can remove the ovum from the uterus (see Scraping), and blood transfusions (if indicated).
Incomplete abortion - rich uterine bleeding, cramping abdominal pain in the lumbosacral region. The value of the uterus several smaller than observed during this period of pregnancy, in the cavity of the uterus remains of parts of the ovum. Treatment the patient should be urgently hospitalized. In the hospital, make a removal of parts of the ovum from the uterus, appoint tools that reduce the uterus, and the evidence produced a blood transfusion. In severe condition of women and the inability of urgent hospitalization midwife should call a doctor immediately for assistance on the spot.
Complete abortion (ended abortion) - fertilized egg completely out of the uterus. The patient may feel periodically minor pain in the lower abdomen. The bleeding stops. The value of the uterus less than usually observed at this stage of pregnancy, the outer cervix the cervix is closed. Treatment - the surveillance of the patient. Instrumental examination of the uterus is at the discretion of the physician.
Missed abortion (delayed abortion) - intrauterine fetal death, and the fetus is expelled from the uterus sometimes a long time. The diagnosis is based cessation increase of the uterus (the value is less than the observed during this period of pregnancy), the disappearance of subjective signs of pregnancy. Treatment - conservative wait-and-see, as usual (with rare exceptions) the fruit eventually expelled. The midwife should refer women with incomplete abortion (or suspected) to the doctor. When the first signs of bleeding or labor (the abortion in late pregnancy) shown surgery (scraping of the uterus) or stimulation generic activities.
Cervical abortion - a kind of abortion in progress. The fertilized egg, separated from the mucous membrane of the uterus, is lowered into the cervical canal. The antenatal women fertilized egg meets many obstacles from the side of the external OS. Therefore it is "stuck" in the cervical canal. The fertilized egg dilates the cervix, forming the characteristic pot its shape. Bleeding in this form of abortion can be abundant. The midwife in the case of cervical abortion should urgently organize medical aid to a woman.

Abortion

There are medical or legal abortion performed by the doctor-gynecologist in the hospital, and the criminal, illegal, unsafe abortion, produced outside the facility by the woman herself or by an outside entity. Criminal abortion is a criminal offence. Punishment shall not be subject only to the very pregnant woman.
Medical abortion is made at the request of the woman to terminate the pregnancy or for medical reasons. Abortion is shown in organic defeat of the heart and blood vessels, liver disease and kidney, malignant tumors, malignant anemia, open form of pulmonary tuberculosis, tireotoksicski goitre, hypertension and other diseases.
Direction to the hospital for the abortion gives the doctor after a thorough examination of the pregnant and clarify, there are no contraindications to abortion. Abortion is contraindicated in acute and subacute inflammatory processes in the sex organs, gonorrhea, cervical erosion, the presence of purulent foci regardless of their location, when pregnancy is over 12 weeks if less than 6 months. after a previous abortion. Termination of pregnancy for a period of more than 12 weeks is allowed only in case if continuing the pregnancy and childbirth can threaten the health and lives of women. Indications for abortion in this case are determined by the physician together with the head of that institution, where the hospitalized patient.
The operation of artificial abortion produces necessarily doctor method curettage, or by vacuum aspiration (see Vacuum accogliere). After surgery, artificial abortion is necessary to monitor the heart rate, temperature, dynamics of contractions and discharge from the genital tract.
On average after surgery abortion the woman is in the hospital for 3 days. The day of discharge is solved your doctor depending on the General condition of the patient: at normal temperature, the absence of pain in the uterus and the absence of bleeding woman may be discharged from hospital.
After discharge the woman should be under the supervision of female consultations, as abortion is dangerous by its complications. They may occur during the operation of abortion: the gap cervical and uterine bleeding and so on, as well as in the remote period - inflammation of the uterus and appendages, menstrual disorder, secondary infertility, abnormal function of the endocrine system, and so on, Especially dangerous abortion for pervoverhovnyh and in the presence of the sex of infantilism.



Medical abortion

Medical abortion (tablets) this artificial interruption of pregnancy is not surgically, and using drugs.
To criminal abortion is more often women, who are not members under surveillance antenatal clinic. Most often, to interrupt pregnancy in the uterus introduce solid objects, plants, and is the inside means that cause uterine contractions, and other
Treatment. Sick with criminal abortion regardless of the General state to be hospitalised.
In hospital there must be no damage to the reproductive organs (the vagina, cervix and the uterus, and so on). Most often, when violations of the uterus (perforation) are common concern, sharp pain around the abdomen, irritation symptoms of peritoneal, frequent heartbeat, low blood pressure (painting internal bleeding). In such cases, see the operation (see the Uterus, damage).
If excluded perforation of the uterus, assistance is provided depending on the General condition of the patient and the presence of bleeding. In profuse bleeding regardless of the presence of signs of infection make a removal of the ovum from the uterus with the subsequent appointment of antibiotics and reduce the uterus funds. If the bleeding is missing or there are slight bleeding, the presence of infection treatment by a conservative, assigning peace, reduce the uterus means, antibiotics, ice on the stomach.
Criminal abortion hazardous many serious complications: there are often gaps soft generic ways, fatal bleeding, septic processes, and so on . After the abolition of the prohibition of abortion in the USSR (1955) mortality in artificial abortion. significantly decreased, largely due to a sharp decrease in the proportion of unsafe abortions.

Infected abortion is one of the serious complications during abortions. Germs can spread into the uterus from the vagina during prolonged spontaneous abortion. (especially if the woman was not long sought medical help), but most often they are put into the uterus during criminal abortion. The clinical picture depends on the distribution process.
If the infection does not spread outside of the uterus (uncomplicated infected abortion), the General condition of women is satisfactory, the temperature is low, the stomach at a palpation mild; the uterus in the study painless, the uterus is not changed.
If the infection has spread to the uterus, pelvic peritoneum, the tissue (complicated infected abortion) appear high fever, abdominal pain, soreness of the uterus, changes appendages; possible infiltrates in parametrium. Sometimes there is a General septic process (septic abortion) with the clinical picture of sepsis (see).
Treatment. When the infected abortion shows urgent hospitalization of the patient. In uncomplicated abortion infected scraping mucous membrane of the uterus is carried out only in the presence of heavy bleeding. Prescribe antibiotics, sulfa drugs. In complicated and septic abortion, if not threatening the life of the patient bleeding, conservative treatment: antibiotics, sulfa drugs, restorative, painkillers, as well as a tool to stimulate the contractility of the uterus (pituitrin, quinine and other).

Prevention of abortions

Continuous and comprehensive care for mothers and children received its expression in numerous legislative acts of the Soviet state and enshrined in the Constitution of the USSR.
One of the most important decisions was the Decree of the Presidium of the Supreme Soviet of the USSR of November 23, 1955, "On the abolition of the prohibition of abortion". Cancel the prohibition of abortions has protected the health of women from the dangers of unsafe abortion and gave her the right to resolve the question about motherhood.
The Decree reads, "reducing the number of abortions can be further ensured by further expansion of state incentives maternity, as well as measures of educational and explanatory character".
Considering the immediate and long-term effects of abortion (inflammation of the genital organs, secondary infertility, the menstrual function and others), required extensive medical and educational work on the harm of abortions. In this work the important role of the midwife.
The prevention of spontaneous abortion primarily to the treatment of diseases, which are the cause of them, the prevention of acute infections in pregnant women, the decrease of morbidity with toxicosis of pregnancy. You must also strict observance of law on labor protection of women. Further growth in public activities aimed at the promotion of motherhood, growth of residential construction, further improvement of the cultural level of the population, the emergence of new effective contraception would reduce the number of abortions.