Today, medical abortion is recognized as the safest method of terminating an unwanted pregnancy at an early stage. Medical termination of pregnancy is carried out using hormonal drugs. Indications, contraindications, description of the method, types of tablets, cost of the procedure, main pros and cons - more on this later in the article.

What is medical abortion

Medical abortion (also known as pharmaceutical abortion or pharmaceutical abortion) is a gynecological procedure to terminate a pregnancy without surgery, using hormone-based medications. The pharmaceutical method is carried out until the 7th week of pregnancy.

This is the most gentle method of terminating an unwanted pregnancy, as recognized by WHO. However, even pharmaceutical abortion does not always guarantee a successful result. Medical mini-abortion up to 42 days from the first day of the last menstruation or with a delay of no more than 2 weeks from the date of onset of menstruation is effective in 95% of cases, after which the effectiveness of using abortive pills decreases.

Medical abortion does not affect a woman’s reproductive function, and a new pregnancy can occur one month after the abortion, so you should definitely use protection.

Indications for medical abortion

There are no strict indications for pharmabort; the procedure is most often carried out at the woman’s request. Doctors strongly recommend taking the necessary tests before the procedure to avoid complications.

Basic medical indications for pharmacobort

HIV infection;

Advanced form of syphilis;

Mental illnesses;

Oncological diseases;

Serious illnesses that threaten the life of the pregnant woman;

Hereditary genetic diseases;

High risk of embryo pathologies or miscarriage.

Social indications for abortion with medications

The mother's stay in prison;

Pregnant woman's age is up to 16 years;

Absence of a legal husband;

Group II-III disability in a born child.

Preparations for pharmaabortion

If you decide to have an abortion at home using pills, then you should familiarize yourself with the list of medications for medical abortion, which are most often used to terminate pregnancy:

1. Postinor is a popular emergency contraceptive drug that is used after unprotected sexual intercourse. The package contains 2 tablets that contain levonorgestrel (an analogue of progesterone). Method of administration: oral. The first tablet should be taken no later than 72 hours after unprotected intercourse, and the second - 12 hours after the first. According to doctors, this is not a very reliable remedy, since it is possible to terminate a pregnancy only in 84% of cases. But it can be done independently at home without prior consultation with a gynecologist. The consequences of the action of postinor lead to hormonal imbalance.

2. Pencrofton is a synthetic hormonal drug for medical abortion. Produced in Russia. The main component of the drug mifepristone is a synthetic steroidal antiprogestogen that is used to prepare for an abortion. This drug is suitable for nulliparous women. Mifepristone does not cause many complications of abortion, such as infertility.

3. Mytholian is a medicine that is used for safe abortion, manufactured in China. The drug also contains mifepristone. The medication is used until the 7th week of pregnancy. The main component destroys the connection between the fetus and the uterus, resulting in a miscarriage. Also, with the help of medication, labor is stimulated.

4. Mifepristone is a drug that provokes the rejection of the fertilized egg from the endometrium (inner surface of the uterus). It is recommended to take 3 tablets at once. The main component of the drug is mifepristone. Tablets are produced in Russia.

5. Mifeprex is an effective medication that is used for postcoital contraception. The drug is well tolerated by women up to 6 weeks of pregnancy. As a result of taking the drug, bloody discharge appears. The drug is produced in Russia.

6. Mifegin– a steroid drug for early termination of pregnancy. Country of origin: France. The components of the drug destroy the connection between the embryo and the uterus, and a miscarriage occurs.

These are the most popular names of drugs for medical abortion based on the synthetic steroid drug - mifepristone; there are many other analogues for terminating an unwanted pregnancy.

Description of the medical abortion procedure

The timing of a medical abortion is very limited; the procedure can be performed up to 6 weeks after the first day of the last menstrual period (or up to 7 weeks after the end of the last menstrual period). The most optimal period for performing a pharmaabortion is 4 weeks of pregnancy, since during this period the fetus is weakly attached to the endometrium. At later stages there is a risk of incomplete miscarriage.

In clinics, medical abortion is performed on the day of treatment; for this, the woman must first undergo an examination by a doctor to determine the presence and duration of pregnancy, the gynecologist must exclude ectopic pregnancy and contraindications to the procedure, the pregnant woman undergoes blood and urine tests, then an ultrasound is performed. After receiving all the examination results, the doctor makes a conclusion about the advisability of performing an abortion with medications.

Many women ask the question: “How is abortion done with pills?” Pharmaceutical abortion occurs in several stages:

1. A woman drinks 3 tablets of Mifepristone in the presence of a gynecologist who observes the patient for 2 hours. The tablets should be taken after meals, 1-1.5 hours later, with a glass of water. As a result of taking the drug, the connection between the uterus and the fertilized egg is destroyed and the embryo dies. Then the doctor recommends medications for the second stage of abortion. Normal phenomena after the first stage of pharmaabortion are nagging pain in the lower abdomen, bloody mucus is released from the vagina.

2. After 1.5–2 days, the woman takes prostaglandins that the doctor selected for her, for example, misoprostol. As a result of taking medications, the uterus begins to contract, and the fetus comes out of its cavity. Characteristic symptoms: nagging pain in the lower abdomen, discharge reminiscent of menstruation. After taking the drug, the woman is under the supervision of a doctor for 2 hours. The patient should strictly follow the doctor's instructions and take only the painkillers prescribed to her.

3. After 48 hours, the woman undergoes an ultrasound examination. After 1 - 2 weeks, depending on how she feels, the patient should undergo a repeat gynecological examination and ultrasound examination.

If a medical abortion was unsuccessful, the pregnancy cannot be continued. It is necessary, if time permits, to do vacuum aspiration or surgical curettage.

Important! While taking medications containing mifepristone, it is not recommended to use non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, aspirin, diclofenac, analgin, etc., for 8-12 days.

How long does bleeding last after an abortion?

According to doctors, bleeding may not stop until the next period, or it may be scanty - the main thing is that the fertilized egg should be released, so after taking the drug you need to monitor the discharge. The next period should come from 20 to 50 days after the medical abortion.

Contraindications to medical abortion

Pharmaceutical abortion is a medical procedure that has a number of contraindications. It is prohibited to perform the procedure if you have an allergic reaction to the components of the drug or various diseases. The harm of medical abortion is obvious, despite the fact that the procedure is considered gentle.

Pharmaboration is prohibited in the following cases:

Hypersensitivity to mifepristone;

Development of the fetus outside the uterine cavity;

Diseases of the digestive tract;

Inflammatory diseases of the genital organs;

Benign tumor of the uterus;

Functional failure of the liver and kidneys;

Pregnancy that occurred while using intrauterine contraceptives (for example, a device);

Anemia and diseases of the blood coagulation system;

Anemia;

Taking corticosteroids and anticoagulants.

Women who smoke after 35 years of age should carry out the procedure with caution, as cardiovascular disorders may occur. Restrictions apply to women with scars on the uterus after surgery, hypertensive patients and lactating women. Nursing mothers after an abortion should transfer their newborn to artificial nutrition for 2 weeks.

Complications after medical abortion

Complications can occur even if the doctor and woman strictly follow all instructions:

Intense uterine bleeding after medical abortion;

Painful sensations in the lower abdomen;

Nausea, bouts of vomiting;

Loss of strength, dizziness;

Increased blood pressure, severe headache;

Temperature above 38°;

Allergy.

What to do if the test is positive after a medical abortion?

This condition indicates an incomplete abortion - this is a pathology in which the fertilized egg does not completely exit the uterus. This is a serious problem that requires surgical intervention, which means that the uterine cavity must be cleared of fetal debris. In this case, vacuum cleaning or surgical curettage is performed.

Cost of the procedure

Many women are interested in how much does a medical abortion cost? This procedure is not available to many, since Mifegin and Mifepristone are quite expensive, and it is impossible to find the drugs in pharmacies, since the procedure must be carried out under the supervision of a doctor. The total cost of a pharmabort is influenced by the following factors: the level of the chosen clinic, the quality and quantity of necessary studies, the manufacturer of the medications used (Mifegin is a French drug, and Mifepristone is Russian). The price range for Mifepristone is from 33 to 60 dollars (2000-4000 rubles), and for Mifegin - from 60 to 75 dollars (3800-5000 rubles). There is also a Chinese drug - Mifolian, which costs from 20 to 40 dollars (1100-2500 rubles).

Where can I get a medical abortion?

These drugs are distributed exclusively by pharmaceutical companies, and pharmaabortion with the help of these medications is carried out only in private clinics and in some public medical institutions.

The cost of a pharmaceutical abortion includes a consultation, gynecological examination, 2 ultrasounds and tests. In a small town clinic, the first appointment, if the tests are ready, will cost about 500 rubles. Tests that include smear and blood tests will cost 600 rubles. For an ultrasound examination you will pay about 550-800 rubles.

If you live in a big city, then you will pay an average of 900-1800 rubles for tests. The remaining procedures with the drug will cost 5,000–8,000 rubles. If you are a resident of Moscow or St. Petersburg, then a medical abortion will cost from 5,000 to 14,500 rubles, this includes consultations, tests, drugs (the cheapest is Chinese, then Russian and the most expensive French) and 2 ultrasounds.

Pill abortions are a test for the female body. A long delay after a pharmaceutical abortion is not normal. If the procedure is successful, your period may be delayed by 8–10 days. In most women, the menstrual cycle is quickly restored, since there was no mechanical damage to the uterus and hormonal disruptions were minimized.

A woman after a medical abortion is strictly prohibited from:

Be sexually active for 14 days after the abortion;

Engage in physical labor;

Take a bath or visit a sauna;

Carry out douching;

Supercool.

Only if these rules are followed will a woman recover faster. Otherwise, uterine bleeding or inflammation may occur.

After pharmaabortion, ovulation may change, because of this there is a risk of repeat pregnancy after 10–12 days. Therefore, it is strongly recommended not to have sexual relations for 2 weeks after the procedure; in extreme cases, protect yourself with contraceptives. With rapid recovery, a woman can plan a pregnancy 12 weeks after pharmaabortion.

Pros and cons of the drug method

Tablet abortion has the following advantages

No anesthesia;

Minimal risk of infection and injury to the uterus;

The procedure can be carried out from the first day of a missed period;

The woman recovers quickly after pharmaabortion;

The effectiveness of the medicinal method is 95% and above.

Abortion using the pill has its downsides

Incomplete removal of the ovum in 4–8% of cases;

High risk of bleeding from the uterine cavity;

There is no complete guarantee of disposal of the embryo;

A large number of contraindications and side effects.

Thus, if you decide to have an abortion, you have no contraindications, and the timing allows, then pharmaceutical abortion is the best choice. In any case, consult a gynecologist and do not self-medicate, because the consequences can be the most terrible!

Pregnancy with an IUD

Medical termination of pregnancy (pharmabortion) is not a method of birth control, but a serious medical procedure that can lead to various kinds of complications. Its essence lies in the fact that a woman must take hormonal pills at a set time to perform a medical abortion and provoke the expulsion of the fertilized egg from the uterine cavity.

According to WHO, such an abortion is recognized as the most gentle method, but it does not always give a guaranteed result. As the gestational age increases, the effectiveness of the procedure decreases significantly.

If a woman wishes to terminate a pregnancy, preference is always given to the most effective methods - medication, or (for example, curettage is ideal in the presence of a placental polyp).

Can I have a medical abortion at 7 weeks, 8 weeks or later? The best option is 14 days after the delay. The reason is that after 6 weeks the fertilized egg is already quite well attached to the wall of the uterus, so the likelihood of its preservation increases. For example, if a medical abortion is performed at 8 weeks, its effectiveness rarely exceeds 88%.

Contraindications and indications

There are no strict indications for medical abortion. The woman must decide for herself whether to continue or terminate the pregnancy.

Relative medical indications for its interruption are:

• diseases that threaten the full development of the baby;
• severe genetic, somatic, infectious diseases;
• taking medications that can cause deformities and disrupt the full development of the fetus.

Social indications:

• minor age;
• rape;
• absence of husband;
• disability I or II in an existing child;
• serving time in prison.

With such a fairly serious procedure as abortion, the main contraindications to terminating a pregnancy with the help of medications will be:

• allergy to drugs used for abortion;
• fibroma or;
• severe renal or liver failure;
• Availability ;
• diseases of the blood coagulation system;
• anemia;
• taking blood thinners;
• high blood pressure, etc.

What is the procedure

In the usual understanding, medical termination of pregnancy is not like an abortion: a woman comes to the clinic, takes pills under the guidance of a doctor, and then she simply begins to have heavy periods, during which the fertilized egg is expelled along with the blood.

Preparation

At the first appointment, the gynecologist explains to the woman all the contraindications, risks, possible complications and how a medical abortion is done in general terms, as well as what to expect after it.

Laboratory and instrumental diagnostics

Before taking this step and deciding on a medical, vacuum or other type of abortion, a woman must undergo a fairly large number of studies:

• General (clinical) blood test , urine, (human chorionic gonadotropin), the level of which in the early stages is evidence of pregnancy. An ECG test is also taken for syphilis (RW).
• Ultrasound . During an ultrasound examination, the presence of a fertilized egg in the uterus is confirmed, ectopic pregnancy, as well as tumor formations of the uterus and ovaries are excluded.
• Examination by highly specialized specialists . Their consultation is necessary if a woman has any serious illnesses. It may also be necessary to adjust the intake of medications regularly taken by the patient in order for the drugs for medical termination of a developing pregnancy to be effective.
• Checking the blood coagulation system . For this, a coagulogram is usually prescribed, because if the blood does not clot well, severe bleeding may occur.

Direct preparation for abortion

If during a medical examination and laboratory diagnostic examination no contraindications were identified, the doctor gives the following recommendations:

• For a week, eliminate alcohol, smoking, taking anticoagulants and some other drugs.
• On the day of taking the first dose of the drug, food should be easily digestible.
• For the entire period of the abortion (3-6 days), care should be taken to ensure that if the woman’s condition worsens, someone will take care of her and run the household.

How is a medical abortion performed?

How is a medical abortion performed in a private or public clinic?

The procedure takes place in 3 stages:

1. At the doctor's office.
2. At home.
3. Follow-up visit to the doctor.

In the doctor's office, a woman who decides to have a medical abortion takes 3 tablets of mifepristone (600 mg) in the presence of a gynecologist, and then remains under his supervision for 2 hours.

Usually, before sending the patient home, the doctor gives her misoprostol tablets containing prostaglandin, leaves her his contact information and schedules the next visit to the clinic. This is done because he needs to observe how the woman’s abortion proceeds, whether the medications have the desired effect, and whether possible complications develop.

At home, after 1.5-2 days, the patient takes 2 tablets of misoprostol (400 mcg), which increases contraction of the uterine muscles. During the period of termination of pregnancy, some women experience severe pain. In this case, you should use medications to relieve pain.

How many days can a medical abortion last? On average, up to 6-7 days. It is at this time that blood loss is most significant and discharge is abundant.

A follow-up examination is scheduled on days 3 and 7-14. If, according to ultrasound and hCG analysis, the pregnancy has persisted, vacuum aspiration or classic curettage is performed.

What to do after a medical abortion

If a woman who has recently given birth had a medical abortion, until how many weeks can she breastfeed? According to most experts, you need to refrain from breastfeeding for 2 weeks, because the drugs used for medical abortion pass into breast milk, and their effect on the baby’s body has not been studied.

In general, the following recommendations should be followed:

• Avoid strenuous physical activity and heavy lifting during bleeding.
• For the first month after a medical abortion, in case of menstruation, use only pads and temporarily abandon tampons and menstrual trays.
• During the entire period of vaginal discharge, you should not take a bath, go to the pool, etc.
• Until how many weeks is sexual rest indicated? Sex after a medical abortion should be postponed for 3 weeks - 1 month. After termination, a new pregnancy can occur immediately with the resumption of sexual activity. Therefore, it is important to use.

It is impossible to predict how the reproductive system will behave after a medical termination of pregnancy has been performed: for some, during the next menstruation, the chest and lower abdomen hurt more than usual, for others, menstruation lengthens, etc.

In general, changes in the cycle are rarely observed, and if the abortion took place without complications, then the pattern of blood discharge during menstruation after it is the same as it was before the medical termination of pregnancy.

Complications

Although medical abortion is considered the least dangerous procedure, it can lead to a number of complications:

• Failed abortion . This condition occurs if the procedure is performed for more than 6 weeks, as well as when taking medications that reduce the effectiveness of mifepristone.
• Incomplete abortion . In this case, fragments of the fertilized egg remain inside the uterus, which can lead to various negative consequences, including death. An incomplete abortion can be suspected when bleeding suddenly stops, when a fragment of the fertilized egg clogs the cervical canal, as well as when there is a sharp increase in discharge during termination of pregnancy with the help of medications.
• Failure in the hormonal system . Pregnancy is a hormonal change in the body. Therefore, even in the early stages, its interruption causes a failure of this system, which can be perceived by the body as a stressful state. For example, as a result of this, after an abortion performed with the help of medications, breast pain may occur, menstruation may be disrupted, or chronic diseases may worsen.
• Complications associated with taking medications . After taking medications during a medical abortion, nausea, vomiting, diarrhea, stomach pain, headaches, fever, general weakness, and hot flashes occur. Dizziness, a sharp drop in blood pressure, loss of consciousness, and allergic reactions are also possible.
• Uterine bleeding . Heavy bleeding can lead to significant blood loss, including loss of consciousness. Therefore, if bleeding at home during a medical abortion increases and exceeds the expected volume of blood released, you should immediately contact your doctor.

Can a placental polyp occur after a medical abortion? Unfortunately, yes, if all particles of the fertilized egg have not been removed.

How to avoid complications

To avoid complications, including the appearance of a placental polyp and excessive bleeding, you should undergo a thorough examination on the eve of medical termination of pregnancy. At the same time, there is no need to hide the facts of the use of any drugs, the presence of a placental polyp after a previous medical abortion, as well as serious diseases that may become a contraindication to the procedure.

The decision to terminate a pregnancy by medication or any other method should be weighed, taking into account all the pros and cons, and not made based on emotions. It is also important to take into account the possible psychological consequences.

Pros and cons of medical abortion

Obvious advantages compared to other types of abortion:

• minimal trauma to the walls of the uterus;
• abortion can be performed already from the first or second day of a missed period;
• rapid recovery;
• when carried out early, the effectiveness is 95%.

Possible disadvantages of the procedure:

• high risk of bleeding;
• preservation of pregnancy in 5-22% of cases (depending on the duration of pregnancy);
• a large number of contraindications.

What is better for a placental polyp: medical abortion or curettage? In this case, curettage, because during this procedure it will be removed.

Medical termination of pregnancy is not a method of birth control - there are contraceptive methods for this. However, if certain circumstances arise as a result of which a woman decides to have an abortion, this method will be the most gentle. To minimize the risk of possible complications, you must undergo an examination and follow all doctor’s recommendations.

Useful video about medical abortion

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Medical methods of abortion are based on the use of drugs of various groups that affect the function of the corpus luteum and the contractile activity of the uterus, which leads to the termination of pregnancy.

Medical termination of pregnancy is considered effective when the products of conception are completely expelled from the uterus without the use of surgical intervention. Medical abortion is performed after pregnancy has been confirmed and its due date has been established. In the Russian Federation, it is legal to use medical abortion up to 6 weeks of pregnancy. Considering that the success of medical abortion largely depends on the gestational age, the latter is best confirmed using transvaginal ultrasound.

With medical abortion, medical supervision of the patient should be more intensive than with surgical abortion methods. After examination and signing written informed consent for the procedure, the woman takes the drug in the presence of a doctor. In some cases, it is necessary to monitor her for 3–6 hours. In cases where a combined method is chosen, the woman visits the doctor every time she takes the medicine. After 4 weeks, a woman is examined to confirm a successful termination of pregnancy.

In cases where medical abortion is ineffective, ends in incomplete abortion, progresses pregnancy, or is complicated by bleeding, surgical termination of pregnancy is performed. In some cases, vacuum aspiration is performed for other medical reasons (uncontrollable vomiting, intense pain).

DRUGS USED FOR MEDICAL ABORTION

The following groups of drugs are used for medical termination of pregnancy.
· Progesterone synthesis inhibitors (epostane©, not registered in Russia).
· Synthetic analogues of PG (misoprostol).
· Antiprogestins (mifepristone).
· Cytostatic drugs (methotrexate).

Progesterone synthesis inhibitors

Progesterone synthesis inhibitor (epostane, not registered in Russia) is an inhibitor of ovarian and placental 3bhydroxysteroid dehydrogenase, suppressing the synthesis of progesterone from its precursor pregnenolone.

A decrease in the concentration of progesterone in the blood is accompanied by expulsion of the fertilized egg. The use of epostan has historical significance. The US Food and Drug Administration does not recommend the use of epostane for medical abortion.

Synthetic analogues of prostaglandins

Synthetic PGs are used to terminate pregnancy because they increase the contractile activity of the uterus. PGE1 (Mirolut©) exerts its effect by enhancing adrenergic transmission at the presynaptic level, which leads to the release of norepinephrine from adrenergic terminals. In addition, PGs, like oxytocin, bind to specific receptors on the surface of myocytes, resulting in increased release of calcium from the endoplasmic reticulum and increased contractile activity of the myometrium.

In Russia, among the synthetic analogues of PGE1, only misoprostol (Mirolut©) is registered.

Unlike all PGs used to terminate pregnancy, misoprostol is stable at room temperature and can be administered orally. Its half-life is 30 minutes. Side effects from the gastrointestinal tract are mild, but occur in 35% of patients when taking the drug orally. There is no information about the development of dangerous side effects. According to various authors, misoprostol can be used up to 7–9 weeks of pregnancy. Various doses (from 400 to 3200 mcg) and regimens of drug use were studied. Misoprostol can be prescribed either orally or vaginally (effectiveness is higher when administered vaginally). In monotherapy, misoprostol is used in an initial dose of 800 mcg vaginally and then 400 mcg every 3 hours for 9 hours or 800 mcg every 12 hours 3 times. The effectiveness of monotherapy is 90–96%, and the average duration of bleeding is 11.7 days. It has been proven that the drug at a dose of 600 mcg is not effective enough.

Some authors consider misoprostol to be so safe that they allow women to take it on their own without a doctor’s prescription, but we cannot agree with this opinion. In cases where misoprostol is ineffective, examination often reveals fetal malformations (skull defects, cranial nerve palsies, cauda equina). This can probably be explained by the teratogenic effect of ischemia caused by vascular spasm during a prolonged increase in uterine tone.

The use of PG is associated with a fairly high risk of side effects. The most common symptoms are pain, dizziness, nausea, vomiting, diarrhea, and rash. 53% of women who received gemeprost at a dose of 5 mg and 16% of patients at a dose of 3 mg required the prescription of narcotic analgesics. For this reason, if a woman is prescribed gemeprost at a dose of more than 3 mg, her hospitalization is indicated.

PG monotherapy can be carried out, however, due to the high incidence of side effects, it is better to use them in combination with mifepristone or methotrexate to reduce the dose of the latter. In addition, PG is sometimes prescribed together with tamoxifen (20 mg for 4 days). The effectiveness of treatment in these cases is 92%.

Antiprogestins

Antiprogestins (progesterone antagonists) are a group of compounds with a pronounced antiprogestogenic effect, which, when prescribed, can terminate pregnancy at almost any stage. Mifepristone is a synthetic steroid. The mechanism of its action is the specific blocking of progesterone receptors, which is accompanied by detachment of the ovum, a gradual increase in uterine contractions and termination of pregnancy.

Mifepristone's affinity for progesterone receptors is 5 times greater than that of progesterone. Unlike progesterone, whose dimer binds to the promoter regions of many genes, causing changes in the structure of epithelial cells and the synthesis of pregnancy proteins, mifepristone blocks the transcription of the corresponding genes, which leads to necrosis and rejection of the fetal egg. The action of mifepristone not only blocks progesterone receptors, but also significantly reduces the concentration of this hormone in the blood. It is possible that the decrease in progesterone levels in the blood under the influence of mifepristone is due to the luteolytic effect of the latter, as well as the ability of mifepristone to reduce the concentration of hCG in the blood.

Under the influence of mifepristone, changes also occur in the decidua (hypoplasia, necrosis), which contribute to its loss. The drug is able to increase the sensitivity of the myometrium to endogenous and exogenous PGs. Mifepristone and PG act as synergists on the pregnant uterus.

Mifepristone monotherapy is not currently used.

· Prescribing mifepristone in combination with PG is the most common and studied method of medical termination of pregnancy, recommended by WHO.

Mifepristone is used in medical practice not only for abortion. Different doses of the drug and different administration regimens have been registered for preparing the cervix for childbirth, adjuvant therapy of uterine fibroids, and emergency contraception. Mifepristone for medical termination of pregnancy in the Russian Federation can be used when the pregnancy period does not exceed 6 weeks (42 days from the first day of the last menstruation). Mifepristone is taken as a single dose of 600 mg orally (3 tablets of 200 mg each) in the presence of a doctor. 36–48 hours after taking mifepristone, a woman is prescribed misoprostol (Mirolut©) at a dose of 400–800 mcg.

After taking PG, a woman should be under medical supervision for 2 hours. A repeat examination is indicated 10–14 days after using mifepristone. The effectiveness of the method is approximately 94–98%.

Complete expulsion of the ovum before PG is prescribed is extremely rare (in 1–6% of cases).

The most severe side effects of the method include uterine bleeding, but the need for blood transfusion rarely occurs (in 0.1% of patients receiving the drugs). The volume of blood loss varies from 84 to 101 ml and significantly increases with increasing gestational age.

Side effects of mifepristone include pain, which bothers almost all women and pain relief is necessary in 9–73% of cases, malaise, weakness, nausea, and vomiting. The teratogenicity of mifepristone was not revealed in studies on rats, mice, and monkeys. If medical abortion fails, the pregnancy should be terminated surgically due to the high risk of fetal malformations as a result of the use of PG.

Cytostatics

The mechanism of action of cytostatics is to suppress the division of trophoblast cells, which leads to rejection of the fertilized egg. Methotrexate is an antagonist of folic acid, which is involved in the synthesis of deoxyribonucleic acid (DNA). Actively dividing cells, including tumor cells, bone marrow cells, and trophoblasts, are sensitive to methotrexate.

Methotrexate monotherapy is less effective than combination treatment. Typically, expulsion of the fertilized egg occurs 3 weeks or more after the drug is prescribed.

The combined use of methotrexate and PG is a very effective method of terminating pregnancy.

· Methotrexate is usually prescribed at a dose of 50 mg/m2 body surface intramuscularly. You can take the drug orally at a dose of 25–50 mg. 3–7 days after the administration of methotrexate, misoprostol 800 mcg is used vaginally. The effectiveness of the method in terminating pregnancy for up to 8 weeks is 84–97%. The effect can be immediate (completed abortion occurs before the use of misoprostol or within 24 hours after the administration of this drug) and delayed (completed abortion is recorded 24 hours or more after the administration of misoprostol). The average duration of bleeding is 10–17 days.

· Data on side effects of combined treatment are contradictory. A number of authors believe that the side effects of misoprostol occur more often when it is used in conjunction with methotrexate. Nausea is noted in 3–66% of cases, vomiting in 2–25% of cases, diarrhea in 3–52% of cases, catarrhal symptoms in 8–60% of cases, pain syndrome in 40–90% of cases. Complications specific to methotrexate are identified: 5% of patients experience stomatitis and ulceration of the oral mucosa.

Methotrexate has a pronounced cytotoxic effect on the trophoblast, which leads to a high incidence of fetal malformations when using this drug. Damage to the extremities (shortened limbs, absence of fingers) is mainly noted. If medical abortion is ineffective, surgical termination of pregnancy is necessary.

Contraindications for medical abortion

Contraindications for medical abortion are given below.

· Allergic reaction to the drug.
· The gestation period is longer than allowed for this method.
· Suspicion of ectopic pregnancy.
· Chronic adrenal insufficiency.
· Long-term therapy with glucocorticoids.
· Hemorrhages and treatment with anticoagulants.
· Kidney failure.
· Liver failure.

Mifepristone and PG should not be used in women suffering from adrenal insufficiency, severe asthma and COPD complicated by diabetes.

Folic acid and its derivatives should not be prescribed during treatment with methotrexate.

Acceptability and accessibility of medical abortion

In a survey of women for whom medical abortion with methotrexate and misoprostol was effective, 84% of patients responded that they would prefer this method to surgical termination of pregnancy if the need arose. 91% of women responded similarly after using mifepristone and misoprostol.

Psychologically, women tolerate medical abortion more easily than surgical intervention under anesthesia. However, there are disadvantages to medical abortion: it is painful, accompanied by side effects, lengthy, expensive, requires repeated visits to the doctor, and as the gestational age increases, the effectiveness of medical abortion decreases.

Currently, medical termination of pregnancy is acceptable in most countries of the world. However, for most specialists it is not routine, and it is not carried out in all medical institutions.

Conclusion

With medical termination of pregnancy, compared to surgical abortion, longer bleeding, intense and prolonged pain, and other side effects are noted.

The long-term consequences of these methods have not been sufficiently studied. When performed correctly, vacuum aspiration in the first trimester of pregnancy is effective in 98–99% of cases, and failures occur in the earliest stages of pregnancy. However, medical abortion is practically not associated with traumatic lesions of the uterus and cervix.

It is probably safer to terminate a pregnancy with medication in the earliest stages. As pregnancy progresses, the effectiveness of drug methods decreases, so vacuum aspiration is necessary.

Ultrasound should be used more widely to detect residual products of conception after termination of pregnancy, especially in nulliparous women.

To prevent traumatic complications, it is recommended to prepare the cervix for surgery (preferably using PG).

For all types of abortion, you should carefully monitor the vaginal microflora, and, if necessary, carry out preliminary sanitation of the genital tract.

It is necessary to pay attention to nulliparous women (especially primigravidas), carefully select and perform an abortion method for them.

During rehabilitation therapy aimed at restoring reproductive function, combined oral contraceptives, vitamin E are prescribed, the microbiocenosis of the vagina and intestines is corrected, and physiotherapeutic procedures are performed.

Medical abortion, which is performed up to 6-7 weeks, is considered less traumatic for the female body. This method of terminating a pregnancy is considered quite effective - the result reaches up to 97%, unless, of course, you do “self-medication” and follow all the doctor’s recommendations. Some women complain that pills do not work for medical abortion, let's figure out why this happens.

The essence of medical abortion

A woman planning to terminate a pregnancy medically needs to know how this abortion is performed.

For a period of up to 6 weeks, the woman alternately - with an interval of 1-2 days - takes Mifepristone and Misoprostol tablets (their analogues can be used).

• The first ones stop the production of the hormone progesterone in the female body, without which further development of pregnancy is impossible - the embryo simply dies as a result of the action of Mifepristone.
• The latter contribute to the fact that the uterus rejects the frozen fertilized egg - it is excreted along with secretions within several days from the moment of taking the first pill (this period varies from woman to woman).

Thus, medical abortion is an artificially induced miscarriage. With a correctly performed abortion, mechanical impact on the cervix and the uterus itself is eliminated, which makes this method the safest for women, especially nulliparous women.

However, it also happens that the pills do not work as expected. The results of this:

• the fertilized egg is partially removed, so the gynecologist resorts to curettage of the uterus with a curette;
• the pregnancy continues, but in this case it is undesirable to leave the child, since taking the drugs will negatively affect its further development.

To prevent this from happening, you should strictly follow the technology.

Why don't abortion pills work as they should?

The first thing a woman who has decided on such a method of getting rid of pregnancy should remember is that a medical abortion should be carried out with the approval of a gynecologist and under his close supervision. It is very important to follow the sequence of actions and dosage.

To understand why the abortion didn’t work, let’s compare what a doctor does in gynecology and how a medical abortion works at home.

Preparing for an abortion:

• Initially, the specialist will conduct an ultrasound and determine the duration of pregnancy, study the medical history and assess the general health of the patient - the latter is important, since medical abortion has contraindications. It is also important to make sure that the pregnancy is not ectopic, since in this case, medical abortion is not acceptable.
• At home.The woman independently calculates the duration of her pregnancy. Most often this is done incorrectly. Some people run the risk of taking abortifacient pills at inappropriate periods. It is also impossible to determine an ectopic pregnancy on your own at home. If you take pills for an ectopic pregnancy, there will be no abortion.

Important! The possibility of an allergy to the components included in the tablets should be excluded, as this can lead to a negative result. The same applies to the presence of an intrauterine device - it must be removed before a medical abortion.

Calculation of the dose of drugs for abortion:

• In the clinic.The gynecologist accurately calculates the dosage and always dispenses two drugs. The dose (200 mg or more) is selected individually, mainly depending on the stage of pregnancy. The woman drinks the first tablet in the presence of a gynecologist, who monitors her condition for a couple of hours (during this time the woman will have to feel changes in her body indicating that the drug has begun to act, and tell the doctor about them). Then the woman goes home. The second tablet is taken after a day or two - this, again, is determined by the doctor. It causes the uterus to contract, and the fertilized egg comes out along with the discharge.
• At home.The woman takes as many tablets as recommended in the instructions. The second drug is not sold in pharmacies, so the chance that an abortion will take place is no higher than 20%. And an overdose ends in hospital.

After an abortion:

• In the clinic.If after a certain time the miscarriage does not occur, the doctor takes other measures. A control ultrasound after an abortion is also required - the gynecologist will make sure that everything went well and the uterus is completely clean.
• At home. If the abortion does not occur, the woman will know about it only when the fetus begins to move. It will be too late to do anything.

Important! Under no circumstances should you induce it yourself - this is quite dangerous and can lead to bleeding. In such a case, as well as if your general condition worsens, you should consult your doctor.

Why else might medications for medical abortion not work?

The pills may not work because the woman behaves incorrectly during a medical abortion. Thus, alcohol and nicotine significantly reduce, and sometimes completely stop, the effect of drugs. Therefore, while taking the pills, you need to completely give up bad habits.

Thus, despite the apparent simplicity and safety of medical abortion, you should not rely on the advice of women who once resorted to it in everyday conditions or who know about this method of terminating a pregnancy by hearsay. Only contacting a reputable clinic and a qualified specialist will guarantee that a medical abortion will take place as expected and without complications.

No matter what scientific terms are used to replace simple words when describing the process of abortion, abortion is the murder of an unborn child. In our country, abortion is legally justified only in cases of rape, death of the child's father during pregnancy, deprivation of parental rights, threat to the mother's life and fetal pathology.

Induced abortion. Surgical and non-surgical methods of abortion.

Any abortion is done almost blindly and there are many circumstances that can contribute to an unfavorable outcome of the operation. Do not rush to blame the doctor if something goes wrong; most likely, it did not depend on him.

Abortions are performed in a gynecological hospital that has its own abortion clinic. Before terminating an unwanted pregnancy, you must undergo tests: a gynecological smear, ultrasound, blood for hepatitis, syphilis and HIV, get a referral from an obstetrician-gynecologist who examined you, confirmed the presence of pregnancy, established its duration and, taking into account all the above conditions, recommended method of abortion. If there is an infection, it is necessary to undergo treatment before an abortion.

Types of abortions. How does Abortion happen?

Methods of artificial termination of pregnancy in a hospital.

If you have already decided to have an abortion, go to the doctor as soon as possible after your missed period.
If you see a doctor before about 2 weeks of delay, a medical abortion or mini-abortion is possible. Both methods have their pros and cons; an individual approach is important. In addition, the cost of medical abortion is significantly higher.

Medical non-surgical abortion (termination of pregnancy between 0 and 8 weeks)

At a very early stage, the fertilized egg does not yet have a close connection with the wall of the uterus, so it is easier to remove it from there than at a later date. After detecting a fertilized egg in the uterus, the doctor explains to you all the features of the method and, having received your consent, gives you to take abortive pills, which act in such a way that the pregnancy stops developing. This drug is now produced by many companies and is called differently. After 48 hours, you must return to see your doctor. During this period, most likely, nothing will happen to you; some women have a little “pulling” in the lower abdomen. Then everything will depend on your body. The doctor will observe whether the fertilized egg is rejected and may suggest that you take medications that will speed up this process. It will feel like a heavy, very painful period. The doctor will monitor you for some time and, if everything goes well, will send you home. Bloody discharge will continue for up to two weeks. After this period, you will be examined by a doctor again.

What problems can arise with a medical abortion?

Firstly, the pregnancy may not be terminated. In this case, it can no longer be saved for medical reasons. A mini-abortion is performed. Secondly, there may be very heavy bleeding. In this case, too, sometimes you have to resort to surgery. Thirdly, it can be very painful, you can feel nauseous, and your blood pressure increases.

The only advantage of this method is the absence of surgical intervention, and therefore the possibility of uterine injury and infection.

Medical or Pharmaceutical abortion refers to a termination of pregnancy induced by drugs instead of a surgical abortion. It often ends in surgical intervention and serious physical and moral consequences. Having the appearance of an ordinary pill, medicinal abortion is designed to reduce the feeling of guilt that inevitably and naturally arises in every woman after an abortion. Medical centers that practice medication abortion mislead women by talking about the false simplicity of this type of abortion. Women who take these pills end the lives of their unborn children.

It is silent about contraindications for the use of drugs: smoking, heart problems and high blood pressure. It happens that taking this drug ends in death for the woman herself.

There is a misconception that Medical or Medicinal termination of pregnancy is an alternative to abortion. No that's not true. Medical termination of pregnancy is a real abortion, as a result of which a human life is killed.

Medical abortion (“French pills”) - the effect of interrupting pregnancy in 90 - 95% of cases with a delay of up to 49 days

A tubal ectopic pregnancy cannot be terminated with medications.

Mini-abortion or Vacuum abortion (for up to 5-7 weeks, i.e. within 6-14 weeks after the last menstruation)

Mini abortion - vacuum aspiration, termination of pregnancy at an early stage. This surgical abortion is performed at an early stage of pregnancy (termination of pregnancy up to 5-7 weeks).

The operation is performed under general anesthesia. In medical centers they use anesthesia, which leaves no consequences in the form of long-term headaches, nausea, etc. That is, for you it will look like this: you lay down on a chair, a catheter was inserted into a vein, you fell asleep, you woke up no longer pregnant. During abortion surgery, the doctor inserts a special tube connected to a device into the uterus. After turning on the device, negative pressure is created in the tube, due to which the fertilized egg is removed from the uterus.

Before the operation, the cervical muscles are stretched with metal dilator rods. or kelp (thin sticks that are inserted hours before the procedure itself);until the opening is wide enough to allow the abortifacient instruments to pass into the uterus. The doctor attaches a special syringe to the tube (it is inserted into the uterus) and the intrauterine child is sucked out.The pump grinds the baby's body into pieces and sucks them out of the uterus. If the fetus cannot be completely removed, subsequent curettage is performed. In this case, the doctor may use a curette (a rounded knife) to scrape the baby's body parts out of the uterus.

Immediately after an abortion, there may be pain in the lower abdomen associated with contractions of the uterus, then for several days you will have light discharge similar to menstruation. Sometimes the doctor prescribes antibiotics after an abortion. In this case, much depends on the skill of the doctor. This method is more reliable regarding the chances that the pregnancy will definitely be terminated. Cases where, after a mini-abortion, pregnancy continued to develop are extremely rare. To increase reliability during an abortion, ultrasound is used. But since there is intervention, there is also the possibility of injury. If the smear before the abortion was bad and treatment was not carried out or was insufficient, infection is possible.

Despite the fact that a mini-abortion is performed at an earlier stage than a regular abortion, a mini-abortion is a means of killing a conceived child—human life.

The physical, moral and emotional consequences of a mini-abortion are no less complex and dangerous than the complications of a surgical abortion. From the very moment of conception, there is a living, little person inside you, with his own individual set of DNA. With already determined eye color, hair color and gender of your child. Don't be fooled by the idea that there is a clump of cells inside you. It is not true.

Medical abortion (6 to 12 weeks or 13 to 24 weeks after your last period).

This surgical abortion is performed during the second trimester of pregnancy. Up to 12 weeks, you can have a regular or surgical abortion. It will feel the same as a mini-abortion, but instead of a tube, a special instrument is inserted into the uterus, which is used to remove the fertilized egg. The same rule applies very clearly here - the longer the period, the more difficult the operation, the more complications there may be.

Because the developing baby doubles in size between the 11th and 12th weeks of pregnancy, its body is too large to be crushed by suction and pass through the tube. In this case, the cervix should be open wider than during a 1st trimester abortion. Therefore, kelp is administered a day or two before the abortion itself. After the cervix is ​​open, the doctor removes the baby's body parts with forceps. In order to easily remove the child’s skull, it is first crushed with forceps.

Only these three methods of terminating a pregnancy are permissible and are not considered a “criminal abortion” in our country, with the exception of termination of pregnancy according to a doctor’s testimony in the later stages.

Late term abortion.

After 12 weeks, abortion on request is prohibited in our country. They do it only for medical and social reasons: a court decision to limit parental rights, pregnancy as a result of rape; death of a husband during a woman's pregnancy. Pregnancy is terminated in the later stages, either by artificially inducing labor or by performing a minor caesarean section. That is, there will be childbirth, but there will be no child. So, you know, it’s better not to let it come to this.

This medical abortion is performed:

From 20 weeks after the last menstrual cycle. The procedure to terminate late pregnancy takes 3 days. During the first two days, the cervix is ​​dilated and the woman is given antispasmodic drugs. On the third day, the woman takes a medication that induces labor. After labor has begun, the doctor does an ultrasound to determine the location of the baby's legs. Grabbing the legs with forceps, the doctor pulls the child out, leaving only the head inside. In this case, parts of the child’s body can be torn off from the body itself and pulled out through the vaginal canal. The rest of the body is pinched and pulled outward. The baby's head is pinched and crushed in order to pass through the vaginal canal. The placenta and remaining parts are sucked out of the uterus.

Previously, saline abortion or saline filling was used, but this method was not effective enough, as did Homeopathy (efficiency no more than 20%), Acupuncture (effect up to 40% with a short delay and depends on the qualifications of the specialist), Magnetic induction ("magnetic cap" with in the absence of contraindications, it is effective in 50% of cases with a delay of no more than 3-5 days)

Precautions after an abortion to prevent consequences.

If, after weighing all the pros and cons, you still decide to terminate the pregnancy, try to minimize the consequences of the abortion.
After an abortion, be it a medical abortion, a mini-abortion or a medical abortion, as well as after a miscarriage, in order to avoid serious complications, a woman must strictly follow certain rules:

In the first two weeks after an abortion, any physical activity should be avoided.

Sexual activity is prohibited for three weeks. Because during sex you can introduce an infection into the uterus, which after an abortion is essentially one big open wound.

In order for uterine contractions to proceed normally, it is important to monitor the timely emptying of the intestines and bladder.

It is necessary to monitor your general health, measure your body temperature daily and avoid hypothermia. If your health worsens, bleeding or pain in the lower abdomen appears, you should immediately consult a doctor.

Pay special attention to genital hygiene. Wash twice a day with warm boiled water and a weak (pink) solution of potassium permanganate. Change your underwear as often as possible, since the cervix remains slightly open, which creates the risk of pathogenic microbes entering the uterus and the development of inflammatory phenomena.

The timing of menstruation after an abortion is the same as before it. If it is delayed or occurs earlier, it is recommended to consult a doctor. Sexual activity can begin only after the onset of menstruation. And be sure to take care of contraception!

Consequences of abortion

When planning to have an abortion, try to minimize the complications and consequences of the abortion:

At the first suspicion of an unplanned pregnancy (delayed menstruation), consult a gynecologist. Don't delay - every day is precious;
Inform the father of the unborn child and make a decision together;
Never try to get rid of pregnancy on your own;
Think twice before deciding to have an abortion.
Consult with your doctor which method is safer to perform an abortion (it is safer to terminate a pregnancy before 6 weeks).

After surgical and medical abortion, a woman experiences bleeding for some time. Their number and duration are individual and depend on the duration of pregnancy, contractility of the uterus and blood clotting.

Abortion is a global stress for the body. An imbalance occurs in hormonal, immune, renal and hepatic functions, regulation of blood pressure, and circulating blood volume. The woman becomes irritable, sleep deteriorates, and fatigue increases.

That is, an “ideal state” arises for the penetration of any infection that provokes the development of infectious and inflammatory diseases. The result of inflammation of the uterine appendages most often is obstruction of the fallopian tubes. In such a situation, a woman is not insured against ectopic pregnancy or infertility. Impaired ovarian function due to abortion can become chronic and also lead to infertility.

In addition, blind curettage of the uterine mucosa during a medical abortion usually leads to microtraumas: thinned areas appear that are not sufficiently saturated with blood, and scars form. All these changes disrupt the normal nutrition of the fetus during subsequent pregnancy. Hence, developmental defects, miscarriages or premature births.

In developed countries, women who have undergone abortion undergo psychological rehabilitation. The so-called “abortion experience syndrome” develops.

There are two types of complications after abortion: early and late. The early ones develop during or immediately after an abortion, and the later ones manifest themselves after some time, sometimes years after the operation.

Complications immediately after an abortion (early consequences)

As a result of an abortion, complications may occur: pain in the lower abdomen, cramps, nausea, vomiting and loose stools. Although in most cases there are no serious consequences, complications can occur in approximately one out of every 100 early abortions. And also, in one out of every 50 late-term abortions.

More serious complications are breakthrough uterine bleeding, infection, perforation and uterine rupture.

The most terrible complication after an abortion is a violation of the integrity of the uterine wall (perforation) and its rupture. Perforation can lead to damage to large vessels, intestines, bladder and inflammation of the entire abdomen (peritonitis).

The most common complications of surgical abortions are bleeding, damage to the cervix, bleeding disorders, and embolism. Quite often, incomplete extraction of the fertilized egg occurs. To prevent this complication, an ultrasound examination is performed, and if remnants of the fertilized egg are detected, repeated curettage is performed. In addition, after any abortion, chronic diseases of the genital organs (salpingoophoritis, endometritis, etc.) worsen.

A much more serious danger is the introduction of infection into the uterus during an abortion (infected abortion). If bacteria have penetrated the uterus, then there is a very high probability of inflammation or inflammation of the ovaries and their appendages. More often, the infection comes from the vagina, and not from instruments. Due to the use of dilators during abortion, the cervix may not close completely, which is manifested by its insufficiency.

Complications after abortion: late consequences.

The consequences of any abortion include inflammatory diseases of the genital organs, hormonal disorders, endometriosis, ovarian dysfunction, infertility, and pregnancy complications.

Due to the use of dilators during surgical termination of pregnancy, the cervix may not completely close, which is manifested by its insufficiency. It is known that the neck is a mass of ring-shaped and cylindrical muscles, and with forced rapid expansion, they often overstretch and tear, and scars form. Subsequently, this can lead to weakness of the muscular apparatus of the cervix, decreased obturator function and, as a consequence, late miscarriages at 18-24 weeks, and the inability to fully dilate the cervix during childbirth.

After an abortion, the incidence of ectopic pregnancies increases sharply. During subsequent pregnancies and childbirth, the frequency of stillbirths and diseases of newborns associated with disorders of the uterine vessels, disturbances in labor and the location of the placenta increases.

If an abortion was done once, the threat of miscarriage during a subsequent pregnancy will be in 26% of women, if twice, the threat increases to 32%, and three abortions or more increases the risk of miscarriage to 41 percent.

After an abortion, the risk of background and malignant processes in the mammary glands, cervix and uterine mucosa increases.

Besides death, the next biggest concern is bleeding. In women who took the drug Mifegin for medical pregnancy control, bleeding usually lasts one or two weeks, and in 10 percent of them it lasts more than a month. This leaves women at risk of infection for a long period of time and, on average, a woman loses four times more blood than with a standard surgical abortion. During testing of the drug in Europe, at least one in a hundred women was hospitalized due to blood loss and the need for a transfusion.

In an unconsummated abortion, the remaining fetal parts can spread widespread systemic infection and cause septic shock and death.

Is it possible to have an abortion at home using folk remedies without going to the hospital or buying abortion pills?

Folk remedies for abortion are a double-edged sword. It is impossible to provoke a miscarriage using folk remedies if the woman is absolutely healthy. If there are any violations, home remedies for abortion will act in such a way that the consequences of the abortion can lead to the death of the woman.

Termination of pregnancy is possible only in specialized medical institutions by qualified specialists. Attempts to independently terminate a pregnancy are called criminal abortion, and in the vast majority of cases they end in serious complications, the least of which is the loss of the uterus. Many of these attempts to self-terminate a pregnancy end in the death of the woman.