Abortion

ABORTION - Abortion in the period up to 28 weeks, counting from the first day of last menstrual period. Distinguish between spontaneous and induced abortion.

Spontaneous abortion (miscarriage, spontaneous abortion) - spontaneous miscarriage before 28 weeks. Depending on the time of abortion conditionally distinguish early (before 12 weeks) and late (12 to 28 weeks) spontaneous abortion. Termination of pregnancy after 28 weeks is usually called a premature birth. Spontaneous abortion, repeated at the next one after the other pregnancies (more than 2-fold), called habitual miscarriage. His reasons may be dysfunction of the ovaries, adrenal cortex, inflammatory diseases of genital organs, previous induced abortions, especially during the first pregnancy, and other factors.

The mechanism of spontaneous abortion is different. In some cases, initially as uterine contractions that cause detachment of ovum. In other cases, uterine contractions preceded by the death of ovum (in toxicosis during pregnancy, infectious diseases, pregnancy, etc.). Sometimes detachment and loss of gestational sac and the uterine contractions occur simultaneously.

Distinguish the following stages of spontaneous abortion: menacing, which began, abortion in progress, incomplete or complete abortion. When threatened abortion marked a feeling of heaviness or weak drawing pains in the abdomen and sacral region, with abortion at later dates can be a pain cramping nature. Spotting minor or absent. The cervix is not shortened, the outer jaws to close it, the tone of the uterus increased. The magnitude of the uterus corresponds to the period of pregnancy.

When incipient abortion cramping and bleeding are more pronounced than threatening. Fertilized egg peel in a small area, so the magnitude of the uterus corresponds to the period of pregnancy. The cervix is retained, its channel is closed or slightly parted.

Abortion in progress characterized by labor-pains in the abdomen, marked bleeding. Fertilized egg is in the canal of the cervix, the lower pole it can act in the vagina. Abortion in progress may complete an incomplete or complete abortion.

Incomplete abortion fertilized egg is partially expelled from the uterus, there are cramping abdominal pain and bleeding of varying intensity. Cervical canal is opened, when vaginal examination free passes finger uterus myagkovatoy consistency, its magnitude is less than the estimated gestational age. In the uterus is usually retained fetal membranes, placenta or part thereof.

When complete abortion, which is more common in the later stages of pregnancy, fertilized egg is released from the uterus, the uterus contracts, the bleeding stops.

If the uterine contractions that occur after the death of ovum are insufficient for his ouster, is a slow detachment of gestational sac, which may be accompanied by a lengthy neobilnym uterine bleeding leading to anemia. At early stages of pregnancy is possible cervical abortion. In this case, external fauces mother is not revealed, but fertilized egg is fully otslaivayas, falls as a result of uterine contractions in the cervical canal, the wall is stretched, and the cervix becomes barrel-like shape. This kind of spontaneous abortion should be differentiated from cervical pregnancy, when the fertilized egg attaches to the cervical canal.

When a miscarriage is possible penetration of microorganisms from the vagina into the uterus with subsequent development of the inflammatory process. Infected (fever) abortion may cause a generalized septic disease. In this case, marked fever, tachycardia, leukocytosis, the uterus may be the size of overweight, painful on palpation, there pussy discharge from the genital tract. In the case of infection the condition worsens, aching, fever, and diarrheal dysuric phenomenon, changes in the blood: high leukocytosis, elevated ESR, developed purulent salpingitis, options, pelvioperitonit, sepsis.

The diagnosis of spontaneous abortion established on the basis of clinical presentation, data vaginal, vaginal-bryushnostenochnogo and ultrasound studies.

When threatened miscarriage in the I trimester of pregnancy, treatment may be conducted in a women's consulting through "hospital at home". If within 3 - 5 days symptoms of threatened abortion did not subside, the pregnant woman should be sent to the hospital. Treatment of threatened abortion is complex, it includes bed rest, sedatives, antispasmodic, I trimester shows hormone replacement therapy, depending on the causes of threats interrupt hormonal blood parameters and (or) urine of pregnancy.

When threatened miscarriage in the II and III trimester of pregnancy a woman should be hospitalized, as required constant monitoring of the cervix, fetal assessment. Used for the treatment of tocolytic and antispasmodic.

When begun spontaneous abortion shows urgent hospitalization at any stage of pregnancy. Treatment is basically the same as when threatened miscarriage. To stop the bleeding with incipient abortion in I trimester of pregnancy estrogensoderzhaschie used drugs. After the cessation of bleeding or simultaneously with mikrofollinom prescribed progesterone or its synthetic analogue turinal. With heavy bleeding hormone therapy began abortion is not effective.

When abortion in progress, incomplete, complete and cervical abortion is carried out removing tool residues ovum and blood clots methods curettage or vacuum excochleation that will stop the bleeding and prevent infection.

In uncomplicated removal of an infected abortion remains ovum is carried out against a background of antibacterial therapy. The principle of treatment for complications of infected and septic abortion is the same as for postpartum septic infection.

For missed abortion, a long wait is inappropriate.

I trimester of pregnancy was lost egg was removed instrumentally. In later stages of pregnancy labor induction is carried out. Before this you need to make a study of blood coagulation. After removal of the ovum prescribe antibiotic therapy and advances that reduce the uterus.

Complications. Immediate complications in spontaneous abortion are uterine bleeding due to delay parts of the ovum in the uterus or breach of the blood coagulation system and the case of prolonged waiting for missed abortion (in severe cases may develop DIC - disseminated intravascular coagulation syndrome), infection of the uterus until the development of sepsis and infectious-toxic shock, complications related to technical errors during curettage or a delivery - uterine perforation, rupture of the body or cervix. Long-term complications: inflammation of the genital organs (salpingo-oophoritis, endometritis), ovarian dysfunction, infertility, chorionepithelioma, exacerbation of extragenital diseases, the development of Rh-sensitization in subsequent pregnancies, etc.

Forecast maintain pregnancy in spontaneous abortion depends on the stage of the process. Saving possible when threatened miscarriage, at least begun.

After a miscarriage a woman must be under the supervision of a physician women's clinic to restore normal menstrual rhythm (in the absence of any infectious complications). 3 months after abortion useful survey of the reproductive system of a couple to determine the causes of spontaneous abortion and the necessary rehabilitation measures to prepare for the next pregnancy.

Abortion - the deliberate termination of pregnancy and up to 28 weeks. Abortion is one of the most widely used family planning methods and to some extent, influences the level of fertility. The main causes of abortion are a woman's desire to limit the number of children per family, or none at all to have an adverse psychological climate in the family, the inability (or unwillingness) to combine work and study with the birth and upbringing of the child, which is especially characteristic of young families, as well as the presence of a small child, many children, the illness of a family member poor material and living conditions, etc. The high frequency of induced abortion is largely due to low awareness of the highly effective methods of contraception, their inaccessibility to most of the population and the lack of a network of specialized institutions (subdivisions study), dealing with family planning, including organization of work on contraception. Induced abortions are responsible for large medical-demographic and economic losses, since it leads to the growth of gynecological diseases, sterility, have contributed to miscarriages and premature births in subsequent pregnancies, increased maternal and perinatal mortality.

The main method of prevention of induced abortion is the introduction of modern contraceptives. The use of women of reproductive age and the modern methods of contraception leads to a decrease in abortions and does not have a subsequent negative impact on women's health, reproductive function, as well as the birth rate. Achieve stable reduction of abortions is possible only under the condition of the purposeful work on contraception, combined with hygiene education of the population, especially adolescents.

Medical abortion is carried out obstetrician-gynecologist in a specialized department of a hospital, nursing home or antenatal clinic at a woman's desire to terminate a pregnancy for medical reasons and in cases where continuation of the pregnancy and childbirth lead to poor health and pose a threat to a woman's life or if the identified fetal abnormalities. The most common is medical abortion in early pregnancy (up to 12 weeks). Termination of pregnancy in terms of more than 12 weeks, carried out mainly for medical reasons. The need for therapeutic abortion establishes an obstetrician-gynecologist in conjunction with specialists from the relevant profile (internist, surgeon, oncologist, psychiatrist, etc.) and the head of the facility after the test patient in a hospital.

Abortion of pregnancy over 12 weeks to 28 weeks is allowed if the birth is not desirable in connection with certain social factors: for example, a minority of pregnant women (conducted with parental consent), the death of her husband's pregnant, stay of the woman or her husband's detention, deprivation of pregnant the rights of motherhood and large (more than 5 children), divorce during pregnancy, pregnancy after rape, the presence of a child with a disability.

Contraindications for induced abortion are acute and subacute inflammations of genital organs, the presence of purulent foci, irrespective of their localization, for less than 6 months after a previous termination of pregnancy, acute infectious disease. In later periods abortion is contraindicated if the interruption of pregnancy in this period is more dangerous to life and health than continuing the pregnancy and childbirth.

Before the termination of pregnancy regardless of her life conducting clinical blood and urine tests, bacterioscopy smear from the vagina, Wasserman reaction and for HIV infection, determine the blood group and Rh-identity. Before the termination of pregnancy in late periods examined the blood coagulation system and conduct special studies, depending on the nature of the underlying disease, the cause of abortion (electrocardiography, the study of kidney function, liver, etc.).

Abortion in the early stages are produced by scraping or vacuum excochleation. At a delay of menses for up to 20 days termination of pregnancy by vacuum excochleation - the so-called mini-abortions can be performed both in hospital and outpatient setting.

Immediate complications during the operation of abortion or soon thereafter - uterine perforation, bleeding. The most frequent complication is retained in the uterus parts ovum. To prevent this complication after an abortion carried ultrasound, in case of detection of residues of ovum - an audit of the uterine cavity.

Long-term complications: inflammatory diseases of genital organs, ovaries and adrenal dysfunction, infertility, miscarriage, ectopic pregnancy, and others in subsequent pregnancies and childbirth increased frequency of stillbirths, birth asphyxia and hemolytic disease of the newborn. With the risk of complications are women who have three or more abortions in the history of suffering from inflammatory diseases of the uterus, menstrual disorders, blood diseases who had undergone previous surgeries on the uterus and ovaries. The method of vacuum-excochleation (especially the mini-abortion) has several advantages over curettage due to lower traumatization of the neck and body walls of the uterus, reducing operation time, decrease the frequency of immediate and late complications.