The intensity of pain is directly proportional to the duration of pregnancy and largely depends on the individual pain threshold women. The duration of pain ranges from several hours to a day, on average about 3-4 hours. A long duration of pain is usually associated with a relatively long pregnancy, since in this situation it is more difficult for the uterus to expel the fertilized egg. After the expulsion of the fertilized egg from the uterine cavity, the pain usually calms down. Penney G. in 2006, during his study, suggested that patients undergoing medical termination of pregnancy , rate your pain on a 10-point scale, where: “1” is mild pain, and “10” is unbearable pain. The obtained statistical data is given below:
- Moderate pain (3-5 points) – 25%;
- Very severe and Severe pain (6-8 points) – 40%;
- Unbearable pain (9-10 points) – 10%.
Preparation includes a smear for flora and an intravaginal ultrasound to determine the gestational age and location of the fertilized egg. It is also specified whether the woman has chronic diseases, which may become contraindications for medication interruption. Before the procedure, do not eat anything salty, fatty, or smoked; after a medical abortion, you should not take a bath or go to the pool until everything is over. You cannot eat 3 hours before the interruption and less than 2 hours after.
The effectiveness of medical abortion
Medical termination of pregnancy manifests itself as more painful periods than usual. Interruption efficiency is 95%. The advantage of a medical abortion is that it does not require general anesthesia. You simply get a pill and take it in front of a doctor. After 72 hours, you go back to the clinic where you are given a pill to contract your uterus. A day later, heavy bleeding begins.
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Timing of medical termination of pregnancy
Duration of medical termination of pregnancy: 5-6 weeks. Medical abortion is performed after complete gynecological examination. Side effects: nausea, headache. Contraindicated for heart defects with severe heart failure, tuberculosis, hypertension and fibroids, obesity and diabetes.
How is medical abortion performed?
Medical termination of pregnancy begins with a preliminary conversation between the woman and the doctor. She is informed about possible contraindications and complications and the very essence of the method. Next, they take blood tests for HIV, hepatitis, Rh factor and a smear for flora and do an ultrasound to clarify the date. The woman signs the consent.
As for pain, it all depends on the period: the longer the pregnancy, the more intense the pain.
After a medical abortion, a woman is given contraception. Conception can occur immediately, so you need to start using protection immediately.
Stages
In any case, a woman goes through the following stages of medical abortion:
- A woman calls a clinic and makes an appointment with a doctor, indicating that she wishes to have an abortion. medicine. Food is not taken 3 hours before.
- At the appointment, the doctor performs an ultrasound.
- You are warned about possible complications procedure and contraindications to it, conduct an introductory conversation.
- Together with your gynecologist, you choose one of the drugs produced in France or Russia.
- Tests may also be ordered if you did not have them shortly before the interruption. Results are ready in 1 day.
- The drug is taken with a doctor.
- Within 72 hours, pain and discharge similar to menstruation appear.
- After the onset of pain and bleeding, prostaglandins are taken. Within 5 days, the fertilized egg comes out entirely.
- The next stage is a control ultrasound.
Remember that the vagina is home to bacteria. This is why pap smears are done before a medical abortion. When the cervix dilates, bacteria can enter the uterus. Unfortunately, sometimes toxic shock occurs with a fatal outcome, but this is stubbornly kept silent about.
Choose a clinic whose doctors have been performing medical abortion procedures for a long time. This will help keep complications to a minimum.
Tablets for medical abortion
Tablets for medical abortion: Mifepristone, Mifegin, Mifeprex, Mifolian, RU-486. Active substance of all these drugs - Mifepristone. It is a complex molecule that has complex effects on female body, determined to maintain the pregnancy. If you had an irregular menstrual cycle before taking the pill, the problem may get worse.
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 the medical history, all the diseases that she had or has.
Mifepristone
Mifepristone blocks receptors for the hormone that supports 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 a surgical abortion may be required due to incomplete removal of the fertilized egg. After taking mifepristone, on the 2nd day you come back to the clinic and take another drug that expels the embryo within 1 hour. The bloody discharge continues for 10 days, after which you come for a follow-up ultrasound. In isolated cases, after taking the drug, diarrhea, dizziness and nausea are possible.
Mifepristone has the following contraindications:
- Pregnancy while using an intrauterine device.
- Scar after cesarean section.
- Leiomyoma.
- Kidney and liver failure.
- Blood clotting disorder.
- Anemia.
- Asthma.
- Diseases of the female genital area.
After taking it, you may experience severe pain in the lower abdomen, dizziness and vomiting. The temperature may rise significantly. Do not take any painkillers or antipyretics - they can stop the abortion. You can take analgin or no-shpu in as a last resort. It's better to call the doctor who performed the abortion. You will be given emergency numbers where you can get advice. If for some reason you cannot contact this doctor, call an ambulance if you have severe pain, persistent vomiting and fever.
Mifegin
Medical termination of pregnancy using mifegin is an alternative to curettage. Unsuccessful result, incomplete extraction of the fertilized egg is possible in 5% of cases.
Mifegin is a progesterone antagonist. The mucous membrane of the uterus, under its influence, 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 in the chair, a consultation with the patient, signing the appropriate paper - consent to an abortion, an ultrasound to confirm the term and the first dose of pills. The next visit should take place in 72 hours. During this visit, prostaglandin is used to expel the fetus from the uterus. In the clinic you need to be under observation for 1.5 hours. If the pain is very severe, you may be given no-shpa. Short-term diarrhea is possible.
After 12-16 days you need to do an ultrasound. If for some reason the pregnancy continues, a regular abortion is performed.
Between visits, you cannot visit the sauna or drink alcohol.
Pencrofton
Medical termination of pregnancy with Pencrofton is an alternative to surgical abortion. Advantages of medical abortion using the Russian drug Pencrofton:
- Early termination of pregnancy on the second day after conception (for example, if you are a victim of violence).
- There is no danger of contracting hepatitis, as happens during an abortion, if the instruments are poorly sterilized.
- Lower cost.
- Curettage can cause a scar on the uterus or perforation, life-threatening bleeding. This does not happen when taking Pencrofton.
- Fertility is immediately restored.
- 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, dilating the cervix. Abortion 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, an ultrasound is performed and curettage if necessary (rare).
When taking Pancrofton, there are a minimum of side effects, 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 Kyiv can be done in many specialized clinics. Misoprostol - a drug for abortion latest generation. As a result of the work of the uterine muscles under its action, the fertilized egg is pushed out.
The method eliminates psychogenic trauma and is best suited for young nulliparous girls.
Abortion after 1-15 days occurs in 65-85% of cases. The introduction of a prostaglandin analogue after 1-3 days increases this figure to 88-98%. The same results were obtained using Pencrofton. Thus, the optimal regimen for carrying out a medical abortion procedure today is 600 mg of mifepristone with the introduction of prostaglandins after 36-72 hours.
Duphaston
Duphaston after medical termination of pregnancy is prescribed in the post-abortion period. On day 16, after an ultrasound, Duphaston is prescribed 10 mg twice a day for 10 days. Duphaston is an active progestogen. It is used for a number of gynecological diseases. When taking it, there are no unwanted hormonal disorders. Duphaston does not affect liver cells and blood pressure.
Along with Duphaston, the gynecologist may prescribe you multivitamins or special vitamin complexes that are used for stressful situations. Abortion, surgical or medical, is stressful for a woman. As a result, not only nervous system, but also the heart. Sometimes post-abortion psychosis develops. The first reaction is always relief. But then the woman often experiences remorse, her self-esteem decreases, and on this day every year she may cry. Understanding 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 towards him. The process of finally getting rid of guilt can be long. Medical termination of pregnancy is usually easier for women to tolerate and does not have such a strong impact on their state of mind.
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Consequences of medical abortion
The consequences of medical termination of pregnancy are mainly reduced to nausea, diarrhea and delay of menstruation up to 12 weeks, headache, chills, endometritis. These are extremely rare side effects, such as Quincke's edema, uterine rupture and toxic shock. Toxic shock can lead to death.
Pregnancy is not interrupted in 3% of cases. Then you have to do scraping. As a result, they may worsen inflammatory diseases, adhesions and infertility develop - not immediately, sometimes 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 configured to carry a pregnancy. Medical abortion artificially stops this process. That is why neuroses, the so-called, are so common. post-abortion syndrome. Diseases are rarely associated with medical abortion thyroid gland, explaining everything with the Chernobyl accident. But in vain. Thyroid takes part in the regulation of hormones that support pregnancy, although not as clearly as the ovaries and pituitary gland. It is clear that people go for an abortion out of desperation and a sudden collapse of plans. But if you think about it, there are no safe abortions. Most of us have carious teeth, tonsillitis or rhinitis. These are infectious foci. After an abortion performed by any method, a woman's the immune system. Harmful bacteria from the vagina can enter the uterus. The risk of getting an infection from the vagina is especially high, because it is located closest, but theoretically, through the bloodstream, the infection can get inside the uterus from any source in the body, even a carious tooth.
Of course, the listed consequences most often occur during surgical abortion. But even with a medical abortion, the cervix dilates when the fertilized egg is expelled. Infection easily penetrates through these gates.
To ensure minimal consequences, a medical termination of pregnancy should end with rest for your body. Do not exercise for a month, do not have sexual intercourse, take a shower or swim in open water, do not go to the sauna, swimming pool, or take a bath earlier than 3 weeks after a medical abortion.
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Harm
The harm of medical abortion is caused by blocking progesterone receptors. There is no trauma to the uterus, so complications are much less common than with a traditional abortion. Frequent complication– incomplete expulsion of the fetus (about 10%). Long-term uterine bleeding. Known cases toxic shock after taking “pregnancy pills”.
Complications
It is rare, but still possible, to experience serious complications after a medical termination of pregnancy. First of all, this is the lack of effect of the drug or incomplete abortion. Menstruation may also become irregular or very heavy. Possible allergies. If any warning signs You should immediately seek advice from the clinic where the abortion was performed.
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Discharge
Discharge after medical termination of pregnancy is usually brownish, with blood, and is often disturbing even if the heavy bleeding has already stopped. To remove all suspicions, be sure to visit a gynecologist and do an ultrasound on days 14-16 after the abortion. If, one and a half months after a medical abortion, the discharge does not stop, this indicates that there has been a failure in hormonal system. To correct this condition, the doctor may prescribe oral contraceptives (mini-pills or combination pills).
You should also pay attention to yellow discharge. This could be a sign purulent inflammation, which developed due to the fact that you carried within yourself for some time dead child. Yellow discharge after a medical abortion may be a sign of E. coli multiplication.
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Bleeding
Medical termination of pregnancy is considered the most in a safe way, however, this does not mean it is harmless. Sometimes it happens that after an abortion it develops profuse bleeding. It can lead to blood loss, life threatening. In this case, you need to lie down and call an ambulance, without hiding the fact that you had a medical abortion. Light bleeding, no more than menstrual bleeding, is considered normal until the onset of menstruation after a medical abortion. If you have to change more than one nightcloth in an hour, seek medical attention.
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Pain
Pain after medical termination of pregnancy varies in intensity for each woman. They are caused by contraction of the uterine muscles. How severe the pain will be depends on the pain threshold and stage of pregnancy. Painkillers for unbearable pain should be prescribed by a doctor because many of these drugs can suppress abortion. Pain after a medical abortion lasts for two days. Pain that is slightly more intense than normal period pain is considered normal. Several menstrual cycles can also be painful. A gynecologist may prescribe you a course of physiotherapy or gynecological massage if the pain and bleeding are very intense and prolonged. To avoid the development of infection in the uterus, a control ultrasound on the 16th day must be done, even if you have no complaints. Abdominal pain, fever, green and curdled discharge- all these are signs of infection. Medical termination of pregnancy, done according to all the rules, in three visits, rarely leads to such consequences. 98% of complications during medical abortion are associated with ignoring medical recommendations.
Temperature
The temperature after medical termination of pregnancy usually rises no higher than 37.5ºC and lasts no more than 4 hours. Temperatures up to 37.2C can last for about 10 days. It is associated with increased progesterone levels. Possible delay in treatment infectious process in the uterus leads to infertility. Blood clots and fever, excessive bleeding should be a reason for ultrasound examination pelvic organs before the date prescribed by the doctor (usually 14-16 days after the abortion). If fever and malaise appear after the abortion, call the doctor home.
Nausea
Nausea after medical termination of pregnancy is not observed in all women and does not last long. If you vomit within an hour of taking the drug, unfortunately, the tablets will not work. You will be referred for a vacuum abortion.
If a woman is very bothered by pain in the lower abdomen, she may be prescribed no-shpa. Aspirin should not be taken. For nausea you can take Cerucal. It has an antiemetic effect by blocking receptors. Maximum concentration the drug is achieved after 30 minutes. The half-life is 5 hours. Adult dose - 10 mg 3 times a day. Possible side effects: headache, increased fatigue, fear, tachycardia, itchy skin. Contraindications: individual sensitivity, intestinal obstruction, epilepsy.
Recovery after medical 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 heavy objects. Ask your family to help you clean. A gynecologist can prescribe you procedures and gynecological massage. Be sure to visit a physiotherapy room if your doctor advises you to do so. After an abortion, vegetative-vascular dystonia and nervous disorders. 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 underwear regularly. For the first month, exclude significant strength loads and sports. You can have sex after your first menstrual period after an abortion. Mifepristone is incompatible with alcohol consumption. We also recommend getting a mammogram.
Sex
Since 1999, every second woman has undergone medical termination of pregnancy. Alas, these are statistics. Few women live without abortions in their lives. Bloody discharge after this lasts another two weeks. During this time, you should, of course, abstain from sex. The risk of inflammation if this recommendation is not followed increases. The same applies to intimacy during menstruation.
Pregnancy
It is advisable to plan pregnancy after medical termination no earlier than 3 months later. Pregnancies that occur earlier are at high risk of complications. Medical termination of pregnancy in 95% does not affect the further possibility of conception; you can get pregnant in the next cycle, so take care of contraception. After a medical abortion, the immune system is often compromised, so if you do not restore the body, you may catch some kind of infection during pregnancy. Menstruation after medical termination of pregnancy Menstruation after medical termination of pregnancy normally returns immediately. A period delay of up to 20 days is considered normal. But for 70% of women they arrive on time. If you experience severe cramping pain during menstruation after a medical abortion, you should consult a doctor - this happens if not all of the embryo has come out.
In Kyiv, you can contact the URO-PRO medical center. Medical termination of pregnancy is done at 5-6 weeks. In 2 days another visit will be needed. During these days bleeding begins. After 16 days, a control ultrasound is performed.
You can also get a pharmabort by contacting the Kyiv clinic “Demetra” (Poznyaki district). Colposcopy of the cervix and preventive examinations women at affordable prices, treatment of STDs, menopause, menstrual disorders. Remember that when the course of diseases is latent, it is not bright severe symptoms, such as bleeding and pain in the lower abdomen. Regular examinations help to avoid serious illnesses, incl. oncological A cancerous tumor never occurs on healthy tissue.
The center performs 300 types of tests. Here you can comfortably undergo rehabilitation after a medical abortion, receive psychological assistance if necessary.
The Atlanta Medical Center is also located on the left bank of the Dnieper in Kyiv. Here you can undergo medical termination of pregnancy in the early stages (6-7 weeks). The center also treats sexually transmitted infections, gynecological and venereal diseases, perform gynecological and general massage.
At the Clinic Doroslikh on Lepse Boulevard in Kyiv you can have a medical termination of pregnancy by affordable price 1200 UAH (ultrasound included). Here you will find understanding. The center's gynecologists know that a woman of any age is not immune from unwanted pregnancy 100%, even if she takes contraceptive measures. Medical abortion performed experienced gynecologist, will not affect your health in any way. The procedure will take place according to all the rules prescribed in the pharmabort protocol. For medical abortion, the clinic uses the drug Mifepristone, which has long proven itself to be reliable and effective. It is well tolerated by women. After graduation bloody discharge You must undergo a control ultrasound again.
Has also proven itself well medical Center"Vemar" on the street. N. Bazhana (Kyiv). Medical abortion is performed here early– up to 42 days from the 1st day of menstruation. Normal size of the uterus, absence of an embryo on ultrasound and no discomfort during a follow-up examination indicate a successful medical abortion. The clinic's doctors do everything possible 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 provides assistance in the treatment of kidney and bladder diseases, as well as inflammatory prostate diseases and sexual disorders in men.
As you can see, the choice of medical clinics providing medical abortion is wide. The method of medical abortion is called by WHO to be the most gentle for women's health.
As you know, abortion is the artificial termination of pregnancy performed at a period not exceeding 20 weeks. It can be either surgical or medical. It is noteworthy that severe pain after an abortion can appear regardless of how it was performed, and such a symptom is not at all uncommon.
Causes of pain after abortion
First, let's look at possible consequences artificial termination of pregnancy surgically, which is the most traumatic. Surgery is often very painful, including in this case– possible injury to the walls of the uterus. After an abortion, these damages may be felt for some time.
Another cause of pain may be contraction of the previously stretched uterus to its normal sizes. However, the latter occurs only when the pregnancy was terminated at a fairly late stage - after the 13th week.
A woman may also experience pain if the injured uterus is penetrated during surgical intervention an infection occurred and inflammation of the mucous membrane began. In addition to pain in abdominal cavity, symptoms of complications are fever, back and lower back pain. In this case, qualified medical assistance is needed as soon as possible.
Another cause of abdominal pain after an abortion may be incomplete removal of the fertilized egg - its remains begin to interfere with the contraction of the uterus, which causes corresponding sensations accompanied by bleeding. Premature stress on the body can also provoke pain: intense sports or resuming sexual activity soon after an abortion.
According to medical statistics, every tenth patient who has had an abortion surgical method, after surgery he needs painkillers for some time.
Pain after medical abortion
Medical abortion is fundamentally different from surgical abortion. Its essence is that the fetus independently leaves the uterine cavity under the influence of pharmaceuticals. In other words, a miscarriage occurs. And if surgical termination of pregnancy is carried out under anesthesia, then medication, of course, does without pain relief. Accordingly, pain after an abortion performed with the help of pharmaceuticals is very similar to those experienced by a woman during a miscarriage.
The sensations during a medical abortion are reminiscent of contractions: they can be very intense and, as a rule, are accompanied by bleeding. After rejection of the fertilized egg painful sensations subside.
Doctors categorically prohibit taking antispasmodics during such an abortion - they can significantly interfere with the process of expulsion of the fertilized egg, preventing uterine contractions.
Sometimes women have breast pain after an abortion, including a medical one. Doctors explain this by saying that the mammary glands react very sharply to hormonal stress. With the onset of pregnancy, they immediately begin to prepare for feeding the baby, and during an abortion, the reverse processes do not always occur smoothly, which causes a certain discomfort, often very painful. And we should not forget that artificial termination of pregnancy often provokes the formation of tumors in the mammary glands. So, if dense nodules and swellings appear in the breast, you should immediately contact a mammologist.
In general, doctors advise absolutely every woman to undergo a thorough examination after an abortion, regardless of whether she is bothered by pain after an abortion or not. This will make it possible to develop an individual course of rehabilitation so that no unpleasant, let alone sad, consequences arise in the future.
The consequences of medical termination of pregnancy are less dangerous than surgical ones, but in the absence of qualified assistance they can lead to infertility and even death. Taking pills is not difficult, however, despite the apparent simplicity of the procedure, it causes major changes in the body: a large dose of hormones affects reproductive system, disrupts the natural processes of preparation for bearing a fetus.
Vomit
This complication develops in approximately 44% of women with orally misoprostol, in 31% - with intravaginal. Studies also confirm that the frequency of vomiting is affected by the interval between doses. hormonal drug(Mifepristone) and prostaglandin (Misoprostol). The likelihood of this symptom is lower if the interval is 7-8 hours than with a daily break.
Nausea
This symptom is more common than others gastrointestinal disorders with medical abortion. It has not been fully established what exactly it is caused by: exposure to drugs or termination of pregnancy.
However, a trend has been identified in which nausea is more pronounced with a high dose of Misoprostol (a prostaglandin), rapid administration and a gestational age of 6-7 weeks. If vomiting occurs, you must inform your doctor. You may need to take the pills again.
Allergy
Allergic reactions as a consequence of medical abortion can develop to the components of any of the drugs taken. Most often it is a rash or hives. Severe manifestations, such as Quincke's edema and breathing disorders, occur extremely rarely. To avoid this complication, after taking medications you should stay in a medical facility (clinic) for at least a few hours.
Diarrhea
Stool disorders develop in approximately 36% of women when taking Misoprostol orally and in 18% when taking Misoprostol intravaginally. The symptom can have varying degrees of severity. The effectiveness of taking antidiarrheals in such cases has not been proven. Diarrhea usually stops on its own after a few hours.
Severe abdominal pain
This symptom is caused by spasm of the muscles of the uterus, which is part of the mechanism of action of the hormonal drug. It is observed in 96% of women and is considered normal. The severity of pain can vary: from mild to unbearable. The symptom begins to increase rapidly 30-50 minutes after taking Misoprostol and most often goes away after the abortion is completed. There is a tendency that the shorter the pregnancy, the easier the pain.
To eliminate it, non-steroidal anti-inflammatory drugs (Ibuprofen, Naproxen) are used, in severe cases- narcotic painkillers (Codeine, Oxycodone).
Convulsions
Appear approximately 1.5-3 hours after taking Misoprostol. Most often localized in the groin area. They subside after the abortion is completed. A warm heating pad can be used to reduce pain.
All of the above complications do not require special treatment and most often go away on their own after the abortion is completed. When they are severe, symptomatic remedies are used.
Medium-term consequences and complications
Medium-term effects occur within a few weeks of medical abortion.
Bleeding
This symptom appears in early period, some time after taking the pills. If the bleeding volume corresponds to menstrual bleeding (no more than 1-2 pads per hour), lasts 7-14 days and gradually decreases, then there is no cause for concern - this is not a complication, but a normal process.
In some cases, women notice discharge for up to 30 days, but it is spotting and is not accompanied by pain or other symptoms. If the bleeding is heavy (2-3 or more pads per hour), prolonged and/or accompanied by pain, then you must immediately inform your doctor. This complication is rare and develops against the background of incomplete abortion or infection.
The longer the pregnancy, the higher the risk abnormal bleeding. In 0.4% of cases, blood transfusion is performed, in 2.6% - suction curettage. Without timely medical care death cannot be ruled out.
Continuing pregnancy or incomplete termination
In 1-4% of cases, the fertilized egg is not expelled from the uterus or does not come out completely. This can happen for several reasons: the dose of the drug is incorrectly calculated, the timing of the procedure is too late, there are hormonal disorders or inflammatory processes in the woman’s body.
Such consequences after medical termination of pregnancy are accompanied by prolonged and undiminished bleeding, prolonged or cramping pain lower abdomen, increased temperature, fever. You cannot cope with them on your own; hemostatic drugs will not help.
An ultrasound and follow-up are required. If this is not done, then in the event of an incomplete abortion, the remnants of the fetal egg will lead to the spread of infection, general blood poisoning and death. If the pregnancy continues to develop, then the risk of having a child with serious malformations is high.
Pain in the lower abdomen
Normally, cramps in the uterus gradually disappear after the abortion is completed. If the pain continues, this may be a sign of infection or incomplete termination of pregnancy. This symptom requires examination by a gynecologist and ultrasound.
Headaches and dizziness
These consequences of medical abortion develop in 20% of women. As a rule, the cause is a large loss of blood. Weakness and decreased blood pressure, pre-fainting state.
If dizziness is accompanied by bleeding, then the help of a doctor is necessary. In another case, you can take an analgesic, rest more often, and change your body position gradually.
Long-term effects and complications
Long-term consequences of medical abortion are rare but most difficult to treat. They appear after several months and even years.
Menstrual irregularities
If menstruation began on time (counting from the date of abortion) or was delayed by 7-10 days, this is a sign that sexual and endocrine system recovered. About 10-15% of women note that in the first few cycles, menstruation is more painful and heavy, but soon becomes the same as before.
A complication will be indicated by a delay of more than 40 days or heavy periods, accompanied by cramping intense pain, fever, and deterioration in general well-being.
In the first case, either a re-occurrence of pregnancy is possible (this happens already 2 weeks after an abortion), or a disruption in the functioning of the ovaries. You need to see a doctor, he will determine the cause and prescribe necessary procedures. Recovery hormonal levels Oral contraceptives are often used.
If your periods are very heavy, with severe pain and a rise in temperature, then perhaps particles of the fertilized egg remain in the uterus and/or an infection has developed.
After a doctor’s examination and ultrasound, curettage is performed and antibiotics are prescribed.
Infectious and inflammatory diseases
Develops after medical abortion as an exacerbation chronic forms or due to remaining particles of the fertilized egg. If a woman had hidden, sluggish infectious and inflammatory processes (salpingitis, gonorrhea, etc.) before the abortion, then after the abortion procedure they may begin to progress.
This is manifested by pain in the lower abdomen, discharge with unpleasant smell And greenish color, purulent impurities, increased temperature. After laboratory diagnosis, the doctor prescribes antibiotics, most often in a hospital setting.
Infertility
The reasons for this severe consequences hormonal disorders or inflammatory diseases of the uterus and appendages occur.
In the first case, the balance of male and female sex hormones is disrupted, as a result of which the process of fertilization of the egg and its attachment to the wall of the uterus is hampered.
Inflammatory processes can lead to the formation of adhesions and narrowing of the lumen fallopian tubes. This prevents the egg from moving to the uterus.
Changes in emotional state, character
Sometimes hormonal disbalance and the abortion procedure itself affects the characteristics of a woman’s psyche. She may become overly irritable, aggressive or whiny, depressed, lethargic.
At first, such reactions are observed only in difficult situations, for example, during or after a quarrel. But soon they become total, arising without external causes.
To eliminate the problem, you need to see a doctor: a psychiatrist or psychotherapist, or consult a psychologist.
Medical abortion and its consequences are still being studied. Research confirms that the earlier the abortion procedure is performed, the lower the risk of complications.
The most common among them are bleeding, pain in the lower abdomen, and infection. The consequences are related to hormonal disorders and the risk of incomplete release of the fertilized egg. Problems may occur menstrual cycle, development of inflammation, infertility.
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May occur following misoprostol administration, although vasomotor changes associated with hormonal fluctuations may also cause some of these symptoms.
In some cases, it can be difficult to determine whether the effects that occur during a medical abortion are caused by the drugs or by the abortion process itself.
Pain and cramping after medical abortion
Pain due to uterine spasms is an expected part of the abortion process. Studies using methotrexate/misoprostol for medical abortion report seizures in more than 75% of women.
Spitz et al conducted the largest clinical trial of mifepristone 600 mg plus oral misoprostol 400 mcg in women ≤ 63 days pregnant and reported that almost all women (≥ 96%) experienced abdominal pain. In this study, women remained in the clinic for 4 hours for observation after taking misoprostol. Sixty-eight percent of women received at least one pain reliever (usually acetaminophen), and 29% also received an opiate. Women who were ≥50 days pregnant took analgesics significantly more often than those who were ≤49 days pregnant.
The severity of cramping pain associated with medical abortion ranges from mild to severe. The amount of discomfort a woman reports will depend on individual and cultural factors. In a US study using a regimen of mifepristone and misoprostol and approved by the Food and Drug Administration, Spitz et al found no association between pain severity and gestational age, but women who were 50 to 63 days pregnant were more likely to report severe pain than women ≤ 49 days gestation.
The pain usually peaks after taking misoprostol and gradually subsides shortly after the abortion is completed. In one study of oral mifepristone and misoprostol that monitored such effects, Peyron et al found that pain began less than 1 hour after taking misoprostol and lasted 1 hour or less.
Another study of two different oral mifepristone/misoprostol regimens found that the average time to seizure onset was 1.4 to 2.9 hours after the initial dose of misoprostol, depending on the route of administration. In studies using methotrexate and misoprostol, pain began on average about 3 hours after taking misoprostol.
Pain is rarely a sign of impending complications. However, doctors should instruct patients to contact the clinic when pain is accompanied by other signs and symptoms such as fever, restlessness, or heavy bleeding. If pain persists, it is imperative to undergo an examination to rule out underlying pathologies, such as infections.
While analgesics play an important role in medical abortions, one of the main tools for managing pain is adequate counseling before the procedure and confidence during the process. During preparatory stage Consultants should inform patients that they may experience cramps comparable to early miscarriage. This will allow women to prepare for the sensations mentally, emotionally and logically (i.e., correctly assess the degree of discomfort). Whenever a doctor receives a telephone complaint of pain, he should contact the patient within a few hours afterward to ensure that the pain has resolved.
Both non-narcotic and narcotic analgesics are used for pain relief during medical abortions. Clinicians should consider providing the patient with either the medication itself or a prescription for analgesics at the time of the visit when mifepristone (or methotrexate) is administered.
Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen are suitable non-narcotic medications. NSAIDs do not affect the action of misoprostol. Although NSAIDs inhibit prostaglandin synthetase, an enzyme involved in the synthesis of prostaglandins, they do not block the effect of exogenous prostaglandin analogues such as misoprostol.
Narcotic analgesics such as codeine or oxycodone may be used in combination with non-narcotic means. In the United States, approximately 25% of women who have a medical abortion at a clinic request narcotic analgesics. Additionally, many women find that placing a heating pad or bottle with hot water on the lower abdomen can relieve cramps.
Bleeding after abortion
Bleeding associated with medical abortion is usually the greatest the only source concerns for patients and doctors. The amount of discharge during a medical abortion is considered normal if it generally does not exceed the loss of menstrual blood. In addition, the quality of bleeding may differ from menstrual bleeding. Women often notice blood clots during pregnancy expulsion, which can be alarming if women are not well informed about the possibility.
In large scale clinical trials Vaginal bleeding occurred in almost all women whose pregnancies were successfully completed using mifepristone and misoprostol. While bleeding is an expected consequence of medical abortion, excessive bleeding that causes clinically significant changes in hemoglobin concentration is uncommon, as is the need for blood transfusion or surgical aspiration to achieve hemostasis.
In big multicenter study In a study of 2000 women who received 200 mg mifepristone followed by 800 mcg misoprostol intravaginally, 0.4% of patients required surgical aspiration to control bleeding. (Note: This medication regimen is different from the FDA-approved regimen.) In a multicenter U.S. study of 2,121 women using an FDA-approved medication regimen reported by Spitz et al, 2.6% of women required suction curettage to control excessive bleeding.
The proportion of women requiring blood transfusions was 0.2% in several large studies. Thus, clinically significant bleeding is a real, although infrequent, problem. In one study, Krenin and colleagues reported that more severe bleeding episodes (requiring ≥ 3 pads per hour) occurred less frequently in women who took misoprostol 6 to 8 hours after taking mifepristone compared to those who took it 24 hours later. after taking mifepristone (13% to 19%). There were no differences between the groups in the frequency of blood transfusions (one in each group). The risk of these effects may be lower in women who are ≤49 days pregnant compared to women who are >49 days pregnant. There have been no reports of the need for hysterectomy to stop bleeding after medical abortion.
The duration of vaginal bleeding after medical abortion with mifepristone and misoprostol varies across studies. Clinical studies conducted in the United States indicate a mean bleeding time of 14 to 17 days, with a range of 1 to 69 days.
In the classic study by Spitz and colleagues, the proportion of women who reported heavy bleeding, was highest on the day of misoprostol administration and then gradually decreased over subsequent days. Thirteen days after taking misoprostol, 77% of women reported bleeding as “discharge,” but by day 30 after treatment, only 9% of women reported some type of discharge. This number dropped to 1% after 58 days.
A comparison study of surgical abortion and medical abortion using mifepristone/misoprostol found that women tended to bleed for a longer period of time after medical abortion, although changes in hemoglobin after treatment were comparable with both methods.
Advance guidance about normal and abnormal bleeding reduces the likelihood that bleeding will be a cause for concern. Adequate counseling also reassures women to promptly report excessive bleeding. Recommended guidance urges women to contact their doctor if they use more than 2 thick full-size sanitary pads per hour for 2 hours in a row.
Because women may be understandably concerned about seeing products of conception, physicians should inform medical abortion patients that fetal tissue cannot be identified until 8 weeks of pregnancy. They may see a gestational sac that looks like a grape, or they may only see blood clots.
All physicians should have clear, documented procedures for assessing and identifying potential abnormal bleeding, including the need for emergency assistance.
If the patient complains of heavy or persistent bleeding, the doctor should clarify the degree and duration of bleeding. If the patient's responses indicate normal bleeding (eg, less than 2 sanitary pads per hour), the physician can reassure the patient and monitor her condition over the phone. If the patient reports slightly heavier bleeding (eg, saturated at 2 or 3 pads per hour for 2 hours) after taking misoprostol, close monitoring by telephone may also be appropriate if the woman is otherwise well.
Acute bleeding, prolonged heavy bleeding or symptoms of orthostasis disease must be quickly assessed. Such situations may require suction curettage to control bleeding or, less commonly, blood transfusion.
Gastrointestinal consequences
Gastrointestinal effects are generally thought to be related to the prostaglandin analogue (misoprostol) but may also occur as a result of mifepristone or methotrexate. Nausea, vomiting and diarrhea may also be associated with both early pregnancy, and with the abortion process itself.
In many studies of medical abortion, nausea is the most a common consequence from the outside gastrointestinal tract. The incidence of gastrointestinal effects is approximately the same for mifepristone/misoprostol and methotrexate/misoprostol regimens.
As a rule, nausea, vomiting and diarrhea are self-limiting and of low severity. Gastrointestinal sequelae are primarily helped by reassurance and compassion in women, but can also be treated with antiemetics or antidiarrheals. However, there are no definitive studies that demonstrate the benefit of these agents in medical abortion patients.
Studies show that the incidence of gastrointestinal effects tends to increase with higher misoprostol doses, faster absorption, and increasing gestational age. Nausea and vomiting occur significantly more frequently in women 50 to 63 days pregnant than in women ≤ 49 days pregnant. (Note: on FDA-approved regimen for ≤49 days pregnant)
El-Refei et al reported that the incidence of vomiting (31% to 44%) and diarrhea (18% to 36%) was significantly lower among women receiving intravaginal misoprostol than among women receiving oral misoprostol. The typical starting dose of intravaginal misoprostol for both mifepristone and methotrexate is 800 mcg.
The effects of buccal versus vaginal administration are reported to be similar, although the incidence of diarrhea was significantly higher in one study. IN Lately However, Winikoff et al reported that in women, effects following buccal administration were similar to those who took the drug orally, with the exception of higher rates of thermoregulatory effects in the buccal group.
Sublingual misoprostol, with its rapid absorption and high peak serum levels, appears to be associated with higher rates of fever, chills and gastrointestinal symptoms compared to other methods of administration.
The length of the interval between mifepristone and misoprostol may also be a significant factor. Krenin et al reported that nausea and vomiting were lower in women who used vaginal misoprostol 6 to 8 hours after taking mifepristone compared with those who used it in the same way 24 hours after mifepristone.
In the rare case where sepsis associated with botulinum bacteria, after a medical abortion, symptoms of severe nausea and vomiting begin more than 24 hours later after administration of misoprostol. Against, normal consequences medications that can be expected occur within the first few hours and are usually short-lived and go away on their own.
Changes in thermoregulation
The term "thermoregulatory changes" refers to fever, chills, or warm sensations that may occur during the medical abortion process. Short-term fever or chills may occur due to any medications used in medical abortion or due to hormonal changes. Reports of changes in thermoregulation vary widely across studies and depend on the parameter being measured (fever, warmth, chills).
Spitz et al report fever in 4% of women using an FDA-approved mifepristone/misoprostol regimen. In a regimen of methotrexate followed by misoprostol, Krenin et al reported subjective fever or chills in 15% of subjects after taking methotrexate and 31% of subjects after taking misoprostol. Another study by Krenin et al using oral methotrexate and intravaginal misoprostol reported fever, warmth, or chills in 30% to 44% of women. Almost all studies of abortion with mifepristone-misoprostol describe the effects of fever and chills commonly associated with misoprostol use, regardless of route of administration.
Changes in thermoregulation usually do not require treatment, as they are usually short-lived. If necessary, doctors may treat fever with acetaminophen or NSAIDs. A temperature of 38 degrees or higher that persists for several hours despite the use of antipyretics, or develops several days after using misoprostol, may indicate an infection. Infection is a rare complication that can occur several days after a medical abortion. About acute infections during the process of expulsion of the fetus given time not reported.
Headache and dizziness
Headache and dizziness occur in approximately 20% of medical abortion patients. When a patient with severe bleeding reports dizziness, the physician should consider the possibility that significant blood loss is causing hypovolemia. The doctor should ask the patient about the amount of bleeding and associated symptoms, such as weakness. profuse sweating and lightheadedness. Patients experiencing these types of symptoms with heavy bleeding require immediate medical evaluation.
Most often, dizziness is mild symptom, which passes spontaneously. You can get rid of it if you rest, gradually change position and move with someone's help. Headache can be treated with analgesics. There have been no reports of cerebrovascular accidents associated with the use of mifepristone, methotrexate, or misoprostol.
Follow-up after medical abortion
Follow-up of all medical abortion patients is critical to determine completion of the abortion and to check for complications. During counseling before medical abortion, the physician should confirm the date and time of follow-up visits and give the patient written instructions. The timing of these visits will vary depending on the medication abortion regimen used, but in most cases they should be within 2 weeks of taking mifepristone or methotrexate.
Choosing a medical abortion does not exclude the possible need to undergo a surgical abortion. Misoprostol, a standard component of medical abortion used in the United States, is associated with a teratogenic risk. Thus, surgical abortion is required whenever medical treatment has failed to successfully terminate the pregnancy.
Follow-up also provides an opportunity for the patient to make decisions about contraception and for the physician to offer other health-related services as needed by the patient. In addition, this meeting provides an opportunity for the physician to improve his competence and ability to examine patients, and may also help the patient achieve a sense of completion of the procedure.
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