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Abortion

Abortion

Introduction

Abortion is a term generally used for termination of pregnancy before the fetus can sustain itself.This type of abortion can be performed safely in the first trimester of pregnancy. Abortions can be voluntarily done on a woman for non medical reasons, provided she grants her consent for the same.Such an abortion is called voluntary abortion.

If the pregnancy terminates by itself before the second trimester it is called a miscarriage. Miscarriage is most commonly cause by genetic abnormality in the fetus. Other causes for miscarriage can be hormonal instability, lupus, diabetes or infection in uterus.

 

Reasons for abortion:-

At various gestational stages, abortion can occur or can be done by doctor for various reasons. In cases where it has been established that the fetus has some abnormality or some other chromosomal problem, an abortion is suggested. Sometimes it is done to save a woman’s life by eliminating fetuses in case of conception of multiple fetuses. Abortion can also be done to protect a woman from mental trauma of carrying an unwanted pregnancy. It can be also caused by trauma, excessive stress and intentional attempts to self abort the pregnancy.

Miscarriage can also be caused by:-

  • Infection in uterus
  • Uncontrolled hormonal activity
  • Abnormalities in the uterine wall
  • Thyroid problems
  • Lifestyle habits like drinking, smoking etc.
  • A medical condition called Incompetent Cervix

To test for causes of repeated abortion following procedures can be used:-

  • Blood test
  • Genetic test
  • Endometrial biopsy:- a piece of tissue is studied under microscope to understand the cause of repeated miscarriage
  • Hysteroscopy:- Study is made with a probe inside the walls of vagina.
  • Laparoscopy:- the pelvic organs are tested in this procedure with a lighted probe to find out the causes.

 

Method of abortion:-

Abortions that are carried out in the first trimester can be performed using a MVA or manual vacuum aspirator or suction. It is a surgical method of abortion which requires a manual syringe to be used. Second method, used more frequently, is called the EVA i.e. electric vacuum aspirator. Vacuum aspiration is considered to be the safest procedure if done by certified doctors who also comply with hygiene standards.

For abortion after twelve weeks of pregnancy often require a combination of surgical and medical methods. Vacuum aspiration along with Dilatation and Curettage is usually carried out. Prior to the procedure an ultrasound is done.If the fetus is believed to develop any abnormality, the abortion is carried in third trimester by inducing artificial labor and under the effect of general anesthesia a procedure called hysterectomy is carried out.

 

After 16 weeks of gestation, in case an abortion is required, it can be done by a procedure called Intact dilation and extraction, also known as IDX. These are surgical methods of abortion.

Abortion can be also done medically using medicines known as abortifacient medicines.

During the first trimester, mifepristone and prostaglandin are observed to be very effective.

Mifepristone combined with prostaglandin is effective to abort the fetus. With progression in gestation period, a combination of mifepristone and misoprostol works better and faster.

In early stages of abortion, induction of mifepristone, followed by vaginal misoprostol within one or two days is considered to be almost 100% effective.

 

Self induced abortion:-

Attempts to cause intentional miscarriage are not unheard of. Unwarranted use of misoprostol, or inserting sharp objects in the uterus can cause self induced abortion.

 

Risks of abortion:-

  • Severe bleeding. Bleeding is caused both in surgical and medical abortions
  • Nausea and vomiting
  • Persistent feeling of fatigue
  • Pain in the abdominal area unrelieved by medicines and other means
  • Fetal tissue might not get properly removed from the uterus
  • Injury can be caused to uterus or the cervix because surgery is an intrusive procedure.
  • Infection can be caused in the uterus if procedure not carried out properly.
  • Passing of clots

Apart from physical side effects, sometimes effects of abortion can also be observed on mental health. Due to fluctuation in hormones during pregnancy and after abortion, depression is often experienced by women. Change in sleep pattern, constant feeling of fatigue is also common. If any of the symptoms are persistent it is advised to contact a doctor.

 

Precautions after abortion:-

Post abortion care is necessary to avoid any future complications. It is advisable to contact a doctor immediately if sudden swelling in abdominal area is experienced. Also a rapid increase in heart rate can be observed in some patients. If a woman does not get her menstrual period within 40 -42 days post the procedure a check-up becomes necessary.

A woman can conceive again normally after abortion. Normally a period of rest for three months is advised before conceiving again. Abortion should not be carried with unsanitary equipment or by uncertified people.