By the nature of the occurrence, artificial and spontaneous abortions are distinguished .
Artificial abortion is an operation in which mechanical expansion of the cervix is performed, then separation and removal of the ovum from the uterus.
According to the procedure established in our country, artificial termination of pregnancy at the request of a woman is carried out only with a gestational age of up to 12 weeks and if the pregnant woman has no medical contraindications for the production of this operation.
At later stages of pregnancy, the risk of abortion increases significantly (the possibility of a traumatic violation of the integrity of the uterus, the occurrence of heavy bleeding, etc.). This is due to the fact that with an increase in the gestational age, the circulatory system between the mother and the ovum changes; there is an increase in the number and size of muscle fibers of the uterus; its blood vessels increase and expand. The walls of the cervix and its body after 12 weeks of pregnancy become especially soft and loose.
The existing procedure for hospitalizing women for abortion does not present any particular difficulties for them . A woman receives a referral to the hospital for termination of pregnancy from the obstetrician-gynecologist of the antenatal clinic or clinic at the woman’s place of residence.
Before going to the hospital, the doctor conducts an examination: confirms the presence of pregnancy, establishes its term and the absence of a woman’s medical contraindications for abortion. A pregnant woman conducts some laboratory tests to protect her health.
The operation of artificial termination of pregnancy is performed in maternity hospitals and hospitals, which include gynecological or general surgical departments, and in rural areas – in district and large district hospitals that have the appropriate conditions for this operation and have an obstetrician-gynecologist on staff. For each abortion operation, painkillers are used.
The time of admission of a woman to the hospital is set taking into account the gestational age. The length of hospital stay after an abortion operation is determined by the attending physician depending on the condition of the woman and other indications. It is known that sometimes women, due to various personal circumstances, most often wanting to keep their pregnancy secret and the fact of having an abortion secret, do not want to go to the hospital for a antenatal clinic doctor for examination at the place of their residence to get a referral . For similar reasons, they sometimes do not want to go to an abortion for an abortion. This legitimate desire of women is taken into account. The heads of health authorities and medical institutions can send pregnant women at their request for examination and termination of pregnancy to medical institutions outside their place of residence.
Spontaneous abortion is an unintentional termination of pregnancy that occurs without any intentional intervention by the pregnant woman or other persons in order to terminate the pregnancy. Often, spontaneous abortion occurs even against the wishes of the woman.
The reasons underlying the occurrence of spontaneous abortion are very diverse.
They are conventionally grouped into:
• predisposing causes (group I);
• causes directly causing abortion (group II).
The I group of predisposing causes of spontaneous abortion includes:
1 disease of the endocrine glands.
2 various common diseases of a woman: diseases of the cardiovascular system and, above all, decompensated heart defects, diseases of the blood-forming organs, incompatibility of the blood of the mother and the fetus by the Rh factor, etc., diseases of the kidneys and other organs.
3 chronic and acute infectious diseases, accompanied by fever and chills, including flu.
4 various intoxications that occur under the influence of chemical factors, some drugs, etc.
5 in severe forms of toxicosis of pregnant women,
6 in the presence of various diseases of the genital organs in women (inflammatory processes, tumors), with abnormalities of their development or in the wrong position.
The II group of causes that directly cause spontaneous abortion include:
• various injuries, both mechanical and mental.
Mechanical injuries (bruises, falls, a sharp rise in heavy weights) by themselves in healthy women rarely lead to spontaneous miscarriage. For this, as a rule, a woman is required to have factors predisposing to this (general diseases, endocrine disorders, etc.).
There are observations suggesting that in a healthy woman with a perfectly normal state of the genitals, even significant trauma does not violate pregnancy. At the same time, a relatively small external effect can lead to an abortion if there are any predisposing reasons for abortion.
The initial stage of a spontaneous miscarriage is characterized by the appearance of pulling pains in the lower abdomen and lower back, which later become cramping in nature. Scanty spotting from the vagina can join the pain, which gradually intensifies with the course of the process.
At the initial stage of abortion, the connection between the ovum and the maternal organism is not yet broken or very slightly broken, and the uterine pharynx is closed. At this time, you can count on preserving the pregnancy with the obligatory condition of creating a special regime for a woman and carrying out appropriate treatment. That is why, with the appearance of pain in the lower abdomen and especially spotting (even the most minor), a pregnant woman should immediately consult an obstetrician-gynecologist.
It should be said that spontaneous abortions are relatively rare. Most abortions are artificial.
In some cases, pregnancy has to be interrupted for the so-called medical reasons, when its continuation can adversely affect a woman’s health condition, lead to a severe aggravation of her existing illness, or when childbirth poses a serious threat to the health and life of the mother, as well as the fetus.
Medical indications for abortion are severe lesions of the heart, kidneys, lungs and other internal organs and systems of the mother, narrowing of the woman’s pelvic bone, in which childbirth is not possible in a natural way, etc.
Thus, artificial termination of pregnancy for medical reasons is a necessary measure. Abortion in these cases is less dangerous for women than gestation and childbirth. In addition, artificial termination of pregnancy is required in cases where a woman can assume the birth of an inferior child.
Every woman needs to know that artificial termination of pregnancy, even if it was performed in a medical institution by a qualified specialist and in the most favorable period of pregnancy (7–9 weeks), cannot pass completely without a trace for her health. This operation, like any other, is a known risk. But is women really evaluating her? Unfortunately, far from all.
COMPLICATIONS AND CONSEQUENCES OF ABORTION.
Mechanical damage to the cervix and uterus.
No matter how this operation is performed, damage to the uterus to one degree or another is actually inevitable. But it cannot be otherwise. Indeed, in order to remove the fetal egg from the uterus, it is first necessary to penetrate into its cavity. And for this, it is mandatory to expand the channel of her neck – the task is far from simple. This expansion should be the greater, the longer the gestational period during which an abortion is performed.
It should also be borne in mind that the channel of the cervix in a healthy woman is very narrow. The entrance to it from the vagina (external pharynx), as well as the exit of the canal into the uterine cavity (internal pharynx) are compressed according to the terminology accepted in obstetrics – “closed”.
Despite the fact that the expansion of the cervix is always done by the doctor very carefully (taking into account the location of the uterus), cracks and tears of the cervix, sometimes quite significant, often occur during the introduction of dilators. As a rule, even in the process of neck expansion at least small spotting appears. This in itself indicates some trauma to the cervix. They are most abundant in the production of artificial abortion in nulliparous women.
After artificial opening of the cervix, a fetal egg is removed from the uterine cavity. First of all, the doctor must exfoliate the fetal egg from the uterine wall. This manipulation is carried out “blindly”, so the doctor cannot be completely sure of the success of his actions.
The final part of the abortion operation is the control curettage of the inner walls of the uterus using a relatively small curette with a sharp loop. This is done so that the doctor is convinced of the complete separation and removal of the entire fetal egg from the uterus. Leaving even minor particles of the ovum in the uterine cavity can cause a number of complications: poor subsequent contraction of the uterine muscles, bleeding, and the development of a focus of infection.
During abortion, the doctor does not see and cannot see the surgical field; he cannot visually monitor the accuracy of all manipulations. In the correctness of his movements associated with the production of this operation, he is completely forced to rely on touch.
This is precisely the essential difference between this operation and any other, its particular complexity and danger.
Unable to clearly determine the place of attachment of the fetal egg, as well as precisely regulate the strength of the necessary scraping movements, the doctor can involuntarily remove not only the entire mucous membrane of the uterus, but also damage its muscle layer.
In the future, such superficial and seemingly minor damage to the muscle walls of the uterus can lead to serious consequences for a woman. No matter how high the doctor’s qualifications and experience, as well as the subtlety of touch, he can never be sure that during the abortion he removed all the fetal egg without leaving any part of it in the uterine cavity. It can never be guaranteed against the possibility of surgical penetrating wounds of the cervix or body of the uterus with surgical instruments – their perforation (perforation).
Perforation of the uterus is a very serious and life-threatening complication, requiring urgent surgery to open the abdominal cavity. Sometimes such an operation is limited to suturing the damaged tissue (perforation), often there is a need to remove the uterus.
To some extent, blood loss is an inevitable companion of this operation, regardless of how it is performed. Any blood loss is not indifferent to the body. Especially dangerous is the so-called massive blood loss, when a person loses a significant amount of blood in a short time.
Most often, bleeding as a complication of abortion is observed when particles of the ovum are left in the uterine cavity during this operation. Bleeding in these cases usually does not begin immediately after removal of the fetal egg from the uterus, but after several hours and even days and may require emergency assistance.
Inflammatory diseases of the genitals.
Inflammatory diseases of the female genital organs among all gynecological diseases occupy a leading place both in the frequency of occurrence and in the severity of long-term consequences. In any inflammatory process, regardless of its location, there may be one way or another a rush of blood to the site of inflammation, the formation of edema, the appearance of pain, impaired function of a certain organ, etc. Sometimes these phenomena increase slowly, manifesting themselves as insignificant, not clearly expressed symptoms. Sometimes the inflammatory process proceeds violently, accompanied by sharp pathological manifestations on the part of the whole organism: general condition deterioration, fever, chills, severe diffuse soreness, metabolic disturbance, etc.
Features of the manifestation and course of the inflammatory process depend not only on the properties and strength of the pathogen, but also on the general condition of the human body, on the degree of its resistance to various influences. All this fully applies to inflammatory processes in the genitals of women.
Microbes are widespread in the environment. They can be found directly on the skin of the hands and other parts of the body, in the nasal cavity, mouth, and throat. In women who have sex, they can be inserted into the vagina and stay there for a long time, without showing themselves. However, if there are favorable conditions for their development, they can cause an inflammatory process not only in the vagina, but also in other parts of the internal genital organs of a woman. With the penetration of microbes into the lymphatic and blood vessels, inflammation can encompass both nearby and distant organs and tissues. Given that the vagina communicates with the uterine cavity through the cervical canal and the uterus through the uterine canal with the abdominal cavity, the inflammatory process that occurs in the vagina can spread not only to the uterus, its tubes, ovaries, but also to affect the perinatal fiber and peritoneum and other organs covered by it (bladder, rectum).
The uterine cavity does not contain microorganisms in its normal state. During an abortion, abrasions and tears are formed on the cervix during its expansion, and the inner surface of the uterus as a result of the operation is a bleeding wound. This creates the “entrance gate” for the infection to penetrate into the underlying tissues, into the blood and lymph vessels.
In addition, blood clots accumulate in the vagina, canal of the cervix and its cavity due to abortion, which represent a good nutrient medium for microorganisms. It is also a prerequisite for the development of postabortion infection and the onset of the inflammatory process.
In nulliparous women, serious tissue damage occurs during abortion more often than in women giving birth, which leads to a more frequent occurrence of inflammatory diseases.