How a surgical abortion is performed and why it is dangerous

2024 Author: Malcolm Clapton | [email protected]. Last modified: 2023-12-17 03:44

This method of abortion has long been recognized as obsolete.

What is Surgical Abortion

Surgical abortion is a method of termination of pregnancy in which the embryo or fetus is removed from the uterus mechanically using instruments.

In modern evidence-based medicine, surgical abortion is subdivided into Abortion. What Happens is of two kinds.

• Vacuum aspiration. She is also a vacuum abortion. This is when the contents are sucked out of the uterus using an electric pump or a special syringe that creates a vacuum.
• Dilation of the cervical canal and curettage (PB). During this procedure, the surgeon opens the cervix, inserts a special surgical instrument (curette) into it and scrapes the embryo or fetus together with the mucous surface of the uterus. Another name for RV is the method of dilatation (expansion) and curettage.

However, in Russian practice, vacuum aspiration is accepted. Rehabilitation after medical abortion - the way to preserve the reproductive health of women is to be singled out as a separate type of intervention - the so-called mini-abortion. Surgical abortion is precisely the curettage of the uterine cavity.

When can a surgical abortion be done?

Almost never, actually. WHO classifies this method of termination of pregnancy as unsafe. And he insists that RV, at the slightest opportunity, should be replaced by vacuum aspiration or medical abortion.

Russian doctors also recognize MEDICINE ABORTION OF PREGNANCY. Clinical guidelines (treatment protocol) that cervical dilatation and curettage is an outdated method of surgical abortion and is not recommended for termination of pregnancy less than 12 weeks.

Unfortunately, in Russia, surgical abortion, even for a shorter period, is still a common practice.

So, in 2015, more than 80% of them were carried out by the method of dilatation and curettage. Although the situation seems to be improving gradually. For example, in 2018, according to the Ministry of Health of the Russian Federation, 34% of all abortions were medication, that is, the share of instrumental interventions decreased.

From the point of view of evidence-based medicine, the RV method is justified only for periods longer than 15 weeks, when neither vacuum aspiration nor medications will be effective anymore, but for some reason it is necessary to terminate the pregnancy.

If we talk about late termination of pregnancy, then in Russia a woman can get a referral for an abortion after 12 weeks by the Federal Law of 21.11.2011 N 323-FZ (as amended on 22.12.2020) "On the basics of protecting the health of citizens in the Russian Federation" (as amended and supplemented, entered into force on 01.01.2021). Article 56. Artificial termination of pregnancy only for medical reasons Appendix to the order of the Ministry of Health and Social Development of the Russian Federation of December 3, 2007 N 736. List of medical indications for artificial termination of pregnancy or social DECISION of February 6, 2012 N 98. On the social indication for artificial termination of pregnancy indications. These include, for example:

• frozen pregnancy;
• severe fetal malformations;
• a mother's health condition that does not allow her to endure pregnancy. We can talk about both diseases (leukemia, different types of tuberculosis, rubella, HIV), and life-saving treatment - for example, chemotherapy;
• pregnancy resulting from rape. By the way, this is the only social indication that exists today.

A complete list of indications can be found out from the gynecologist. The decision on the possibility of termination of pregnancy beyond 12 weeks is also taken by the doctor - as a rule, as part of a medical council.

How is a surgical abortion done?

Dilation and curettage are done only in a hospital, where the pregnant woman is referred by the gynecologist. This happens after the woman undergoes an examination and passes all the tests prescribed by the doctor.

The procedure itself is performed under anesthesia. The operation usually takes 10 to 20 minutes, but it may take additional time for the cervix to dilate. Previously, metal dilators were used for dilation. But the method is recognized as traumatic, and WHO recommends Safe Abortion: Policy and Practice Guidelines for Health Systems. Second edition to open the cervix with special medications.

Next, the doctor uses a curette to scrape the contents of the uterus. In late pregnancy, when the fetus is already large, other surgical instruments, such as a scalpel, may be required.

After the operation, the woman remains in the hospital for several hours, under the supervision of doctors. Then, if everything went without complications, she is discharged home.

Does it hurt to have a surgical abortion?

WHO calls this method of termination of pregnancy the most painful. That is why the operation is performed under Abortion anesthesia. What Happens.

Why a surgical abortion is dangerous

The method of dilatation and curettage has the highest number of complications. According to Safe Abortion: Guidelines for Health Systems Policy and Practice. The second edition of the WHO, they happen 2-3 times more often than with vacuum aspiration.

The most common complications are:

• infections and the inflammatory processes caused by them in the genitals;
• ruptures of the cervix. As a rule, they get rid of them by suturing immediately after the abortion. However, this can affect the ability of the cervix to dilate in subsequent births;
• perforation of the uterus. This happens if the instrument accidentally pierces the wall of the uterus. This situation is dangerous with internal bleeding and sepsis;
• uterine bleeding. Sometimes it is so great that a woman needs a blood transfusion;
• under-removal of the ovum. In this case, the remnants of the fetus or embryo remain in the uterus, which can provoke an inflammatory process;
• allergic or adverse drug reactions. That is, for those drugs that were used for anesthesia and dilation of the cervix.

When to see a doctor as soon as possible

Call your gynecologist or talk to an ambulance on 103 if you have these symptoms of Dilation and curettage (D&C) after a surgical abortion.

• Severe bleeding from the vagina. You can talk about it if you have to change the pad every hour.
• The appearance of blood clots the size of a chicken egg. It is especially dangerous if they fall out of the vagina for more than two hours in a row.
• Unusual vaginal discharge with a distinct foul odor.
• Pain or cramping that gets worse, although more than 48 hours have passed since the surgery.
• Temperature rise over 38 ° C.