Abortus

Abortus

Abortus or miscarriage is a termination of the pregnancy. Arguments for the abortion are based on the stand that the woman should have control over her body and the power to make her own decisions, because she is the most affected by the reproduction process and she should choose. The right to choose is meaningful both individually and politically and it means more than just a fight for equal rights. Abortus can be intentional or spontaneous. Spontaneous abortion has similarities to giving birth and there are rare complications. Usually, when we say abortus, we are thinking about the intentional abortus arteficialis, to terminate pregnancy. Induced abortus is a very sensitive subject and there are many problems that cannot be ignored. It is a known fact that the number of abortus done are higher and higher and that many private clinics do not even repost them. The decision whether to give birth or not is a difficult one to make and either way you decide, your life could change drastically, so careful consideration should be done about what is the most important for you and your family.

Legal terms:

Today, any pregnant, adult woman has the right to choose abortus. The request is submitted to an OB/GYN clinic or hospital, alongside with a document that states that the pregnancy is prior to week 10 and that the termination would not endanger the woman’s health. Abbiding by the Law for terminated pregnancy, the abortus is done by an expert doctor and at a clinic that meets the required medical standards and equipment. Other than a specialist in a hospital, spontaneous abortus could be finished off at a medical facility by any M.D., but only if the baby or the mum’s life are at stake.

Indications for pregnancy termination

If pregnancy is past week 10, there should be a medical committee meeting to decide whether an abortus should be done. After week 10, a pregnancy can be approved for termination only if there are indications such as:

  • Medical reasons – a constant ailment that could endanger the health or the life of the woman
  • Ethical or legal – a pregnancy resulted from rape or adultery or over a minor, incest etc.
  • Eugenics – genetic factors that might damage the fetus, ailments or infections the mother could have had in the first trimester, like rubeola, use of tetracycline, inappropriate blood type etc.
  • Social – poor material conditions, many children in the household, pregnancy out of wedlock

Risks and complications

Every medical intervention, even abortus, carries a certain risk of complications. How often they would be is affected by many factors: The woman’s age, her health condition, the duration of the pregnancy, the method used, the anesthesia, additional surgeries, the expertise of the doctor, the hygienic conditions etc. The risks and possible complications from an abortus in the first trimester are very low. The further ahead the pregnancy has progressed, the higher the risk of complications after the abortus. Infections are the most common, all the other complications are very rare.  Complications after an abortus can be divided into 2 groups – early and late.

Possible complications:

  • Infections- even though sterilized instruments are used during the procedure and taking antibiotics is advised, infections are the most common complication after an abortus. You would have high body temperature, pain in the lower abdomen, unpleasant odor of the vaginal secretion. If it’s not treated, an infection such as this one could cause serious medical conditions, sterility, sepsis or death.
  • Long term bleeding – massive hemorrhage during and after an abortus is usual for terminations done in the third trimester. Sometimes, it could indicate left-over tissue, perforations or inability of the uterus to contract or shrink. If there is heavy bleeding over a longer period of time, notify your attending doctor.
  • Left-over tissue – if the doctor performing the abortus cannot see the interior of the uterus clearly, he could miss a certain amount of the tissue. This would cause heavy bleeding for longer than 2 weeks, discharge of clotted blood, cramping or possible signs of pregnancy. Sometimes medication is given to induce contractions in order to expulse the remaining tissue.
  • Post-abortus syndrome (blood in the womb)- if the womb isn’t shrinking, blood could be help up in it and the clotted blood could clog up the exit. This would cause pain, cramping and discomfort. Sometimes, it is possible to squeeze out the clotted blood with skillful pressure to the womb, but sometimes aspiration has to be performed.
  • Perforation – Perforation is damage or tearing of the uterine wall done by a medical instrument during the abortus. The womb is a very strong muscle, if the damage is superficial, it would heal on its own. If the damage is greater or a blood vessel is damaged, an operation could be needed. This is why, an abortus should be performed by an expert at a well-equipped clinic with ORs.
  • Cervical tearing – An abortus done in the second trimester is more probable to cause damage to the cervix than an abortus in the first trimester. The woman might not feel the damage being done to her body, but the doctor is obliged to inform her and to note them in her medical file. Slight tearing could heal on its own, bigger tears need stitching.
  • Embolism – Embolism is a clogging of the blood vessels, caused by an embolus, most commonly it’s an air bubble or clotted blood. After an abortus, it is not uncommon for a blood clot to clog up an artery in the lungs, causing and pulmonary embolism and a heart attack. The clinical symptoms are chest pain, heavy breathing, coughing and/or coughing up blood.
  • Anesthesia complications – Local anesthesia can cause tingling in the hands and feet, a sense of void in head and bussing. Serious allergies are extremely rare. General anesthesia can cause fatigue, headaches, discomfort and disorientation. There could be cramping, very rarely there could be damage to other organs such as the liver. Bleeding is heavier because the uterine muscles are relaxed.
  • Unsuccessful abortus – continuation of the pregnancy – very rarely the abortus is ineffective and the woman is still pregnant after the procedure. Thus, we should check if every piece of tissue is precisely removed. Such a case is possible if it was multiple pregnancy and one fetus was taken out and one remained or if there was double pregnancy. This usually happens if the abortus is done prior to week 6. The abortus could be repeated after a week.

Which period of the pregnancy can an abortus be performed?

The vast majority of women have their abortus around week 10. This is the period allowed by the law. After this period the decision is made by a medical committee if there are indications to terminate the pregnancy.  Abortus done prior to week 10 is easier, safer and cheaper than those after week 10.

How do women feel after the abortion?

How do women feel after the abortion?

Most women feel a sense of relief, but the hormonal changes could cause grief, anger, guilt. Serious, longer-lasting emotional problems after an abortus are rare and unusual, unlike after childbirth. These would appear in these cases:

  • The pregnancy was wanted but the mum and/or fetus were in danger
  • The decision for abortus might have caused serious relationship issues
  • The woman was already emotionally instable when the abortion decision was made

Will the abortion affect the next pregnancy?

No, there is no scientific poof that a properly done abortion would affect the next pregnancy, or cause ectopic pregnancy or premature birth or stillborn children in the future.

Spontaneous abortion

Terminating the pregnancy prior to week 28 and when the fetus is less than 1000gr and unable to survive. The most common causes are:

  • Endometrium tumor
  • Lack of progesterone
  • Congenital defects or birth defects
  • Cervical tissue changes

Types of spontaneous abortions:

  • Abortus habitalis – habitual abortion
  • Abortus imminens – high-risk abortion
  • Abortus incipiens – beginning abortion
  • Abortus completus – complete abortion
  • Abortus incompletus – incomplete abortion
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