Abortion – Pregnancy Termination

Abortion or termination of pregnancy is the termination of a pregnancy in the uterus by special methods. Termination of unwanted pregnancies is a legal and contemporary right granted to adult women in our country.

Abortion (curettage with its original pronunciation) is applied only by Gynecology and Obstetrics Specialist and physicians who are certified in this regard in health institutions or clinics. And of course, the process is between the doctor and the patient.

According to the laws of the Republic of Turkey, unwanted pregnancies can be terminated at the request of the woman until the 10th week of pregnancy. If the person is married, the consent of his spouse is required, while if he is not married and has reached the age of 18, his own will and consent is sufficient. For women under the age of 18, parental consent is required.

If the pregnancy is medically inconvenient for the mother or the baby (in case the baby is disabled or the mother is too sick to bear the pregnancy), pregnancies longer than 10 weeks can also be terminated. In such a case, more than one specialist doctor should make a board decision.

All the risks of abortion increase as the gestational week gets older.

The legal limit has already been determined for these reasons. Termination of pregnancies older than 10 weeks is also more problematic medically.

Therefore, when abortion is decided, the 10th week, which is the legal limit, should not be passed. Even if there is no delay in menstruation, a gynecologist should be consulted in case of suspicion of pregnancy.

One of the frequently asked questions is whether the pregnancy can be terminated by using certain drugs. The abortion drug (RU-486), which is used in some countries abroad, is not used in Turkey. In addition, pills and injections, which are sometimes used by physicians in the delay of menstruation and known as menstruation among the people, do not work in termination of pregnancy.

In many countries of the world and in us, termination of pregnancy is still applied with vacuum technique, that is, by pulling into the injector with negative pressure.

Since abortion actually means “scraping” as a word, it can also be applied for different purposes in order to take tissue from the uterus. In other words, curettage (abortion) is not only for termination of pregnancy.

Diagnostic curettage can be performed especially in bleeding disorders seen in women and postmenopausal bleeding. In addition, it is necessary to understand whether there is ovulation in infertility research, etc. purposeful abortion can also be applied.

What are the types of abortion?

1. Pregnancy Discharge

It is the most common form of abortion in women of reproductive age. It is done with the aim of terminating unwanted pregnancies.

2. Probe Curettage

It is a diagnostic procedure in bleeding disorders and especially in post-menopausal bleeding. The uterus is curetted (scraped) with special instruments (curette). It can be applied both to detect the underlying cause and to stop excessive bleeding in severe and prolonged bleeding.

Thanks to this procedure, endometrial hyperplasia, uterine cancer, age-related weakening (atrophy) of the uterus can be diagnosed.

3. Fractionated Curettage

Its application purpose is almost the same as probe curettage. However, here, separate samples are taken from the membrane layer lining the inside of the uterus and the canal lining the inside of the cervix and sent for pathological examination. It is an important diagnostic tool, especially in the differentiation of uterine cancer and cervical cancer.

4. Revision Curettage

It is the name given to the curettage performed to clean the remaining placenta or fetal parts after a spontaneous abortion. Even if it is thought that the miscarriage is complete, that is, there is no part left inside, revision curettage can be performed.

In addition, if it is suspected that there are pieces of placenta (the child’s partner) inside after birth, the remaining pieces are removed with special curettes. This procedure is also considered as revision curettage.

5. Endometrial Dating (updated)

In the diagnosis of infertility, a sample is taken from the uterus on the 21st day of menstruation in order to understand whether there is ovulation or not.

With the effect of the hormone progesterone secreted after ovulation, the endometrium enters the secretion phase. The purpose of endometrial dating is to understand whether the endometrial status is compatible with the menstrual cycle. For this purpose, a single sample is taken from the uterus with a special curette.

This method, which has been widely used until recently to test the presence and quality of ovulation (endometrial dating), that is, the date of the inner layer of the uterus, is gradually losing its validity today.

What is the technique of abortion for termination of pregnancy, how is abortion applied?

To give brief information, the vagina and cervix are cleaned with disinfectant liquids to prevent germ contamination during the procedure, a plastic tool is inserted through the vagina to fix the cervix, and the necessary drugs are given by the anesthesiologist for general anesthesia.

Rarely, local anesthesia can also be applied. However, local anesthesia can be applied more easily in women who have had a normal delivery before, otherwise general anesthesia should be preferred.

Then, very thin plastic cannulas (tube) are inserted into the uterus through the cervix. Sometimes it may be necessary to use larger diameter plastic cannulas to widen the cervix. In this case, tools called bougies are used to widen the cervix.

After the cannula is inserted, a syringe is attached to the cannula. With the help of the vacuum created in the injector, the inside of the uterus is evacuated by vacuum.

What will happen after the abortion?

After the procedure, you will be taken to the recovery room where you will rest for half an hour.

After the procedure, you can go to your home or work normally. You can eat and drink anything unless your doctor has suggested otherwise. There are no restrictions in this regard. Since you have been hungry for a long time, it is beneficial to eat something sugary.

It would be appropriate not to engage in activities that require attention, such as driving for 6-8 hours after general anesthesia.

It is normal to have mild menstrual-like pain in your groin that day and the next. In this case, you can take any painkiller you are used to.

In our center, we apply antibiotics as a preventative during the procedure. Therefore, you do not need to additionally use antibiotics after abortion (unless there is a special reason).

You will have spotting bleeding for 3-4 days after the procedure. Small clots or pieces may also fall off along with bleeding. This is a completely normal state. On the other hand, the absence of bleeding does not mean that it is an abnormal condition. Therefore, even if you do not bleed, do not worry. In addition, if you have excessive bleeding in the form of menstrual bleeding, be sure to call your doctor.

After the procedure, you can take a standing bath in the form of a shower, but as long as the staining continues, it is inconvenient to enter the pool or the sea.

It is not appropriate to have intercourse for 4-5 days after the procedure, since the cervical dilation process is applied. In addition, as long as your bleeding continues, sexual intercourse is inconvenient. You can have intercourse after your bleeding is over.

If there is an unexpected increase in fever after the procedure, you should definitely contact your doctor.

Another frequently asked question is whether women who have an abortion in their first pregnancy will be able to get pregnant again.

Under appropriate conditions, there is no such danger in abortions that are duly performed by experienced people. In the past, the possibility of damage to the inside of the uterus was higher in abortions performed using only a curette without the use of vacuum technique. In addition, in previous years, such a belief has survived from the past to the present, since the possibility of infection (inflammation) after the procedure was high due to the lack of effective disinfectants and antibiotics.

However, in abortions performed by experienced physicians in a hygienic environment and with appropriate technique, the possibility of post-procedure complications (an undesirable problem) is almost negligible, even if it is the first pregnancy.

Attention !

In very small pregnancies, sometimes the product of pregnancy may not be discharged and the pregnancy may continue in the uterus. This is more common in pregnancies younger than 5 weeks. Once noticed, the procedure may need to be repeated after 1 week. For this reason, the earliest of abortion is 5-6. For this reason, it is important to do it every week and to go to the control.

What is “parts left” after abortion?

Within the limits of legal pregnancy evacuation (<10 weeks of gestation) and duly performed abortion practices, approximately 2-3% of the problems may arise where some parts of the pregnancy cannot be completely removed. This problem may occur especially in cases where there is a fibroid in the uterus and the normal anatomy of the uterine cavity is disrupted due to this fibroid.

This situation manifests itself in the form of bleeding that continues after a week or two. In some cases, especially in the abortion process applied during the big weeks of pregnancy, if the piece remains, it can be observed that the piece falls off with bleeding from the vagina.

Definitive diagnosis can be made by ultrasound examination.

If it cannot be determined that the piece remains, some drugs and antibiotics are given to increase uterine contraction.

In cases where it is certain that the part remains after the examination, the procedure usually performed is to apply a second abortion, albeit shorter, to clean these parts.

Accumulation of blood in the uterus after abortion

It can be seen in abortion applications especially in very small weeks of pregnancy and in women with very narrow cervix.

Continuing bleeding after the procedure in small weeks of pregnancy accumulates in the uterus and this causes the uterus to overgrow and cause cramp-like groin pain. In the examination, it is determined that the uterus is larger than normal and that there is blood accumulation in it, and the uterus is emptied by widening the cervix and the problem is solved. This is a very rare problem.

Menstrual delay after abortion

The first menstruation after abortion is usually seen 1 month later. The day of abortion is considered the first day of menstrual bleeding, and it is expected that the first menstruation will occur after a period of time, as is the number of days normally seen. Rarely, this period may take up to 50-60 days.

If menstruation is not seen on the expected day, a gynecological evaluation is absolutely necessary. If the cause of the delay in menstruation is not a problem such as the continuation of pregnancy or Asherman’s Syndrome (the formation of dense adhesions in the uterus and consequently less menstruation or lack of menstruation), menstruation is achieved by using drugs.

What kind of anesthesia is used in abortion?

Termination of pregnancy can be performed under general anesthesia or with local anesthesia. Since the cervix is ​​small and closed in women who have not given birth before, it is more comfortable to open the cervix under general anesthesia. The procedure itself takes 10-15 minutes, and in the case of general anesthesia, the entire procedure takes an average of 30 minutes. Abortion can also be performed with local anesthesia in women who have given birth normally before.

What are the most common problems during the procedure in abortion applications performed under local anesthesia?

Hypersensitivity to the anesthetic applied in local anesthesia and vasovagal syncope (reflexive fainting due to the device inserted to fix the uterus). This is a temporary and benign condition. It is seen in approximately 1% of cases.

The most common problem immediately after the procedure is nausea and vomiting. Sometimes a feeling of fainting may also occur. This condition is observed at a rate of about 1% and is a temporary condition that does not pose a life-threatening condition.

-Sometimes, the cervix may be too rigid to allow the cannula to pass and the procedure may be interrupted (very rare). Evacuation is delayed for a few days after administration of a cervix-opening drug.

You can return to your home approximately 1 hour after the abortion procedure, which is performed under general anesthesia, is completed.

It is important that you come back for a check-up after a week. In this control examination, you will also be informed about family planning and the method of contraception that is suitable for you will be discussed.

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