The foreseen and invisible risks of abortion

Abortion (uterus evacuation) applied voluntarily or involuntarily affects the lives of women in their reproductive ages. Especially in those who use ineffective contraceptive methods such as withdrawal and calendar method, we have a higher chance of encountering abortion. In those protected by the withdrawal method (unfortunately, the most widely used contraceptive method in our country), the fastest sperm (male germ cells) that come with the first discharge just before ejaculation (ejaculation) pose the risk of conception if the male cannot be withdrawn in time. Even in the presence of the hymen (virgins), unwanted pregnancy occurs with escaping sperm. The plural of those who are protected by the calendar method think that the egg will come out 12-14 days after the period and time their sexual intercourse accordingly. This rule may be valid for those who have a period every 28 days. But menstrual bleeding can sometimes come early and sometimes late. In women, the egg usually comes out 14 days before menstruation. The last 14 days are usually stable. In this case, if the woman will menstruate in 44 days, the egg will hatch on the 30th day, and if she expects her period after 24 days, the egg will hatch on the 10th day. Considering that the egg lives for 2 days and the sperms live for 3 days, we should consider how wide the conception period can be. We should know that the menstrual cycle may change due to factors such as stress, fatigue, travel, and weather changes. We know that those who are protected by the calendar method for many years face unintended pregnancies one after the other due to the deterioration of their menstrual cycle as age progresses.
Law No. 2827, which came into effect in 1983 regarding the termination of unwanted pregnancies in our country, allows uterine evacuation (abortion) until the 10th week of pregnancy.
Pregnancy is calculated from the first day of the last menstrual bleeding. A 3-day delay in menstruation is considered 5 weeks of pregnancy in a woman with regular menstruation. In a one-month delay, the 9th week of pregnancy is reached. If the woman to have an abortion is married, her husband’s consent and written consent are mandatory.
If this procedure is carried out without approval, both the abortionist and the doctor are sentenced to prison according to the Turkish Penal Code.
If there is no legal marriage, the woman can apply for an abortion alone. However, those who are under the age of 18 are not allowed to have an abortion without the consent of their father or legal representative.
One in two women has an abortion at any time during their reproductive years. The main reason for this is not using an effective contraceptive method or not using effective methods correctly and not seeing a doctor for regular check-ups. Even if effective contraception methods are used correctly, there may be a risk of getting pregnant at different rates according to each method.
Abortion can be performed under local anesthesia in public hospitals and family planning clinics that perform a lot of procedures in our country, due to the possible risk of general anesthesia.
Abortion with general anesthesia is prohibited in the practice, and it is inconvenient because there is no anesthesia device required in emergency situations.
In an abortion, the pregnancy product inside the uterus, which is the size of a pear, is emptied. The mouth of the cervix, which is closed at the tip of the vagina, is enlarged to 6-7 mm in order with thin rods of 2-12 mm diameter, which we call bougie. Through this tiny hole we have created, sticks like plastic pipettes are inserted into the uterus, the ends of the sticks are connected to a hand or electrically powered aspirator, and the negative pressure created by the aspirator empties the pregnancy product in the uterus. If the pregnancy product is not fully discharged, the inner surface of the uterus is scraped with hollow metal spoons called curettes.
Abortion is sometimes easy and sometimes difficult. Unfortunately, it is not always possible to foresee the difficulties. It is necessary to pay attention to the prerequisites for a safer practice of abortion.
It is not appropriate to have an abortion in the first three or five days, as soon as the menstrual period is delayed. . Since the cervix is ​​not softened enough, it may be more difficult to open. In addition, the vacuum aspirator may not fully pull out the pregnancy product. On the contrary, abortion becomes more difficult when the pregnancy becomes too large. It is difficult to empty the product of pregnancy, the uterus, which grows and softens like a balloon, becomes more difficult to contract and shrink, and the risk of bleeding during the procedure and damaging the other organs in the abdomen by perforating the uterus increases. Perforation of the uterus may occur in earlier pregnancy abortions, even if it is one in a thousand.
The embryo reaches a length of 1.5 cm at 8 weeks of pregnancy, and 3.5 cm at 10 weeks. Enlarging the cervix by 6-7 mm is not enough to empty the pregnancy product over 8 weeks. In this case, it is necessary to open the mouth of the uterus much more. The process becomes difficult, the cervix can not withstand the tension and tear, and it takes longer to close again and the risk of infection may increase.
In pregnancies greater than 8 weeks, the vacuum aspirator may not be sufficient to evacuate the pregnancy product. In this case, it is necessary to use a curette..
Insufficient contraction of the uterus and the continuation of bleeding may cause us to scrape more with the curette (sometimes to the extent that it includes the inner layer of the uterus). When a child is desired later, there may be a problem in the nesting of the fertilized egg into the uterus, or the embryo and placenta may settle in unsuitable areas in the uterus.
The most suitable period for abortion seems to be between 6 and 7.5 weeks from the first day of the last menstrual period.
Especially in a woman who has not given birth, abortion can be more risky because the cervix is ​​harder and more difficult to open. Adhesion in the cervix; It can make abortion difficult in women who have had a previous cesarean section, abortion or any surgical intervention in the cervix. Unfortunately, the presence of this adhesion cannot be determined by examination and ultrasonography before the procedure.
In particular, the gestational week is evaluated more precisely in ultrasonography. The position of the uterus, whether it is excessively curved forward or backward, and lying on its side are evaluated. It is important to determine the presence and location of fibroids (benign tumors) consisting of hardened uterine muscle tissue, which normally occurs in one in four women and in half of premenopausal women. Myomas that put pressure on the inner layer of the uterus or the cervical canal can prevent the passage through the cervix and reaching the pregnancy product. Sometimes very small fibroids, which we call intramural fibroids, can be missed by ultrasonography devices with low sensitivity and cause great difficulties in the abortion procedure.
Large fibroids can sometimes make it difficult for the uterus to contract, increasing blood loss during and after the procedure.
Normally, bleeding can be as much as menstrual bleeding after an abortion, lasting 5-6 days. Sometimes there may be no bleeding at all. Sometimes there is no bleeding at all (especially in women who have not given birth and the cervix closes prematurely), a few days later, with the effect of the blood accumulating in the uterus, bleeding may occur with clotted, fragmented, pressure in the groin pain.
In order to prevent infection, it is not enough to perform abortion under sterile conditions and the sterile work of the doctor who performs the procedure. The woman who has abortion is required to take a shower only for at least one week, not to sit in the bathtub, not to swim in the pool, to the sea, not to leak water in the vagina, to wash from front to back after using the toilet, not to leave the genital area moist, to dry quickly, and to change frequently by wearing woolen and cotton underwear.
After abortion, sexual intercourse is not recommended for at least one week, depending on the size of the divorced pregnancy.
When hygienic conditions are not followed, microbes can come out from the non-sterile vagina, from the open cervix to the sterile uterus, and from there to the canal and cause an infection. Later, the infection can block the channels and cause infertility or pregnancy in the canal (ectopic pregnancy).
A woman who has an abortion must consult her doctor for a control examination within two weeks. In the control examination, it is determined that the pregnancy product is sometimes not fully discharged. Rarely (especially in very early pregnancy abortions) the placental tissue next to or below the pregnancy product or a second small gestational sac is emptied and we see a viable pregnancy growing despite the abortion. In these cases, abortion is applied again.
The dimensions of the psychological damage caused by abortion in women can be very different. We must emphasize how important the support of the spouse or close circle is in this context.
Thus, we emphasize that abortion is not a method of family planning. We know that ovulation can occur 10 days after an abortion and the risk of conception begins. For this reason, it is useful to talk to your doctor about effective contraception methods before abortion. Intrauterine devices (spiral) can be applied safely at the time of abortion, birth control pills and many other effective methods can be started within three or five days after the abortion.
Hope you don’t encounter unwanted pregnancies…

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