What is Abortion? :It is the process of surgically terminating the product of pregnancy for the purpose of causing a voluntary abortion. Abortion is a surgical procedure used for diagnosis and treatment purposes as well as terminating pregnancy. These issues will be addressed later. The subject that will be explained here is the legal termination of pregnancy up to 10 weeks. The legal 10-week period is the 70-day period starting from the first day of the last menstrual bleeding. (10 weeks)
With the law no. 2827 passed by the Turkish Grand National Assembly in 1983, abortion up to 10 weeks was legalized in our country and came into force with the regulation no. 510. has entered. The conditions and conditions for abortion are determined by this law and regulation.
Who can terminate a pregnancy with 10-Week Legal Abortion?
If married, the consent of his/her spouse is required. If he is not married and is a minor (under 18 years of age); Approval of parents or guardian is required. If the woman is of legal age, that is, she is over 18 years of age and is not married, she can have a voluntary abortion of her unwanted pregnancy up to 10 weeks. However, here the doctor must take a good history, perform a good physical examination, and determine that the patient's mental and physical health is normal.
Can an abortion be performed after 10 weeks?
It can be done. However, a medical board report from the hospital showing that this procedure is medically, psychologically and socially necessary and approved by at least two physicians is required. Some of the reasons due to medical necessity are as follows: Some serious diseases related to the mother. Example; Psychiatric diseases such as severe heart failure, severe diabetes, previous pregnancy toxicosis (eclampsia), previous severe genital surgical operations (prolapse), toxic goiter, maternal congenital diseases, cancer, schizophrenia, psychomanic depressive depression can be listed. Dead fetus in the womb, unavoidable or incomplete miscarriage. Down syndrome seen in the baby, cardiac, gastroentestinal, uregenital anomalies, chromosomal disorders such as trisomy 18 and trisomy 13, and brain anomalies can be listed.
For the reasons listed above, the abortion method performed over 10 weeks is more effective than the abortion method performed in pregnancies less than 10 weeks. different and more It is complicated and risky.
What is the method of abortion performed in pregnancies older than 10 weeks?
First of all, this procedure should be performed under hospital conditions. The aim here is to stimulate uterine contractions and initiate miscarriage. The most commonly used methods for this are: Hypertonic solutions given into or outside the child's water bladder. Sometimes, the cervix is dilated directly and the product of pregnancy is evacuated with blunt curettage (forceps). If all these fail; Abdominal hysteretomy method is applied. (With abdominal minilaparotomy, the uterus is opened with a small incision and surgically evacuated). As mentioned above, all these procedures are performed under hospital conditions and on patients who have received a medical board report.
HOW IS ABORTION (CURETTAJ/ABORTION) DONE?
Our topic is; It is the process of terminating 10-week pregnancies (70 days from the first day of the last menstrual period) with an abortion operation, as determined by Law No. 2827 enacted in our country in 1983. The questions our patients ask during their first abortion are: is abortion easy or difficult? I want to abort a child, but will I be infertile if I abort my first child? I want to learn about the abortion operation. I am afraid of abortion. Is abortion dangerous? I am curious about abortion. I want to abort a child, but is it ethical? First of all, abortion is an easy operation.
The method chosen by 75 percent is VACUUM ABORTION. (suction curettage) (suction, traction curettage) This process is performed with an electrically operated aspirator or hand-operated specially made 200-250cc syringes. The procedure is performed as follows: with local or general anesthesia, the cervix is first dilated with special bougies or laminaria, then a disposable (disposable) sterile cannula suitable for the week of pregnancy is placed into the uterus and the gestational product is sucked with a negative pressure of 50 to 60 mm of mercury with an injector.
After vacuum curettage up to 10 weeks; There is no need for sharp curettage (with sharp metal tools). Because the entire pregnancy crop is removed by vacuum abortion. Intrauterine adhesions (Ascherman's Syndrome) or bleeding may be detected in the second check-up of sharp curettage (sharp curettage). and increase the risk of infection.
Are there risks of vacuum abortion performed up to 10 weeks?
As with every surgical operation, there may be very small risks. However; Properly evaluating the position of the uterus and the angle of the canal opening of the cervix, complying with asepsis and antisepsis conditions and working quickly minimizes risks. In this procedure, the risk of infection, bleeding, and pregnancy is low. The risk of death is very rare.
Which anesthesia should be taken during an abortion?
If the gestation period of the patient to be aborted is less than 6 weeks, vacuum curettage can be performed with local anesthesia. General anesthesia is recommended for pregnancies longer than 6 weeks, especially for patients who have not given birth. The total duration of the procedure, anesthesia and operation is around 30 to 40 minutes. One hour after the operation, the patient can go home and take food orally. She can work at her normal job the next day.
Miscarriage - What is Miscarriage?
Is abortion required after miscarriage?
The involuntary, spontaneous termination of pregnancy before the 20th week is called miscarriage. Abortion after miscarriage is unnecessary if the gestational age is around 3 to 5 weeks and there is no bleeding or pain. However, in older weeks, dead intrauterine decidua cells are cleaned with a light curettage, even if it is completely miscarried, in order to accelerate the healing of the uterus, stop bleeding and prevent infection.
THINGS TO BE CONSIDERED AFTER ABORTION
Post-Abortion Pregnancy (post-abortion pregnancy)
Ovulation occurs again 20 days after the operation. Therefore, in order to avoid pregnancy after an abortion, if there is no protection between the 15th and 25th days after the abortion, a new pregnancy may occur. If 45 days have passed since the abortion operation and there is no menstrual bleeding, it is necessary to consult a doctor.
Post-Abortion Bleeding
For abortions performed up to 10 weeks, the first 7 days. There may be bleeding in the form of drips. If this bleeding occurs in large amounts with patches and clots, it is necessary to inform the doctor. Sometimes after abortion there is no bleeding at all, but after 4-5 days there is spotting that lasts for 4-5 days. 35 days from this date There is menstrual bleeding. If 45 days have passed since the abortion operation and there is no menstrual bleeding, it is necessary to inform the doctor.
Post-Abortion Piece Remaining
Immediately after the abortion, 5-6 pads a day. If there is partial clotted bleeding and this bleeding lasts more than 7 days, fragments (fetal and placental residues) remain. After going to the doctor again and being checked with ultrasound, the abortion operation is performed again. If this operation is not performed, the bleeding will not stop.
Continuation of Pregnancy After Abortion
After the abortion, it is necessary to check with ultrasound and make sure that the pregnancy and its appendages have been removed. If this control is not performed, especially in pregnancies that are short term (3-4 weeks), if there is a curtain (septum) in the uterus or the thickened endometrium (inner glands of the uterus) outside the gestational sac may come into the vacuum, giving the wrong image as pregnancy and its appendages and deceiving the doctor. Thus, you may be faced with an unpleasant enlarged pregnancy situation after 1.5-2 months.
Menstrual Delay After Abortion
For pregnant women with longer weeks of pregnancy, the pregnancy can last up to 2 months after abortion. It is normal for menstrual delays to occur. Sometimes, especially in abortions performed with iron instruments (sharp abortion), sometimes no menstruation (amenorrhea) may occur due to excessive scraping of the inner glands of the uterus. Considering all these, if menstruation does not occur after 45 days after the abortion, it is necessary to inform your doctor.
Sexual Intercourse After Abortion:
Sexual intercourse for 10 days after the abortion. it is forbidden. It is necessary to apply a contraceptive method between the 15th and 25th days to prevent pregnancy again.
Other Situations to Consider After Abortion Are These
1-Bathing after abortion: can be done immediately, but it is necessary to take a bath in the form of a shower for 15 days.
2- Protection after abortion: Since ovulation may occur again 20 days after abortion, it is necessary to apply a method of protection. .
3-If there is Rh incompatibility, anti D should be administered within 72 hours.
4- If preventive antibiotics are not administered during the procedure, 5 days. It is necessary to use antibiotics.
5-To protect against pregnancy It is necessary to learn and apply the methods of contraception that are suitable for your own body structure from the doctor.
Can infertility occur after abortion?
Infertility can occur in an operation that is technically clean and respectful of tissue. There is no risk. There is no risk of infertility in vacuum abortions, especially during pregnancy less than 10 weeks. There is a rare risk in pregnancies greater than 10 weeks.
Is there a risk of miscarriage after abortion?
In abortions performed before 10 weeks, the dilation operation (delatation) is very slow and gentle. If it is performed in some way, there is no risk of miscarriage.
Where is abortion performed other than voluntary abortion?
It is generally performed for treatment and diagnosis purposes. These are briefly:
1-In abnormal uterine bleeding: In cases such as fragmented and clotted bleeding, myoma bleeding, etc. It is sent and performed to make a definitive diagnosis.
2-In endometrial (inner uterine wall) polyps
3-Post-menopausal bleeding or In cases where the inner wall of the uterus exceeds 5 mm in menopause.
4-Dysfunctional uterine bleeding.
5-For biopsy purposes ( To understand whether there is a parallelism between the endometrium and the day of ovulation in luteal phase failure after the ovulation period.
6-Fractional curettage: to understand whether the pathology is in the uterus or the cervix, both the uterus and the cervix are examined. These are curettages performed separately through the cervix.
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