Abortion or termination of pregnancy is the termination of a pregnancy in the uterus using special methods. Termination of unwanted pregnancies is a legal and modern right granted to women of age in our country.
Abortion (originally called curettage) is performed only by Gynecologists and Obstetricians and physicians who are certified in this regard, in health institutions or clinics. And of course, the procedure is between the doctor and the patient.
According to the laws of the Republic of Turkey, unwanted pregnancies can be terminated up to the 10th week of pregnancy upon the woman's request. If the person is married, his/her spouse's consent is required; if he is not married and over the age of 18, his own will and consent are sufficient. For women under the age of 18, parental consent is required.
If the pregnancy is medically dangerous for the mother or the baby (in cases where the baby is disabled or the mother is too sick to bear the pregnancy), pregnancies older than 10 weeks can also be terminated. In such a case, more than one specialist doctor must make a decision.
All risks of abortion increase as the gestational age increases.
The legal limit has already been determined for these reasons. Termination of pregnancies older than 10 weeks is also medically more problematic.
Therefore, when deciding to have an abortion, the legal limit of 10 weeks should not be exceeded. Even if there is no menstrual delay, 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 some medications. The abortion drug (RU-486) used in some countries abroad is not used in Turkey. In addition, pills and injections, which are sometimes used by doctors in case of menstrual delay and are popularly known as menstrual stimulants, do not work in terminating pregnancy.
Since curettage actually means "to scrape", it can also be applied for different purposes to remove tissue from the uterus. In fact, curettage (abortion) is not only done to terminate pregnancy.
Curettage can be performed for diagnostic purposes, especially in bleeding disorders seen in women and post-menopausal bleeding. Also, in infertility research, to understand whether there is ovulation or not, etc. Purposeful abortion can also be performed.
What are the types of abortion?
1. Pregnancy Abortions
It is the most commonly performed procedure in women of reproductive age. It is a form of abortion. It is performed to terminate unwanted pregnancies.
2. Probe Curettage
It is a procedure performed for diagnostic purposes in bleeding disorders and especially post-menopausal bleeding. The inside of the uterus is curetted (scraped) with special tools (curette). It can be applied in severe and long-term bleeding to both detect the underlying cause and stop excessive bleeding.
Thanks to this procedure, endometrial hyperplasia, uterine cancer, and 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 distinguishing between uterine cancer and cervical cancer.
4. Revisional Curettage
It is the name given to curettage performed to clean the parts of the placenta or fetus remaining inside after a spontaneous miscarriage. Revisional curettage can be performed even if the miscarriage is thought to be complete, that is, there are no pieces left inside.
Additionally, if it is suspected that there are pieces of the placenta (the child's partner) left inside after birth, the remaining pieces are removed with special curettes. This procedure is also considered as revision curettage.
5. Endometrial Dating
In order to determine whether ovulation has occurred or not in the diagnosis of infertility, a sample is taken from the uterus on the 21st day of the menstrual period.
The progesterone hormone secreted after ovulation is affected. With its effect, the endometrium enters the secretion phase. The aim of endometrial dating is to understand whether the condition of the endometrium is compatible with the menstrual cycle. For this purpose, it is removed from the uterus with a special curette. A single sample is taken.
This method (endometrial dating), which was widely used until recently to test the presence and quality of ovulation, is now gradually losing its validity.
What is the technique of abortion performed for the purpose of terminating pregnancy, how is abortion performed?
To give brief information, the vagina and cervix are cleaned with disinfectant liquids to prevent infection with germs during the procedure, and plastic bags are used to fix the cervix. An instrument is inserted through the vagina and the necessary medications 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 previously given birth normally, otherwise general anesthesia should be preferred.
Then, very thin plastic cannulas (tubes) are placed through the cervix into the uterus. 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 placed, a syringe is attached to the cannula. The inside of the uterus is evacuated with the help of the vacuum created in the syringe.
What will happen after the abortion?
After the procedure, you will be taken to the recovery room and rest there for half an hour.
After the procedure, you can go home or work normally. You can eat and drink anything unless your doctor recommends otherwise. There are no restrictions in this regard. Since you have been hungry for a long time, it would be beneficial for you to eat something sugary.
After general anesthesia, it would be appropriate not to engage in activities that require attention, such as driving, for 6-8 hours.
That day and the next day, it will be appropriate for you to eat something sugary. It is normal to have mild menstrual-like pain. In this case, you can take any painkiller you are used to.
In our center, we apply antibiotics as a preventive measure during the procedure. Therefore, there is no need to additionally use antibiotics after the abortion (unless there is a special reason).
You may experience spotting bleeding for about 3-4 days after the procedure. We will be sad. Small clots or fragments may also fall out along with bleeding. This is a completely normal state. On the other hand, the absence of bleeding does not mean that there is an abnormal situation. Therefore, do not worry even if you are not bleeding. Also, if you have excessive bleeding in the form of menstrual bleeding, be sure to call your doctor.
After the procedure, you can take a shower while standing, but as long as the spotting continues, it is dangerous to go to the pool or the sea.
After the procedure. It is not appropriate to have intercourse for 4-5 days as the cervical dilation procedure is performed. In addition, sexual intercourse is harmful as long as your bleeding continues. You can have intercourse after your bleeding ends.
If you experience an unexpected fever after the procedure, you should definitely contact your doctor.
Another frequently asked question is whether women who had an abortion during their first pregnancy will ever become pregnant again. It is a matter of whether they can stay or not.
There is no such danger in pregnancy terminations performed properly by experienced people under appropriate conditions. In the past, the possibility of damage to the inside of the uterus was higher in abortions performed using only a "curette" without using the vacuum technique. In addition, in previous years, since the possibility of infection (inflammation) was high after the procedure due to the lack of effective disinfectants and antibiotics, such a belief has survived from the past to the present. Even if there is pregnancy, the possibility of complications (an undesirable problem) occurring after the procedure is almost non-existent.
Attention!
In very small pregnancies, sometimes the pregnancy product may not be evacuated. and pregnancy may continue in the uterus. This condition is more common in pregnancies less than 5 weeks old. If noticed, the procedure may need to be repeated after 1 week. Therefore, abortion should be done at 5-6 days at the earliest. For this reason, it is important to have it done in weeks and to have a check-up.
What is "remaining piece" after abortion?
Within the limits of legal pregnancy evacuation (<10. gestational week) and the rate of pregnancy is approximately 2-3% in properly performed abortion practices. The problem of not receiving some parts completely may arise. This problem may occur especially in cases where there is a myoma in the uterus and the normal anatomy of the internal cavity of the uterus is disrupted due to this myoma.
This situation manifests itself as bleeding that continues even after a week or two. In some cases, especially if a piece is left during the abortion performed during the older weeks of pregnancy, it may be observed that the piece falls out along with bleeding from the vagina.
Definitive diagnosis can be made by ultrasound examination.
If it cannot be determined that there is a piece left, uterine contraction may occur. Some enhancing drugs and antibiotics are given.
In cases where it is certain after the examination that there are pieces remaining, the procedure usually performed is to perform a second curettage procedure, albeit shorter, to clean these pieces.
It can be seen especially in abortion procedures in very young weeks of pregnancy and in women with very narrow cervix.
Continues after the procedure in young weeks of pregnancy. Bleeding accumulates in the uterus, causing the uterus to grow excessively and cramp-like groin pain. During the examination, it is determined that the uterus is larger than normal and there is blood accumulation in it, and the uterus is emptied by dilating the cervix and the problem is solved. This is also a very rare problem.
Menstrual delay after abortion
The first menstrual period after abortion usually occurs 1 month later. The day of the abortion is considered the first day of menstrual bleeding, and the first menstrual period is expected to occur after the number of days it normally occurs. Rarely, this period may extend up to 50-60 days.
If menstruation does not occur on the expected day, gynecological evaluation is definitely required. If the reason for the menstrual delay is not a problem such as the continuation of pregnancy or Asherman's Syndrome in the uterus (dense adhesions in the uterus and resulting in low or no menstrual periods), menstruation can be achieved by using medications. What type of anesthesia is used in abortion?
Pregnancy termination can be performed under general anesthesia or with local anesthesia.
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