Timing of termination of pregnancy for medical reasons. Reviews from women who experienced abortion for medical reasons. Care and concerns

Application. List of medical indications for artificial termination of pregnancy

Order of the Ministry of Health and social development RF dated December 3, 2007 N 736
"On approval of the list of medical indications for artificial termination of pregnancy"

With changes and additions from:

Registration N 10807

According to current legislation, if there are medical indications and the consent of the pregnant woman, artificial termination of pregnancy is carried out regardless of the stage of pregnancy.

In this regard, the List of medical indications for artificial termination of pregnancy has been approved.

The List includes: tuberculosis and rubella; malignant neoplasms requiring chemotherapy or radiation therapy to the pelvic area; illnesses endocrine system, eating disorders and metabolic disorders (diabetes mellitus, hyperparathyroidism, acromegaly, prolactinoma, Itsenko-Cushing syndrome); some diseases of the blood and hematopoietic organs; mental disorders; illnesses nervous system(including epilepsy, catalepsy and narcolepsy); malignant neoplasms of the organ of vision; diseases of the circulatory system (rheumatic and congenital heart defects, myocardial, endocardial and pericardial diseases, cardiac arrhythmias, vascular diseases, hypertension, etc.); some diseases of the respiratory and digestive organs, genitourinary system, musculoskeletal system and connective tissue; pregnancy-related illnesses; congenital anomalies, deformations and chromosomal disorders.

In the case of physiological immaturity of a pregnant woman before reaching the age of 15 years, artificial termination of pregnancy is allowed until the period of fetal viability.

The public in all centuries has condemned women who wanted to get rid of their unborn child, citing selfish desires and a simple reluctance to spoil their figure and their life.
Not everyone knows that doctors can give indications for abortion for a number of reasons. Each of them is approved by the Russian Ministry of Health and written down in the order. This law was revised six years ago by the Ministry of Health and Social Development and the list of diseases was slightly reduced after the revision. Now women can fight for the life of their baby and not worry about the development of the fetus, even if the pregnant woman has already reached 40 years of age.

Abortion for medical reasons

Officially, by law and according to medical indications, a doctor has the right to perform an abortion before the 22nd week of pregnancy. In the later stages, it is possible to get rid of the fetus only for medical or social reasons. A child in the 3rd trimester of pregnancy is already formed, and taking his life for no apparent reason can safely be called murder. In all physical respects, artificial childbirth resembles the standard birth process, only the fetus is removed ahead of time.

Abortion for medical reasons is most often done in cases where the life of the pregnant woman is at risk or serious abnormalities in the development of the fetus are detected.

Stories end with unconditional abortion after diagnosing severe heart failure, acute hypertensive crisis and insulin-dependent diabetes mellitus.

It is recommended to terminate the pregnancy if the mother or father is diagnosed with a genetic hereditary disease. If a pregnant woman suffers from chronic inflammatory processes in the kidneys or has severe liver damage with obvious impairments in its functioning.

Doctors will strongly recommend agreeing to an abortion for women who have clear signs indicating the presence of Graves' disease, pernicious anemia, retinitis or optic neuritis, or severe diseases of the cornea.

Termination of pregnancy for medical reasons is planned if there is a deep deformation of the bone tissue of the pelvic region, which leads to a narrowing of the pelvis.

It should be emphasized that it will be impossible to carry out an abortion for medical reasons if the woman does not agree.

In any trimester, examination may reveal a disease that can negatively affect the physical condition of the fetus or lead to its death. But if the disease is not included in the list of the law, then the final decision about the future of the mother and child is made by a specially assembled commission. The following doctors must be included in its composition: the attending gynecologist, a doctor who is a specialist in the field in which the problem was discovered, and the head physician of the hospital (medical center).

An abortion for medical reasons must take place if doctors are confident that the woman is risking her life with further pregnancy. The doctor will also insist on an abortion if, during examination, developmental defects are discovered in the fetus, which will inevitably lead to his death. But in any case, the doctor will not go against the law and will be guided by this document when making a “sentence.”

Remember the list of diseases that are listed in Order No. 736 of the Ministry of Health of the Russian Federation. Abortion for medical reasons is recommended when a pregnant woman is diagnosed with:

actively developing tuberculosis;
rubella (if a pregnant woman for up to 12 weeks had close contact with a carrier of this disease);
malignant tumors, the treatment of which involves X-rays of the pelvic organs or other irradiation procedures;
severe form of diabetes mellitus, which led to kidney damage;
Graves' disease;
acute leukemia and some severe blood diseases;
severe forms of mental illness;
addiction to any type of drug;
neuroinfections that led to meningitis, encephalitis, etc.,
acute cerebral hemorrhage;
epilepsy, which cannot be treated and manifests itself in the form of frequent seizures;
severe heart defects;
bleeding ulcer;
the last stage of hepatitis or cirrhosis of the liver;
glomerulonephritis;
acute intoxication that cannot be treated;
exacerbation of chronic rheumatic diseases.

After the 12th week of pregnancy, a woman no longer has the right to make her own decision, but thanks to social testimony, this issue can be resolved. However, today the Ministry of Health and Social Development has revised the list of aspects that are considered a social indication for abortion and has reduced their list.

Every woman should know that, having received indications for an abortion, the doctor must, based on the duration of pregnancy, physical condition pregnant woman and a number of other factors, choose the most suitable method.

Today, gynecologists perform abortions according to the following principles:

using medications (for up to 6 weeks);
using a vacuum installation (mini-abortion, carried out for up to 5 weeks);
using special surgical instruments(curettage method);
induction of labor artificial method(in later stages) followed by curettage.

Women's right to motherhood

A woman who has received indications for termination of pregnancy due to medical or social factors must remember the following. According to Russian law, a pregnant woman has the right to decide for herself whether she is ready to become a mother or not.

Also remember that only a special commission has the right to make indications for termination of pregnancy, based on the results of tests and procedures that were carried out under the supervision of doctors in a hospital. The consultation usually consists of the attending physician (gynecologist), a specialist in the profile of the problem (surgeon, oncologist, therapist, etc.) and the head physician of the hospital or maternity center. And this suggests that during a routine routine examination, the antenatal clinic doctor has no right to make a verdict on his own, much less to persuade the woman to terminate the pregnancy.

Today, more and more often you can hear the following shocking facts from women. During a visit to the antenatal clinic, the attending physician begins to assure the expectant mother that she will not be able to bear healthy child(for medical or social reasons) and suggests an abortion. If this situation has affected you, then before you fall into hysterics, think about how one doctor can so confidently make diagnoses without a comprehensive examination? To convict this doctor of incompetence, you immediately need to write a complaint against him addressed to the chief physician.

But, if after all the research, the diagnosis made at the consultation turns out to be disappointing, try not to lose your sobriety. If you want to give birth to a healthy baby in the future and save your life today, then it is better to trust the doctors and their testimony.

Having gone through this test, the main thing is not to give up and not push away loved ones who will try to help you. Do not dwell on your grief; if it is still difficult to cope with the loss, ask for help from a psychologist who will restore your faith in the future.

After any type of abortion, a woman must follow the following instructions:

For 21 days you should abstain from sexual relations. This is not just a recommendation. This caution will save the woman from the possibility of infection in the wounded uterus. Sexual activity can be resumed after the end of the first menstruation, after surgery;
Listen to your body for two weeks after your abortion. Measure your body temperature daily, try not to freeze and don’t overwork your weakened body with strong ones. physical activity. If you notice even the slightest deterioration in your condition (bloody discharge, pain), immediately go to the doctor;
Do not neglect personal hygiene (wash yourself daily and change your underwear);
For the first 2 weeks, avoid swimming in open water and pools. Try to limit water procedures to taking a shower;
Maintain regular bowel movements and do not retain urine. bladder. These procedures, performed on time, will provoke better uterine contractions;
If after an abortion you have lost your menstrual cycle(which should not be the case) immediately contact your gynecologist with this problem;
To prevent any more unplanned pregnancies, ask your gynecologist to find the right contraceptive for you.

Causes and consequences of criminal abortion

Only at the beginning of the twentieth century did abortions become legal. At this time, any manipulations aimed at terminating a pregnancy were considered prohibited. When our grandmothers were young, in special clinics it was already possible, with the direction of a gynecologist, to have a legal abortion.

If a woman turns for “help” to people who do not have the right to perform abortions or provokes a miscarriage through her own efforts, then she greatly risks not only her life, but also her freedom.

Manipulations aimed at terminating the pregnancy of the pregnant woman herself or other persons outside the hospital are called criminal abortion. Person being held this operation, is punishable by law.

Often the reason for such a rash act is the pregnant woman’s desire to hide her interesting situation from loved ones, relatives, parents, and sometimes even from her husband. Criminal abortions are carried out illegally, so the process often takes place in premises completely unsuitable for this purpose. Unsanitary conditions and instruments that are not sufficiently disinfected can lead to the most terrible complications, infectious infections that lead to infectious-toxic shock, renal failure and even the death of a client.

Complications after a criminal abortion can cause enormous irreparable harm to women's health. The list of the most common complications includes: blood poisoning, suppuration of the internal genital organs, rupture of the uterine cavity, severe bleeding, poisoning medicines, infertility, and sometimes criminal abortion can lead to death.

None of the women for whom pregnancy is desired even thinks about abortion, but, unfortunately, there are cases when termination of pregnancy is necessary for medical reasons, even in the later stages.

The decision to terminate a pregnancy can be made if the unborn child is found to have:

Deformities
Chromosomal abnormalities
Defects in the development of the fetus that can lead to its death in the womb

IN in this case, indications for termination of pregnancy are prescribed when prenatal diagnosis reveals the non-viability of the fetus or abnormalities in its development.

Termination of pregnancy can be performed in four ways

What a woman should know

The verdict - abortion for medical reasons must be preceded by an examination of the woman in a hospital setting. In addition, it can only be carried out by a council of doctors, which includes the attending physician, a specialized specialist (oncologist, therapist, cardiologist, etc.), as well as the head of the medical institution. Such a decision cannot be made by the doctor of the antenatal clinic alone, just as he does not have the right to persuade a woman to terminate her pregnancy.

However, if the diagnosis is nevertheless confirmed (and by several specialists), then in order to preserve health, and sometimes life, as well as to preserve the opportunity to bear and give birth to a child in the future, the woman should agree to terminate the pregnancy.

Consequences of abortion

When we're talking about about abortion, even for medical reasons, you should know what consequences a woman can expect from terminating a pregnancy, and these are:

In addition, there are psychological consequences of abortion, in the form of the so-called post-abortion syndrome, which is characterized by deep depression, sexual dysfunction, fear, deep feelings of guilt and other factors traumatic to a woman’s mental state. That is, in addition to the physiological stress suffered, the woman also suffers psychological stress.

Such a serious load can cause a malfunction of the immune system, which can lead to the occurrence of various diseases, including those related to reproductive system. Therefore, you should not neglect communicating with a psychologist who can ease your worries and help you cope with false feelings of guilt and depression.

What to avoid after an abortion

A woman’s condition after an abortion depends not only on doctors, so you need to know the contraindications after an abortion, and these are:

Sexual intercourse is prohibited for three weeks.
No physical or psychological stress.
Hypothermia.
Swimming in any body of water, including taking a bath, for at least two weeks.

Abortion for medical reasons is an artificial termination of pregnancy, performed strictly in a specialized medical hospital, when a life-threatening condition is detected for the woman or when fatal gross abnormalities on the part of the fetus are detected.

Until twelve weeks, the legislative right to decide whether to continue pregnancy belongs to the woman. After the specified period, interruption is possible only taking into account medical indications.

Methods and terms

The choice of method for termination, taking into account medical indications, is directly related to the duration of the pregnancy being terminated.

An abortion performed before 12 weeks is called early.
Interruption starting from the 12th week until the 22nd week is late.

The correct determination of the period when deciding whether to perform an abortion has important to select the most appropriate interrupt method.

Termination of pregnancy is possible at any stage if there are medical indications.

If the period exceeds 22 weeks, termination is achieved by artificially induced labor.

The following methods are widely used by specialized medical institutions to terminate pregnancy:

Use of oral medications for a period not exceeding six weeks.
Vacuum aspiration - used for up to 12 weeks.
Curettage and dilatation are used until the 12th week if the first two methods are unproductive, and as an independent method at a later date.
Artificial birth is the method of choice after the 22nd week and when the fetus weighs more than 500 g.

The choice of method is influenced by: the current clinical situation, gestational age, woman’s condition, equipment medical institution, qualifications and preparedness of medical personnel.

Legal aspects

The decision to perform an abortion for medical reasons is not made by a single medical specialist.

The official conclusion must be justified and drawn up by a medical council after a complete examination of the woman with the obligatory signatures of all members of the council and the seal of the relevant medical institution.

Making such a decision is preceded by a mandatory detailed examination of the pregnant woman, identification of life-threatening conditions, pathological processes requiring immediate therapeutic measures, incompatible with the further course of pregnancy, or identification of pathological conditions on the part of the fetus.

It is mandatory for the pregnant woman to be fully informed about the threatening situation that has arisen and to have her written consent to terminate the pregnancy for medical reasons. The exception is situations when the severity of the pregnant woman’s condition does not allow her to make such a decision. In this case, the consent of relatives (trusted persons) is mandatory.

In all other cases, consent to an abortion, taking into account medical indications, is given by the patient after providing her with reliable information on the results of the examination, the motivation for the validity of making such a decision, with explanations about possible consequences woman's refusal to interrupt.

Indications for abortion based on the woman’s health condition

These diseases, if special treatment is not started in a timely manner, can lead to a fatal deterioration in the woman’s health, and against the background of ongoing pregnancy and in the absence of proper treatment, result in death for her.

Indications for abortion due to identified fetal pathology

Indications for making a decision to terminate a pregnancy may include identified abnormalities in the development of the fetus:

Statement of intrauterine fetal death identified as a result of examination.
Genetic anomalies of fetal development discovered as a result of genetic testing.
Identified anomalies of anatomical development, incompatible with life, deformities.

All identified pathological conditions of the fetus must be confirmed by instrumental research methods, results of laboratory and genetic tests.

It is the doctor’s responsibility to explain to the pregnant woman the need to perform an abortion for medical reasons, explaining the consequences of refusal. The decision to terminate the pregnancy remains with the patient.

Surveys

In addition to general clinical standard tests of blood, urine, coagulogram, gynecological examination with smears, special research methods are necessary to clarify the nature of the pathological process, genetic tests, ultrasound examinations, microbiological tests, results of histological and cytological studies when establishing an oncological diagnosis. Required list additional methods examinations are prescribed according to the recommendations of the attending physician and specialized specialists, depending on the nature of the identified pathology.

Interrupt on early stages

From the entire available arsenal of therapeutic manipulations for termination of pregnancy in the presence of medical indications, the following are used in the early stages: method medical abortion, vacuum aspiration of the fetal egg, curettage of the uterus.

Usage medicinal method It is mainly indicated in the absence of contraindications in a woman to take prostaglandins and progesterone, and when gross abnormalities of fetal development are detected in the early stages. A combination of medicinal tablet forms is used, leading to rejection of the fertilized egg and increased contractile activity of the uterine muscles. Recommended for termination of pregnancy no more than 6 weeks.
The method of aspiration of the fertilized egg with a vacuum is used for a period of no more than 12 weeks. Indications for use may include both abnormalities in the development of the fetus and detected pathology in the mother.
The method of curettage of the uterine cavity is dilation, curettage. Indications are: pregnancy for no more than 22 weeks, identified pathological abnormalities in the mother or child. To perform curettage, a stationary regime is required, the conditions of the operating room of the gynecological department, incision is performed under intravenous anesthesia.

Late interruption

If indications are identified in the third trimester, pregnancy can be terminated in two ways: surgical and conservative.

The method of surgical termination is a conventional caesarean section.
Conservative methods of termination in later stages are induced artificial labor. Contractile activity The uterus is stimulated by the introduction of a hypertonic saline solution into the amniotic membrane. Under its influence, the tone of the uterine muscles increases and contractions are stimulated. Abortion resembles labor and ends in miscarriage.

Consequences

Of course, termination of pregnancy, even if it is performed for medical reasons, is inherently an endocrine disaster for the woman’s body. Hormonal imbalances, risk of gynecological diseases of inflammatory and non-inflammatory nature, infertility, serious mental and emotional experiences- This is just a small list of possible adverse consequences.

At the same time, maintaining pregnancy is not always possible or justified. It should be understood that there are special critical conditions that threaten a woman’s life, when timely and complete treatment is required, which is not always compatible with the process of bearing a child, when it comes to saving the patient’s life.

That is why the conclusion about the presence of evidence must be justified and supported by the necessary results of a medical examination. Conclusions should be made collectively, taking into account the decision of the patient herself.

Every woman has a choice whether to give birth to a child or terminate the pregnancy. But, such a decision must be made before 12 weeks. During this period, abortion is least risky for women's health. It is true that it is possible to terminate a pregnancy at a later stage for medical reasons. Such an operation is necessary to save the health and life of the mother or if the fetus is not viable.

Reasons for late termination

Every expectant mother must undergo regular examinations and tests. This allows doctors to monitor the development of the fetus and the health status of the pregnant woman. One of the most important techniques is ultrasonography, which allows us to determine the degree of development of the child’s systems and organs.

An ultrasound, which is performed between 12 and 14 weeks, can show that the fetus has anomalies and defects that will prevent the child from developing properly. In such cases to the expectant mother An MRI is prescribed to clarify the diagnosis. If the presence of abnormalities is confirmed, the woman is advised to terminate the pregnancy. Parents have the right to decide whether to keep a non-viable or sick child.

Sometimes carrying a child poses a threat to a woman’s health and life. In this case, late pregnancy termination is also performed. There are other reasons for carrying out such operations:

Death of the child's father.
Spouse's disability.
Serious illness of the first child.
Conception that is the result of rape.
Imprisonment of a pregnant woman.
Deprivation of a woman's parental rights to existing children.

In this case, the pregnancy is terminated later for social reasons.

Methods for performing late-term abortion for medical reasons

Late pregnancy termination is carried out for medical reasons in two stages. First, prostaglandins are introduced, which soften and make the walls of the cervix more elastic. After this, labor is induced. Considering that a long-term abortion may result in a live baby being born, feticide of the fetus is performed before the operation. This kills the fetus.

The procedure is performed using an ultrasound machine. In this case, potassium chloride is injected into the fetal heart. To do this, an injection is performed through the abdominal wall. As a result, during artificial birth a lifeless body appears.

Experts believe that it is safer to have a late-term abortion through dilation. This is the dismemberment of the fetus in the uterus and its removal in parts. Such operations are performed in the second trimester, when the body is not yet ready for childbirth.

If such an abortion is performed for medical reasons, local paracervical or epidural anesthesia is used. Medications The tissue of the cervix is softened, dilators and a curette are installed, and the uterine cavity is cleaned with a vacuum.

Rivanol can be used in late-term abortions. Previously in medicine, this drug was used to resolve hematomas. This medication with a high alcohol content is injected into the amniotic fluid. As a result, the child dies and premature birth begins. At the same time, the woman feels pushing and contractions, as during natural childbirth.

If necessary, abort the fetus large sizes A caesarean section is performed. This method is used only when the child has no muscle contractions, breathing, pulsation of the umbilical cord, or heartbeat, that is, a frozen pregnancy is observed.

Consequences of late termination of pregnancy

Every woman should be aware that late pregnancy termination is fraught with serious consequences. In addition to the fact that as a result of such an operation it is necessary to kill a child, which is contrary to the rules of morality, mental and physiological complications for health may also arise.

May be observed stressful state, after premature birth Bleeding often occurs. If you need to have a late-term abortion, you should prepare for the fact that this procedure is painful.

Sometimes women turning to medical institutions to terminate a pregnancy are refused because there are no medical or social indications for a late abortion. They find specialists on the Internet or use information from friends to carry out an underground operation.

It should be understood that performing surgery at home at a later date can not only lead to serious complications, but also death. Therefore, this method of getting rid of a child cannot be used.