Obstetrics and Gynecology - A.M. Gromova 2000

Induced abortion
Artificial termination of pregnancy up to 12 weeks

In modern practice, abortion has assumed significant social importance, as it is viewed—alongside Contraception and sterilization—as a method of population growth regulation and family planning.

In 1955, a Decree of the Presidium of the Supreme Soviet of the USSR was issued, permitting Artificial abortion upon request up to 12 weeks of Pregnancy in a medical facility. This decree allows women themselves to determine social indications for the termination of pregnancy up to the twelve-week term.

Aside from a woman's personal desire to terminate an unwanted pregnancy, there are medical indications for this Procedure. These include any conditions that, if the pregnancy were to progress, would threaten the woman's life and health, as well as non-viable fetal development.

Medical indications for early-term pregnancy termination

1. Infectious and parasitic diseases (tuberculosis, Syphilis, AIDS, HIV infection, cytomegalovirus infection, leprosy).

2. Malignant neoplasms of various localizations.

3. Endocrine System disorders (moderate and severe forms of thyrotoxicosis, uncompensated hypothyroidism, severe Diabetes Mellitus, diabetes insipidus, adrenal disease).

4. Blood disorders (hemolytic anemia, purpura, and hemorrhagic conditions).

5. Mental disorders.

6. Neurological diseases (meningitis, encephalitis, myelitis, hereditary and degenerative Diseases of the Central Nervous system, multiple sclerosis).

7. Stage I and II Hypertension.

8. Severe forms of keratitis, visual field defects, and visual acuity below 0.05.

9. Congenital deaf-mutism, otosclerosis.

10. Myocarditis, cardiomyopathies, endocarditis with severe cardiac impairment; severe rhythm disorders, aortic aneurysm, congenital Heart and Circulatory system defects.

11. Severe Bronchial Asthma, tracheal, bronchial, or Laryngeal stenosis.

12. PEPTIC ULCER DISEASE of The Stomach and duodenum complicated by stenosis or Hemorrhage.

13. Liver dystrophy or cirrhosis, cholelithiasis (exacerbation).

14. Acute Glomerulonephritis and exacerbation of Chronic Glomerulonephritis, renal failure, Hydronephrosis.

15. Absence of a limb in the female patient.

16. Hereditary pathology and congenital fetal malformations, Monogenic Diseases detected via prenatal Diagnostics.

Given the indications outlined above, early attendance at an antenatal clinic becomes exceptionally important. The task of the antenatal clinic physician is to conduct a comprehensive examination of the woman to determine the feasibility of carrying the pregnancy to term. If contraindications to carrying the pregnancy exist, the physician must inform the pregnant woman about all adverse outcomes for both her and the future child, and recommend terminating the pregnancy. However, it must be remembered that in all cases, the decision to terminate a pregnancy is made independently by the woman, and no one can force her to do so against her will.

Contraindications to the procedure

1. Acute and subacute Inflammatory Diseases of the reproductive Organs.

2. Acute and subacute infectious diseases (typhoid fever, diphtheria, tonsillitis, dysentery, Influenza, furunculosis, paraproctitis, etc.).

3. Elevated body Temperature.

4. Suspected abnormal localization of pregnancy.

5. Grade III and IV vaginal cleanliness.

The listed conditions are relative contraindications for artificial abortion, which should preferably be performed after an appropriate course of Treatment.

Conditions for the Procedure

1. Gestational age of no more than 11-12 weeks.

2. Absence of pustular and inflammatory infectious diseases.

3. Vaginal flora cleanliness of at least grade I-II.

4. ESR within physiological limits.

5. Strict adherence to asepsis and antisepsis rules.

6. Clear orientation regarding the position and size of the Uterus.

7. Absence of obstacles to instrument insertion within the birth canal, specifically the feasibility of adequate cervical canal dilation.

Preoperative Examination Required

1. Determination of blood group and Rh factor in primigravidae.

2. Blood test for HIV Antibodies.

3. Complex serological tests for the Diagnosis of syphilis.

4. Bacterioscopic examination of vaginal discharge.

Anesthesia

Anesthesia is required in all cases of artificial pregnancy termination. Anesthesia Methods are selected individually for each patient depending on her psychosomatic status, obstetric history, and gestational age.

For local infiltration anesthesia, a 0.25% or 0.5% novocaine solution is used, administered paracervically into the lateral vaginal fornices (at 2, 4, 8, and 10 o'clock positions, 10-20 ml per injection site).

General anesthesia involves the intravenous administration of ketamine, ketalar, or sodium thiopental, or inhalation anesthesia with a mixture of oxygen and nitrous oxide. In specific, particularly complex cases, anesthesia involving Muscle relaxants and controlled ventilation may be necessary.

The procedure must be performed in a hospital Setting within a minor operating room, using a gynecological chair or operating table. The physician scrubs in as for major abdominal surgery.

Artificial abortion may be performed via uterine curettage, vacuum aspiration, or medical methods.