Interruption of pregnancy in late terms is possible only in exceptional cases. The desire of a woman at the same time is not an indication for surgical intervention. Doctors are afraid of possible negative consequences of late abortion, the main of which is secondary infertility.
Are abortions made at a later date?
Interruption of gestation at the request of a woman can be carried out at the initial stages of fetal development. The latest period for termination of pregnancy initiated by the mother is 12 weeks. Abortion after this time is called late and is performed only in exceptional cases. The choice of the method by which the pregnancy process is interrupted is done on the basis of the current period, the age of the pregnant woman and the state of her health. So, after 20 weeks of gestation, doctors use not classical abortive techniques, but perform artificial birth.
Indications for abortion
The decision that there is a need for an abortion at a later date is taken by a medical commission. The incoming doctors (obstetrician-gynecologist, specialist in the field that causes the need for abortion (sociologist, representatives of state bodies)) take into account the results of the medical examination, the social conditions in which the pregnant woman is. The final decision on the need to interrupt gestation after 12 weeks may be taken on the basis of:
- medical indications;
- social indications.
Medical indications for abortion
This kind of indication for termination of pregnancy at a later date is taken into account initially. In most cases, they are associated with the presence of a pregnant woman with diseases that can prevent her from normally taking out and giving birth to the baby. In addition, late-term abortion can be indicated by identifying fetal malformations and developmental disorders that, after birth, will cause a child's disability or death. Among the main medical indications for abortion after 12 weeks are:
- mental and physical diseases of a pregnant woman;
- presence of pathologies of chromosome character in the fetus, incompatible with life;
- frozen pregnancy ;
- severe diseases of the pregnant (hematite, viral infections, tuberculosis);
- the possibility of the death of a woman with further progression and development of pregnancy.
Social indications for abortion
Social reasons for abortion in later terms are due to the presence of factors that can worsen the living conditions of the most pregnant or future baby. Often, doctors take into account those social factors that arose directly during pregnancy itself:
- death of the spouse;
- the arrest of one of the parents of the baby.
In addition, there are a number of social factors that can also be taken into account when deciding on an abortion, but their availability is not a strict indication to the interruption of gestation:
- lack of housing;
- presence in the family of more than 3 children;
- the age of the future mother is less than 18 years.
How do abortions take place at a later date?
Methods of abortion in late terms practically does not differ from those used by doctors at early stages of gestation. However, the interruption of pregnancy in late-term pills is not carried out. The choice of methods is carried out by the medical commission on the basis of the results of the examination, taking into account the period of pregnancy and the features of its course. Each of the techniques has its own characteristics, a certain technique. Among the methods used to interrupt pregnancy, after 12 weeks use:
- Intraamnial administration of fluids.
- Forced cervical dilatation.
- Artificial childbirth .
- Small cesarean section.
The method of intraamnial introduction of liquids
Abortion in late pregnancy with the use of hypertonic solutions is a common technique. The mechanism of action of this method of interrupting gestation is associated with a change in the volume of the amniotic fluid, its osmotic pressure. As a result of such changes, there is a stretching of the muscular structures of the uterus with a subsequent reduction.
Increase in the tone of the uterus in this case, the doctors associate and with the possible toxic effect of substances that begin to emerge after the fetus has died (as a result of the influence of hypertonic solution). Strong contractile movements of the myometrium lead to expulsion of the fetus to the outside, as a result of which the pregnancy is completely interrupted. By its mechanism, the method resembles a drug-induced termination of pregnancy, which is not used in later terms. After the procedure, doctors carefully examine the uterine cavity to exclude the presence of fetal tissue remains.
Dilatation and evacuation
The abortion of pregnancy on late terms for medical reasons is often carried out by the method of dilatation and evacuation. The optimal time for abortion is 15-18 weeks. First, the doctor performs an artificial dilatation of the cervical canal, using surgical instruments with a gradual enlargement of the dilator (dilatation).
After gaining access to the uterine cavity, physicians perform fetal dissection and scraping of fetal membranes. At the end of this stage, they begin evacuation - extracting fetal remains outward with the help of vacuum suction. Evacuation with pre-dilatation is recognized as a gentle method of abortion in later periods and recommended by WHO as an alternative method of abortion.
Small cesarean section
This type of surgical abortion in late terms practically does not differ from the usual cesarean. Access to the fetus is through an incision in the anterior abdominal wall, through which subsequently the fruit is extracted. The operation is performed under general anesthesia. This method is rarely used, in cases of contraindications to the method described above. During the operation, there is a high risk of uncontrolled bleeding, so the decision to take it is taken when there is a threat to the life of the woman herself.
Method of artificial delivery
When there is a need to carry out abortion at a later date, after 20 weeks , doctors change tactics of artificial delivery. The fetus in this case is not withdrawn from the uterine cavity, but procedures are carried out which cause its independent expulsion to the outside. Talking about how abortion occurs late in life, doctors often use the term "stimulation of premature delivery".
In the late term, abortion is not termed abortion from the point of view of psychology: the fetus by this time can already be called a child, and the future mother already has affection for the baby. Synthesized in her hormones form a sense of motherhood. Artificial births start with stimulation - they inject prostaglandins into the body, which increase the tone of the uterine musculature and cause its contraction. As a result, tribal activity begins.
Discharge after termination of pregnancy in later periods
Abortion is always a factor for the body, weakening immunity, so it is important to monitor the state of health of a woman. The reproductive system creates a favorable environment for the development of infection and inflammation. As an indicator of the condition of the reproductive system, discharges after abortion are assessed. Normally, they appear on the 2-3rd day after the procedure, may have small amounts of blood, but do not smell. The change in these parameters may indicate an infection. Yellow discharge with the smell of rot should be the reason for contacting a doctor.
The brown discharge that occurs after a late pregnancy is interrupted can last up to 10 days. In some cases, women may notice the appearance of blood clots (folding occurs under the influence of body temperature). The volume of such secretions is moderate, and they themselves are not accompanied by painful sensations in the lower abdomen or in the vaginal area. Changing the secretions to dark brown may indicate polyps in the uterus.
Recovery after abortion in later periods
The duration of the recovery period is determined by the method of termination of pregnancy and the period at which it was carried out. Abortions on late terms are characterized by high morbidity and stress for the body. To exclude possible early complications, a woman is under the supervision of a specialized doctor in a hospital. In general, recovery from abortion involves:
- Prevention of blood loss.
- Exclusion of the possibility of infection (antibiotic therapy, anti-inflammatory drugs).
- Instrumental examination of the female reproductive system to exclude residual fetal membranes.
Consequences of termination of pregnancy on late terms
Interested in the doctors about the possible consequences, women are trying to find out whether it is possible to have an abortion and how dangerous this procedure is. Gynecologists argue that this procedure is highly undesirable - complications and consequences of a previous abortion may appear after several months and years. Given the time of their development, doctors subdivide possible complications into:
- Early - occur during the interruption procedure (perforation of the uterus, bleeding).
- Deferred - develop within a month after the operation (endometritis, hematoma, progression of pregnancy).
- Distant - appear after a year and later (cicatrical changes in the internal pharynx, cervix, endometrium damage, violation of the passableness of the fallopian tubes).