abortion or termination of pregnancy It is the termination of a pregnancy in the uterus using special methods. Termination of unwanted pregnancies is a legal and modern right granted to adult women in our country.
Abortion (originally called curettage) is performed only by Gynecologists and Obstetricians and physicians who are certified in this field, 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 Türkiye, unwanted pregnancies occur at the woman's will.10th week of pregnancy can be terminated until. If the person is married, his/her spouse's consent is required; if he is not married and over 18 years of age, his own will and consent are sufficient. For women under 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 ill 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 board 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 more medically 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 pregnancy some medicines Whether it can be terminated using The abortion drug (RU-486) used in some countries abroad is not used in Türkiye. In addition, in case of menstrual delay, there are some treatments sometimes applied by doctors and popular among the public. menstrual stimulant Pills and injections, known as these, are useless in terminating pregnancy.
In many countries of the world and in our country, termination of pregnancy is still vacuum technique, i.e. into the syringe negative pressure pulling It is implemented as. Since curettage actually means "to scrape", it can be applied for different purposes to remove tissue from the uterus. In fact, curettage (abortion) is not only done to terminate a pregnancy. Curettage can be performed for diagnostic purposes, especially in bleeding disorders and post-menopausal bleeding seen in women. 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 Excretion
It is the most common form of abortion in women of reproductive age. 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. Even if it is thought that the abortion is complete, that is, there are no pieces left inside, revision curettage can be performed. Additionally, if it is suspected that pieces of the placenta (the child's partner) remain 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 diagnose infertility, a sample is taken from the uterus on the 21st day of the menstrual period to determine whether ovulation has occurred. Under the influence of the progesterone hormone secreted after ovulation, 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, a single sample is taken from the uterus with a special curette. 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 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, a plastic device is inserted through the vagina to fix the cervix, and the necessary medications are given by the anesthesiologist for general anesthesia.
Rarely, local anesthesia may also be applied. However, local anesthesia can be applied more easily in women who have had a normal birth before, 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, to dilate the cervix spark plug tools called are used.
After the cannula is placed, a syringe is attached to the cannula. With the help of the vacuum created in the syringe, the inside of the uterus is evacuated.
What happens after abortion?
After the procedure, you will be taken to the recovery room where you will rest for half an hour.
You can go home or work normally after the procedure. 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 is beneficial to eat something sugary.
It would be appropriate not to engage in activities that require attention, such as driving, for 6-8 hours after general anesthesia. It is normal to have mild menstrual pain-like pain in your groin that day and the next day. 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, you do not need to additionally use antibiotics after an abortion (unless there is a special reason).
You will have spotting bleeding for about 3-4 days after the procedure. Small clots or fragments may also fall out along with bleeding. This is completely normal. 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 such as menstrual bleeding, be sure to call your doctor.
After the procedure, you can take a standing shower, but as long as the staining continues, it is dangerous to swim in the pool or the sea.
It is not appropriate to have sexual intercourse for 4-5 days after the procedure, 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 stops.
If you experience an unexpected fever after the procedure, you should definitely contact your doctor.
Another frequently asked question is whether women who have an abortion during their first pregnancy can become pregnant again.
There is no such danger in pregnancy terminations performed properly by experienced people under appropriate conditions. In ancient times, without using vacuum technique, only “curette” There was a higher probability of damage to the inside of the uterus in abortions performed using this method. Moreover, in previous years, since there was a high probability of infection (inflammation) after the procedure due to the lack of effective disinfectants and antibiotics, such a belief has survived from the past to the present. But nowadays hygienicIn abortions performed by experienced physicians in an environment and with appropriate techniques, the possibility of complications (an undesirable problem) occurring after the procedure is almost non-existent, even if it is the first pregnancy.
Attention !
In very young pregnancies Sometimes the product of pregnancy may not be evacuated and the pregnancy may continue in the uterus. In pregnancies less than 5 weeks This situation is more common. 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 do it every week and go for a check-up.
after abortion "remaining in pieces" what is it?
In abortion practices performed within the limits of legal pregnancy evacuation (<10th week of pregnancy) and in accordance with the procedure, the problem of not completely removing some parts of the pregnancy may occur in approximately 2-3% of cases. Especially in the uterus myoma This problem may occur in cases where the normal anatomy of the uterine cavity is disrupted due to this myoma. This condition manifests itself as bleeding that continues after a week or two. In some cases, if a piece remains during the abortion procedure, especially during the older weeks of pregnancy, it may be observed that the piece falls out along with bleeding from the vagina. definitive diagnosis ultrasound can be determined by examination. If it cannot be determined exactly whether there is a piece left, some drugs and antibiotics that increase uterine contraction are given. In cases where it is certain after the inspection that there are parts remaining, the process usually performed is a second, albeit shorter, cleaning process to clean these parts. abortion implementation of the process.
Accumulation of blood in the uterus after abortion
It can be seen especially in abortion procedures in very young weeks of pregnancy and in women with very narrow cervix. In the early weeks of pregnancy, bleeding that continues after the procedure accumulates in the uterus, which causes 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 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 the continuation of pregnancy or the pregnancy occurring inside the uterus. Asherman Syndrome If there is no problem such as (dense adhesions in the uterus and consequent lack of menstruation or amenorrhoea), menstruation can be achieved by using medications.
What type of anesthesia is used in abortion?
pregnancy termination general anesthesia under or local anesthesia It can be done with . Since the cervix is small and closed in women who have not given birth before, it is more comfortable to perform cervical dilation under general anesthesia. The procedure itself takes 10-15 minutes, and in case of general anesthesia, the entire procedure takes approximately 30 minutes. Abortion can also be performed with local anesthesia in women who have previously given birth normally.
What are the most common problems during abortion performed with local anesthesia?
It is hypersensitivity to the anesthetic substance applied during local anesthesia and vasovagal syncope (reflexive fainting due to the device inserted to fix the uterus). This is a temporary and benign situation. It is seen in approximately 1%.
-The most common problem immediately after the procedure is nausea and vomiting. Sometimes a feeling of fainting may also occur. This condition is observed at a rate of approximately 1% and is a temporary condition that is not life-threatening.
-Sometimes the cervix may be hard enough to not allow the cannula to pass and the procedure may be interrupted (a very rare situation). Evacuation is postponed for a few days following the application of a cervical dilator.
Approximately after the abortion procedure, which is performed under general anesthesia, is completed. 1 hour later You can return to your home. a week later for control It is important that you come back. During this follow-up examination, you will also be given information about family planning and the method of contraception suitable for you will be discussed.