Third: the safety of medical abortion is proven, but only with strict adherence to the protocol. For medical abortion in the early stages, the frequency of complications is small and does not exceed 0.1-5.4%.
Abortions are surgical and medical. In 2003, WHO formulated the concept of Safe Abortion, updating these guidelines in 2012.
The first and main rule: abortion should be carried out in a medical institution under the supervision of professionals.
Abortion is dangerous and unavoidable.
The second rule: for the seventh year already, there has been a recommendation to abandon curettage of the uterine cavity with an acute curette. By surgical abortion, WHO experts do not mean “cleaning”, but vacuum aspiration of the contents of the uterine cavity, which does not require aggressive expansion of the cervical canal. It is the expansion of the cervical canal and the use of sharp metal curettes that creates a high risk of perforation (perforation. – Ed. ) Of the uterus and even damage to other internal organs.
Many developed countries abandoned curettages in the late sixties of the last century. In our country, for this, there are all the conditions. An alternative to a curette can be simple and inexpensive devices .
In the first trimester of pregnancy, surgical abortion (vacuum aspiration, not curettage!) Is a highly effective method for terminating an unwanted pregnancy. The main possible problems are incomplete evacuation, perforation of the uterus, complications of anesthesia and purulent-septic complications.
WHO estimates that there are still 22 million unsafe abortions per year in the world, leading to the death of 47,000 women and five million more severe complications. However, 13% of pregnancy-related deaths are due to complications associated with unsafe abortion, corresponding to approximately 67,000 deaths annually.
In the medical method of abortion, the effectiveness is slightly lower, in 2-8% of cases surgical termination of pregnancy is required. It is important to understand that with incomplete evacuation of the fetal egg from the uterine cavity, it is customary to talk not about complications, but about the failure of the method, so there are very few complications from medical abortion.
Check out the 2013 publication of 233,805 medical abortions. Serious adverse events or outcomes were recorded in 1,530 cases (0.65%). Of these, the majority was prolongation of pregnancy (inefficiency) – 0.5%, and significant adverse effects – 0.16%. Including the death of one patient from an undiagnosed ectopic pregnancy.
The frequency of postabortion uterine inflammation is generally comparable in both interruption methods. Deadly septic complications are more likely to occur with medical interruptions. The frequency of life-threatening bleeding is also comparable, but if a surgical abortion can be caused by trauma to the cervix or uterus, then with medical abortion, it is atonic bleeding or bleeding associated with the remains of the fetal egg and chorion in the uterine cavity.
Abortion is more dangerous than pregnancy and childbirth
It really is. But only if we are talking about unsafe abortion – outside the walls of a medical institution, when various “craftsmen” try to carry out the procedure or “folk remedies” are used. Barbarian attempts to terminate a pregnancy by introducing a ficus leaf or soap solution into the uterus can be deadly.
Unsafe abortions include the introduction into the uterine cavity of various objects or substances (roots, branches, probes, mixtures), the expansion of the cervical canal and curettage, performed incorrectly or by an unskilled person, ingestion of toxic substances and the application of external force. In some countries, local healers terminate their pregnancy by striking the woman’s lower abdomen, which can lead to uterine rupture or death.
Pregnancy and childbirth are also far from always safe – this is not a fun walk in the park. The older the woman, the higher the risks. Pregnancy after 40 years is associated with a high risk of complications. Moreover, the risk of a woman dying from causes related to pregnancy and childbirth in women after 40 years is 5.3 times higher than in the age category 20-30 years.
Mortality from pregnancy-related causes is assessed using the maternal mortality rate. In the Russian Federation, this indicator is steadily decreasing. According to the report of the Ministry of Health of the Russian Federation , in the period from 2012 to 2017, a decrease of 36.5% was achieved (from 11.5 to 7.3 per 100 thousand children born alive). These data include women who died from abortion. I have not yet found more or less fresh, open statistics on maternal death, where abortions would be highlighted separately.
From the WHO guidelines you can see US 2004 data. Very indicative schedule.
If the first pregnancy ended in abortion, then everything is infertility. Teenagers should not have an abortion at all
If this statement were true, there would not be women in the world who do not know the exact number of abortions performed. “About 20 or 30” is the usual response of women practicing regular “cleansing” instead of contraception.
Teenagers, of course, need to be protected. But today’s statistics in Russia are such that adult intelligent women 45–49 years old have more abortions than teenagers aged 15-17. We seem to have taught teenagers how to use condoms, and adult patients have been “convinced” that it is impossible to get pregnant after 40, so there is no need to protect yourself.
I had several cases when, after the first abortion, young women embarked on the fragile ice of the experiment “I did the first abortion, now I am barren” and immediately became pregnant again, interrupted the second pregnancy and then immediately became pregnant again (“after two abortions, I definitely never get pregnant. ”)
Abortion increases the risk of breast and cervical cancer
In February 2003, the National Cancer Institute (NCI) organized a workshop in which more than one hundred leading world experts studying the risk of pregnancy and breast cancer attended. Workshop participants reviewed existing population-based clinical trials as well as animal studies on the relationship between pregnancy and breast cancer risk, including studies of induced and spontaneous abortions. They concluded that abortion or miscarriage does not increase the subsequent risk of breast cancer in a woman.
Back in 2003, not all experts agreed with this statement, disputes are still ongoing.
In 2018, a large systematic review with a meta-analysis was published – the relationship between abortion and breast cancer partly explains the spread of the breast cancer epidemic in South Asia as it is westernized. According to the authors of the review, the continued denial of the association of abortion and breast cancer can cost the lives of many millions of women over the next few decades.
In 2017, US pediatricians drew attention to an increasing number of studies demonstrating the relationship between termination of pregnancy up to 32 weeks and an increased risk of developing breast cancer – cells cannot “ripen” before lactation begins. Despite ignoring this information in medical circles, pediatricians find it important to tell teenage girls about it. Abortion is a social issue. Short-term and long-term risks include increased mortality from suicide and other forms of violence, increased substance abuse, increased risk of morbidity and mortality of subsequent babies as a result of preterm birth (especially prematurely premature births).
Breast cancer is the most commonly diagnosed type of cancer in women worldwide. Most cases of breast cancer are sporadic (random. – Approx. Ed. ) In nature, the causes of the disease are not completely clear.
It is considered proven that a well-term pregnancy reduces the lifetime risk of breast cancer, but if the first child is born at an older age, the situation changes to the exact opposite – the risk increases.
A full-term pregnancy significantly reduces the risk of developing ovarian and endometrial cancer. Every born full-term baby makes this risk even lower. However, a separate (fortunately, rare) type of cancer is associated with pregnancy – gestational trophoblastic disease. Cancer cells grow in tissues formed after conception.
There is evidence that pregnancy may affect the risk of other types of cancer, but these relationships are not as well understood as in breast cancer and gynecological cancer. Everything is as usual – more research is needed.
Medical abortion pills can lead to weight gain, menstrual irregularities, and other health problems
For medical abortion, a combination of two drugs is used: mifepristone (antihormonal, antiprogesterone drug) and misoprostol (prostaglandin). Of course, these are not vitamins. Side effects and contraindications are reflected in the instructions for use. The dream of a safe “menstrual abortion” – pills that any woman can simply buy at the pharmacy – collapsed a long time ago. Medical abortion – is ser yo heat of intervention, which should be under the supervision of a qualified professional.
Not that you are afraid, girls. You can even die from abortion pills. Fortunately, these cases are rare, isolated .
Weight gain can occur after any termination of pregnancy, not every body can easily cope with the hormonal fluctuations “pregnancy / not pregnancy”, the menstrual cycle can fail for the same reason. Abortion is not a toy, contraception is much safer.
The substances used for medical abortion are toxic, they poison the body
These are medicines that have passed the required stages of research before they are registered. Supplements in which it is not known what is poured can be much more dangerous. You can read about the kind of research that pharmaceutical companies conduct before the medicine was on the drugstore counter in Peter Talantov ’s fascinating book “0.05. Evidence-based medicine from magic to the quest for immortality. ”
During the abortion, the embryo experiences pain and suffering
This well-known speculation, which is often used as the main argument by supporters of the prohibition of abortion. History is 35 years old – Bernard Natanson directed the shocking documentary Silent Scream in 1984. Dr. Nathanson himself, for his medical practice, made more than 60 thousand abortions, then “reforged” and joined the ranks of violent opponents.
Back in 2010, RCOG published a review that put an end to this issue. Until the 24th week of gestation, the nerve endings of the fetus are not developed enough to experience pain. The above arguments did not bother anyone. Fighters for banning abortion immediately stated that abortion was still a murder, albeit painless.
Currently, most researchers believe that the fetus is probably able to experience pain in the third trimester.
Abortion is terribly painful, in addition, traumatic, the recovery process takes a lot of time
The Safe Abortion Concept (WHO) explicitly implies adequate pain management. This is not necessarily anesthesia – it has its own risks. Usually women choose the combined method – analgesics, local anesthesia, sometimes tranquilizers or sedation. The longer the gestation period, the more attention is paid to pain relief.
Cruel practices when channel expansion and curettage are carried out “live” should be forgotten, like a nightmare.
Recovery after an abortion is an individual issue. Sometimes psychological trauma requires more rehabilitation efforts than physical trauma. Patients who become pregnant immediately after an abortion in the first cycle are not uncommon. That is why it is so important to start using effective methods of contraception on the same day that the pregnancy was terminated.
An abortion is not such an important and necessary medical operation, if you remove it from the compulsory medical insurance, nothing bad will happen.
The history of our country recalls what the prohibition of abortion leads to. Thousands of women were pierced by a fetal bladder on a heap of coal, their uterus was scraped out with incompetent hands, or an infusion of furatsilin was made by the envelope, formalin was introduced into the fetal bladder. Often, the women themselves tried to cause an abortion in order to “hide the shame” and not give birth to an “extra mouth” for other life circumstances.
The essence of abortion tragedy: a woman will not bear a pregnancy, which she considers unnecessary. Since the decision to abort, a woman is extremely difficult to convince. If doctors cannot quickly and effectively help, the woman will go where she is promised to terminate the pregnancy. Let unskilled, but right now.
Anyone who advocates a ban on abortion and offers a variety of obstacles in the form of withdrawal from the compulsory health insurance system should read Andrei Lomachinsky’s book Criminal Abortion.
Obstetrician-gynecologists take an unequivocal and balanced position. Only free access to an early safe abortion can significantly reduce high levels of maternal morbidity and mortality. This is the only way to deal with unsafe abortion and the only prevention of abortion tragedies. The same position has been taken by WHO for several decades.
