(Abortion, abortion)

In countries where abortion is legal, abortion is generally safe, and complications are rare. 13% of maternal deaths are due to the consequences of induced abortion worldwide, with the vast majority of these deaths occurred in countries where abortion is illegal.

In the US, an abortion of a viable fetus still is legal, although recently the state-specific restrictions (eg. As mandatory waiting periods, restrictions on gestational age) were introduced. (N. D. Talk .: In Germany, the indication for abortion by § 218a of the Criminal Code is regulated.) About half of pregnancies in the US are unintended. About 40% of unintended pregnancies are terminated by elective abortion, 90% of the procedures are performed during the first trimester. In countries where abortion is legal, abortion is generally safe, and complications are rare. 13% of maternal deaths are due to the consequences of induced abortion worldwide, with the vast majority of these deaths occurred in countries where abortion is illegal. Frequently used methods of induction of abortion are instrumental emptying through the vagina Drug induction (induction of uterine contractions) Surgical procedures on the uterus (Hysterotomy or hysterectomy) are a last resort, some are trying to avoid because of the increased mortality. A Hysterotomy leaves a scar on the uterus, which can rupture during a subsequent pregnancy. Before the induction of abortion, the pregnancy should be confirmed. The gestational age is determined in most cases by sonography, sometimes the medical history and physical examination can confirm the exact gestational age in the first trimester. A Doppler sonography should be considered in women in the second trimester into account the placenta previa or have an anterior placenta and uterine scar in history. The termination of pregnancy can be confirmed by direct observation of the removal of the uterus content by means of ultrasound during a procedure. Is not performed sonography during the procedure, the completion can be confirmed after the operation by quantitative measurement of the ? chain of human chorionic gonadotropin (?-HCG) in the serum before and; a decrease of> 50% after 1 week confirms the termination. On the day of abortion should antibiotics that attack against genital pathogens (including chlamydia) are effective, are given. Usually doxycycline is used; 100 mg be given before surgery and then 200 mg. After the procedure, women receive (D) immunoglobulin to Rh-negative blood Rh0. An induced abortion in the first trimester can be performed under local anesthesia often being trained physicians should also offer sedation. Later abortions sometimes require a deeper sedation. Contraception (all methods) can be started immediately after an abortion <28 weeks of gestation (pregnancy). Instrumental removal Under the 14th week of pregnancy is usually performed a dilation and curettage, usually using a suction large diameter, which is inserted into the uterus. Under the 9th SSW manual vacuum aspiration can be used. They generated enough pressure to remove the uterus. MVA devices are portable, do not require a power source and are quieter than devices for electric vacuum aspiration. A manual vacuum aspiration can also be used for the treatment of miscarriage in early pregnancy. After the ninth SSW an electric vacuum aspiration is used; it involves attaching a cannula to an electrical vacuum source. In the 14th-24th SSW is performed dilatation with evacuation. For fragmentation and for extracting the fetuses Abort pliers is used, and by means of a suction probe amniotic fluid, placenta and fetal tissue debris be removed. The dilation with evacuation requires greater skill and experience than the other methods of instrumental avoidance. Frequently are increasingly growing, tapered dilators to expand the cervix used before the procedure. However, doctors have to use another dilator, depending on the gestational age and parity instead of or in addition to the tapered dilators to minimize the damage to the cervix by the tapered dilator. To select the prostaglandin E1 analogue (misoprostol) and osmotic dilators, such as laminaria (dried Seetangstiele) are. Osmotic dilators can be introduced into the cervix and there for ? 4 hours (often overnight at a pregnancy> 18 weeks) are left. Misoprostol expands the cervix by stimulating the release of prostaglandins; expand osmotic dilators the cervix by expansion. Osmotic dilators are commonly used from the 16 weeks of gestation. Misoprostol is usually given buccal 2-4 hours before the procedure. If patients want to avoid pregnancy and subsequent abortion, an intrauterine device (IUD) can be used immediately after the abortion. This makes re-abortion unlikely. Drug Introduction Drug introduction comes at <9 SSW or> 15th week of pregnancy in question. In patients with severe anemia, drug introduction should only be performed in a hospital, so that, if necessary, a blood transfusion could be performed. In the US, 25% of abortions omitted from the <9 SSW to drug introduction. For pregnancies <9 SSW are 2 effective schemes are available, both of which contain the progesterone receptor antagonist mifepristone (RU 486) and the prostaglandin E1 analogue misoprostol: Evidence-based scheme: mifepristone 200 mg po, hereinafter misoprostol 800 ug vaginal itself applied by 6-72 hours or buccal after 24-48 hours (only 2 medical visits) FDA-approved scheme: Mifepristone 600 mg po, misoprostol below 400 ug po given by a doctor for about 48 hours (3 medical visits) The evidence-based scheme terminates a pregnancy to 9. SSW in about 98% of cases; The FDA-approved scheme is effective in 95% of cases in <7 weeks. Following each scheme, a check-up is necessary to confirm the termination of pregnancy and, if necessary, to prescribe contraception. After the 15th week of pregnancy a predischarge reduced (24-48 hours prior to induction) of 200 mg of mifepristone, the induction times. For induction of abortion prostaglandins are used. Are possible prostaglandin E2 (dinoprostone) as pessaries, vaginal and buccal misoprostol tablets or prostaglandin F2a (dinoprost tromethamine) as i.m. Injection. The dose of misoprostol is usually 600-800 .mu.g vaginal, followed by 400 ug buccal every 3 hours for up to 5 doses. Or it can be taken every 6 hours two 200 microgram misoprostol vaginal tablets; abortion takes place within 48 hours in almost 100% of cases. The adverse effects of prostaglandins include nausea, diarrhea, hyperthermia, facial flushing, vasovagal symptoms, bronchospasm and a decrease in the seizure threshold. Complications The complications of induced abortion (severe complications in <1%; deaths in <1 / 100,000) is higher than that of contraception; however, the rates are 14 times lower than after the birth of a mature child, and they have declined in recent decades. The complication rates rise with increasing gestational age. Early serious complications include perforation of the uterus (0.1%) or less frequently of the intestine or other organs by an instrument. Severe bleeding (0.06%) can result from trauma or uterine atony. Zervixrisse (0.1-1%) ranging from superficial pulling of a forceps to cervicovaginal cracks, which, in rare cases to fistula formation. General anesthesia or local anesthesia rarely cause serious complications. The most common long-term complications include. a. Bleeding and significant infection (0.1-2%), which usually occur due to a retention of placenta residues. If bleeding occurs or suspected infection, sonography of the pelvis is performed; impacted placenta radicals may be visible during an ultrasound examination. With a slight inflammation can be expected in mäßiggradiger to severe infection, however, peritonitis or sepsis can develop. Sterility can set as a result of an infection due to synechiae in the endometrial cavity or through a tube fibrosis. Forcible dilation of the cervix in advanced pregnancy may contribute to cervical incompetence. However, an elective abortion does not increase during a subsequent pregnancy, the risk to the fetus or the woman likely. To psychological complications it does not, as a rule, but can occur in women who Pre-pregnancy psychological symptoms had a significant emotional attachment to the pregnancy had (z. B. abort a desired pregnancy due to a medical indication in the mother or the fetus ) Conservative political views on abortion have a Limited social support have Summary About 40% of unintended pregnancies are terminated by an elective abortion. Frequently used methods of abortion include instrumental emptying through the vagina or the drug induction (triggering uterine contractions). Prior to performing the abortion pregnancy is confirmed, and determines the gestational age based on a medical history and physical examination and / or ultrasound. The instrumental emptying is usually by dilatation and curettage until the 14th week of pregnancy and by dilation with evacuation in the 14th-24th SSW performed, which occasionally precedes a cervical dilation with misoprostol or osmotic dilators (z. B. Laminaria). In drug induction mifepristone followed by misoprostol in pregnancies <9 SSW given; at a pregnancy after the 15th week of pregnancy then a prostaglandin (eg. B. dinoprostone, misoprostol vaginal, vaginal and buccal, prostaglandin F2a i.m.) is administered in advance mifepristone, or vaginal misoprostol. Serious complications (eg. As uterine perforation, severe bleeding, severe infection) occur in <1% of abortions. An elective abortion does not increase the risk in subsequent pregnancies.


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