The impact of different types of abortion on future pregnancies
Induced abortion is the deliberate termination of pregnancy using various medical means. A correctly performed procedure should not affect the ability to conceive and bear a child in the future. Nevertheless, complications are not so rare, and their nature depends on the type of abortion.
Medical abortion
Medical abortion is performed by sequentially taking two hormonal tablets: Mifepristone (Mifeprex) and Misoprostol (Cytotec). This method can be used up to the 10th week of pregnancy. During the procedure:
- A woman takes the first drug (Mifepristone) in the clinic during an appointment with a gynecologist. This drug blocks the action of progesterone, a hormone that is necessary for the implantation and growth of the embryo in the uterus.
- The doctor gives the second drug (Misoprostol) to the patient with him, providing her with preliminary instructions for the procedure. After taking the first tablet, a few hours to 4 days should pass before the woman needs to take the second drug.
- A few hours after taking the second medication, the patient will begin to experience cramping and heavy bleeding. Misoprostol causes the uterus to contract to push out its contents. The pregnancy will be terminated within 4-5 hours after taking the pills, sometimes it may take up to 2 days.
Taking Mifepristone and Misoprostol as part of a medical abortion procedure allows you to terminate an unwanted pregnancy in the early stages without surgery
This type of abortion has minimal negative consequences and is recommended for young girls who have not previously given birth. Ovulation, and with it the possibility of getting pregnant again, is restored 3 weeks after taking the medicine. Menstruation will begin in 4-6 weeks. Possible complications include hormonal imbalances due to taking large doses of hormonal drugs, which can potentially negatively affect the possibility of subsequent conception.
Vacuum aspiration
Vacuum aspiration, or the so-called mini-abortion, is a method of terminating pregnancy, which is used in the first trimester, until approximately the 5th–7th obstetric week. Aspiration may be the primary method or an additional measure after medical abortion.
The procedure takes place in a clinic and involves using a medical vacuum suction to remove the embryo from the uterus. It lasts from 5 to 10 minutes. It usually does not cause intense pain, but may be accompanied by cramps in the lower abdomen. The patient remains in the clinic for several hours after the operation. This allows doctors to verify that the abortion is complete.
Vacuum abortion: a thin disposable catheter attached to a suction is inserted into the uterus, and the fertilized egg is sucked out
Menstruation returns after 4–6 weeks. A properly performed vacuum abortion should not affect a woman’s fertility. Potential complications include bleeding and inflammation. It is not recommended to have sex for at least a week after the procedure.
Dilation and curettage
Dilation and curettage (literally: dilation and curettage) is an abortion procedure that is performed in the first and second trimester, including in cases of serious fetal abnormalities. The operation takes place in 2 stages. In the first stage, the doctor dilates the cervix to make tissue removal easier. Then the placenta and fetus are removed using a special instrument: forceps and a curette (surgical spoon).
Late-term surgical abortion is performed only for medical reasons.
The procedure is performed in a hospital and takes no more than 30 minutes. Analgesics are used as it can be quite painful. Side effects are more likely than with a medical abortion and may include mechanical damage to the walls of the uterus, rupture of the body and cervix, and infection. During this period, bleeding may occur, cramps in the lower abdomen, and nausea may occur.
Abortion in late pregnancy threatens the ability to conceive and bear a child in the future.
Menstruation returns 4–8 weeks after the procedure. You must abstain from sexual activity and physical activity for at least 2 weeks. Before planning your next pregnancy, you will need to undergo a gynecological examination and consultation with a doctor.
Artificial birth
Artificial birth is a method of terminating an unwanted pregnancy in the later stages, mainly from the 20th to 24th week of pregnancy. It may be a necessary measure due to serious fetal developmental abnormalities. The essence of the method is to provoke premature birth by taking prostaglandin hormones. This procedure is performed in a hospital or specialized clinic. The drug causes intense contractions of the uterus, so sedatives or epidural anesthesia are used to relieve pain. The entire procedure can take from several hours to a day. It will take about 1–2 months for menstruation to return. Sexual activity is prohibited for 2–6 weeks after the procedure.
In Russia, abortion after the 12th week of pregnancy is allowed only for medical reasons.
Artificial termination of pregnancy in late stages is prohibited in many developed countries, including the Russian Federation, except in cases where the life of the mother is at risk or the fetus is obviously non-viable. Most often, complications, including difficulty trying to get pregnant in the future, can occur in the case of so-called late abortions. Some doctors consider an abortion to be “late” if it is done after the 20th week of pregnancy. Others include interventions in the third trimester. Still others consider termination of pregnancy late, when the fetus is so mature that it can already survive outside the uterus.
Reviews
We have collected reviews of women who are faced with the problem of missed abortion and planning a child after it in this section.
Anna, 26 years old
“My first pregnancy ended badly - the baby stopped developing at 6 months. Doctors induced artificial birth. Two months later, I started taking the hormonal medications that were prescribed to me - after discontinuation, I became pregnant through the cycle. A healthy son was recently born.”
Maria, 21 years old
“It was not possible for my husband and I to have children for a long time, and the long-awaited pregnancy stopped at an early stage. They cleaned it up and started bleeding heavily. Spent two weeks in hospital. The doctor advised me to postpone new planning for six months, but I unexpectedly became pregnant two months later. I was afraid that I would lose control again, but I reported - even though they made a threat. I gave birth to twins."
Difficulties with conception and complications of pregnancy after abortion
Of course, as with any surgery, there is a small chance of complications that could affect a woman's fertility or future pregnancy. While this is rare, it is good to know what the risks are.
The first step in the surgical procedure for abortion is dilatation of the cervix. In the case of a tight neck, more force must be applied to expand it, which can injure the tissue. This can weaken the cervix so that in the future it will lead to the threat of miscarriage or premature birth. This condition, when the uterus cannot cope with the increasing load of the growing fetus and its premature opening occurs, is called isthmic-cervical insufficiency.
If a woman has had several abortions, the risk of infection after the procedure increases. Acute infectious and inflammatory processes can develop into chronic ones, which gradually leads to blockage of the fallopian tubes with connective tissue scars, causing their obstruction. In this case, the egg and sperm cannot meet and natural conception will not occur.
There is a small chance that the mucous membrane of the uterus (endometrium) may be damaged during an abortion, which will provoke the development of endometritis - an inflammatory process of the mucous membrane of the organ, and the occurrence of scar changes. This may cause low implantation of the fertilized egg during subsequent pregnancies. Normally, it is located on the bottom or back wall of the uterus. If the endometrium is damaged in this area, then the fertilized egg is attached in the lower part. This indicates a threat to normal pregnancy, and the development of placenta previa is dangerous - this is when the placenta completely or partially covers the uterine os. Placenta previa can cause fetal growth restriction.
Damage to the endometrium in the form of scar changes after curettage can cause problems with the attachment of the fertilized egg in the uterus
There is evidence that the likelihood of Rh conflict increases if a woman has previously had an abortion. Rh conflict is an immune reaction of a mother with Rh-negative blood factor to the penetration of Rh-positive red blood cells of the fetus. The anti-Rhesus antibodies formed in this case cause the breakdown of fetal red blood cells, which leads to hemolytic disease of the newborn.
The soft tissue of the pregnant uterus is easily damaged by medical instruments used to perform an abortion. In this case, a through hole or rupture of the uterus occurs. These injuries are life-threatening and require surgical treatment, and in some cases the entire organ must be urgently removed. Puncture of the uterus with a surgical instrument can cause rupture during a subsequent pregnancy.
Discharge
Usually bleeding begins immediately after a mini-abortion. In appearance they resemble regular periods, but in reality they are simply the body’s reaction to intervention.
Normally, the duration of bleeding should be no more than 10 days. At the same time, as the specified period approaches, the discharge should gradually decrease.
You should pay attention and seek medical help if bleeding:
- is painful;
- too much (you have to change the sanitary pad often - once every 1-2 hours);
- clots come out along with the blood;
- blood flows continuously for more than 12 hours in a row.
When does your period start after a mini-abortion?
The onset of menstruation varies from person to person - some start earlier, others later. On average, the delay lasts about a month (from the day of the operation).
It will take some time for the menstrual cycle to fully recover.
- In women who have given birth, this process goes faster - within three months after vacuum aspiration.
- For those who have not given birth, this process can take up to six months.
The very nature of discharge during menstruation may also change towards a decrease, and is associated with suppressed ovarian activity. However, if after several months the cycle has not returned, you will need to consult a doctor.
What are the dangers of early pregnancy after an abortion?
Conception after an abortion can occur as early as 2-3 weeks and the probability of this is quite high. But doctors categorically do not recommend subjecting a woman’s weakened body to such a load. This is too dangerous for both the woman herself and her unborn child. The first time it is necessary to protect yourself. A gynecologist-endocrinologist will advise the optimal method of contraception. Side effects from an abortion may last several weeks and include:
- bleeding;
- pain and cramps;
- nausea and vomiting;
- chills;
- dizziness.
Whether it is a medical or surgical abortion, the tissue takes time to heal. In a medical abortion, the uterus softens due to the effects of drugs that cause the contractions needed to expel the fetus. Doctors recommend planning pregnancy no earlier than 6 months after medical termination of pregnancy.
Vacuum, or mini-abortion, is considered a more serious load on the reproductive organs; in particular, the inner layer of the uterus must recover within 6 to 9 months after the procedure. After this time, you can make attempts at a new conception.
Surgical abortion is performed by vacuum suction followed by curettage, which means damage to the blood vessels inside the uterus. It is necessary to wait until the physical and psychological state returns to normal, and the woman is ready to endure the stress and strain of a new pregnancy. This will take at least one year.
A woman’s body takes the longest to recover after an artificial birth, which is equal in load to a normal one. Experts say that the optimal period between childbirth and subsequent pregnancy should be at least 2 years.
When to start contraception after an abortion and what methods are preferable
The first ovulation after an abortion occurs on average 21–29 days after the procedure. In the absence of complications and additional risks associated with specific diseases, you can choose any method of contraception immediately after an abortion. The most effective methods of contraception include long-acting hormonal contraceptives, such as:
- contraceptive implants (Implanon, Norplant) - a thin rod about 4 cm long and 2 mm in diameter, which is installed subcutaneously in the area of the inner surface of the shoulder and is valid for 3 years (the implant can be removed at any time and fertility will be restored almost immediately);
A subcutaneous contraceptive implant is installed for 3 years, during which it provides continuous protection from pregnancy.
- injection contraceptives (Depo-Provera or Sayana Press) - intramuscular injections of a hormonal drug that act continuously for 3-6 months (after discontinuation, fertility is restored within 6-9 months);
- an intrauterine device is a small device made of plastic with copper, which is installed in the uterine cavity for 3–5 (up to 10) years, depending on the type.
Repeated abortion, whether surgical or medical, can have negative consequences for a woman's fertility and can sometimes be life-threatening.
If, after an abortion, a woman is diagnosed with an infection in the uterus, installation of an IUD is contraindicated until the infection is cured. Other methods of contraception are also effective, but require remembering them and using them promptly according to instructions. These include:
- birth control pills (pure progestin or combined);
Birth control pills are a reliable contraceptive if taken in a timely manner according to the instructions.
- contraceptive patch;
- vaginal ring;
- condoms (external male or internal female).
It is important to take precautions to avoid becoming pregnant soon after an abortion, as repeat abortions can reduce your chances of getting pregnant naturally later.
About deadlines
Still, you can get pregnant a month after an abortion, but is it worth it? A hasty pregnancy can cause bleeding and again end in self-abortion. In the end, pregnancy is a stress and restructuring of the body, which is a serious test. Have pity on yourself, your reproductive organs and don’t rush into it!
Sex life must be restored wisely and not follow only natural instincts. It is very important to use protection after returning to regular intimate life. An equally important task is to restore hormonal levels, because abortion destroys them. Doctors recommend waiting at least three months after an abortion and not forgetting about contraception.
Recommendations for women planning pregnancy after an abortion
It is possible that feelings of guilt and emotional depression will push a woman to want to get pregnant soon after an abortion. However, it is recommended to plan a child no earlier than 6–9 months after the abortion procedure. The specified period is the minimum period for the woman’s body to recover and prepare for a new pregnancy.
A consultation with a gynecologist and a check of your general health is necessary. First of all you need:
- undergo an ultrasound of the uterus and appendages (transvaginal ultrasound) - to identify potential tumors or deformities of the reproductive organs;
Transvaginal ultrasound makes it possible to assess the structure and size of a woman’s reproductive organs
- take a bacteriological smear from the vagina and/or scraping from the cervix - tests for sexually transmitted diseases (chlamydia, uroplasmosis, mycoplasmosis, toxoplasmosis).
Additionally, blood tests may be required:
- for sex hormones - the level of prolactin, progesterone, testosterone, DHEA sulfate is examined;
- for thyroid hormones, including thyroid-stimulating hormone, thyroxine and triiodothyronine.
A short (less than 6 months) interval between pregnancies after an abortion increases the risk of premature birth in a subsequent pregnancy by 35%.
If any problems or diseases are detected, you will need to undergo a course of treatment and retake tests. It is advisable to start taking folic acid (vitamin B9) when planning pregnancy after an abortion. This vitamin is a catalyst for metabolic processes, takes an active part in the maturation of the egg, and also reduces the risk of developing pathologies of the neural tube in the fetus.
If there are systemic chronic diseases (diabetes mellitus, thyroid dysfunction), a woman needs to undergo a full medical examination. Assessing your health immediately before planning a pregnancy will help you better cope with possible problems in the process of bearing a baby.
Operation
Vacuum cleaning of the uterus during a frozen pregnancy can be carried out using two methods:
- Manual. This technique uses a syringe, which the doctor uses to suck out the contents of the uterus.
- Machine. To carry out this operation, a special pump is used.
In both types of procedures, the woman is given anesthesia, after which the genitals are treated with an antiseptic. The doctor then inserts a speculum into the vagina and, if necessary, administers a second injection of anesthesia into the cervix.
Using a special device, the distance to the uterus is measured. If the cervix is not dilated enough, a dilator is used. Only after this is a tube inserted, which sucks in tissue and cleanses the uterine cavity. Then the patient is injected with drugs that shrink the endometrium. The duration of the entire procedure does not exceed 15 minutes.
As a rule, doctors prefer general anesthesia, because with it the patient will not feel anything.
But the disadvantage of such anesthesia is the long recovery from it (at least 2 hours).
After vacuum cleaning, the embryo is sent for research to determine the causes of pregnancy failure.
