Cuprins
Proceduri de intervenție pentru avort
Two techniques are used to perform a voluntary termination of pregnancy:
- drug technique
- tehnica chirurgicală
Whenever possible, women should be able to choose the technique, medical or surgical, as well as the mode of anesthesia, local or general16. |
Medication technique
The medical abortion is based on the taking of drugs allowing to cause the termination of the pregnancy and the expulsion of the embryo or the fetus. It can be used up to 9 weeks of amenorrhea. In France, in 2011, more than half of abortions (55%) were done by medication.
There are several “abortion” drugs, but the most common method is to administer:
- an anti-progestogen (mifepristone or RU-486), which inhibits progesterone, the hormone that allows pregnancy to continue;
- in combination with a drug of the prostaglandin family (misoprostol), which triggers contractions of the uterus and allows the evacuation of the fetus.
Thus, the WHO recommends, for pregnancies of gestational age up to 9 weeks (63 days) the intake of mifepristone followed 1 to 2 days later by misoprostol.
Mifepristone is taken by mouth. The recommended dose is 200 mg. Administration of misoprostol is recommended 1 to 2 days (24 to 48 hours) after taking mifepristone. It can be done by vaginal, buccal or sublingual route up to 7 weeks of amenorrhea (5 weeks of pregnancy).
The effects are mostly related to misoprostol, which can cause bleeding, headache, nausea, vomiting, diarrhea and painful abdominal cramps.
In practice, medical abortion can therefore be performed up to the 5st week of pregnancy without hospitalization (acasă) and up to the 7st week of pregnancy with a few hours of hospitalization.
From 10 weeks of amenorrhea, the drug technique is no longer recommended.
In Canada, mifepristone is not authorized, due to possible infectious risks (and no company has made a request to market this molecule in Canada, at least until the end of 2013). This non-marketing is controversial and denounced by medical associations, who consider the use of mifepristone safe (it is commonly used in 57 countries). Medical abortions are therefore much less common in Canada. They can be done with another drug, methotrexate, followed by misoprostol, but with less effectiveness. Methotrexate is usually given by injection, and five to seven days later, misoprostol tablets are inserted into the vagina. Unfortunately, in 35% of cases, the uterus takes several days or several weeks to empty completely (compared to a few hours with mifepristone). |
The surgical technique of abortion17-18
Most abortions in the world are performed by a surgical technique, usually aspiration of the contents of the uterus, after dilation of the cervix (either mechanically, by inserting increasingly large dilators, or medicinally). It can be performed regardless of the term of pregnancy, either by local anesthesia or by general anesthesia. The intervention usually takes place during the day. Aspiration is the recommended technique for surgical abortion up to a gestational age of 12 to 14 weeks gestation, according to the WHO.
Another procedure is sometimes used in some countries, dilation of the cervix followed by curettage (which involves “scraping” the lining of the uterus to remove debris). WHO recommends that this method be replaced by aspiration, which is safer and more reliable.
When gestational age is greater than 12-14 weeks, both dilation and evacuation and medication can be recommended, according to the WHO.
Abortion procedures
In all countries that authorize abortion, its performance is framed by a well-defined protocol.
It is therefore necessary to find out about the procedures, the deadlines, the places of intervention, the legal age of access (14 years old in Quebec, any young girl in France), the terms of reimbursement (free in Quebec and 100% reimbursement in France).
You should know that the procedures take time and that there are often waiting times. It is therefore important to quickly consult a doctor or go to a facility performing abortions as soon as the decision is made, so as not to delay the date of the act and risk arriving at a pregnancy date when it is necessary. will be more complex.
In France, for example, two medical consultations are compulsory before the abortion, separated by a reflection period of at least one week (2 days in case of emergency). “Consultations-interviews” can be offered to women before and after the operation, in order to allow the patient to talk about her situation, the operation and to receive information on contraception.19.
In Quebec, abortion is offered in a single meeting.
Psychological follow-up after an abortion
The decision to terminate a pregnancy is never easy and the act is not trivial.
Having been unwantedly pregnant and having an abortion can leave psychological traces, raise questions, leave a feeling of doubt or guilt, sadness, sometimes regret.
Obviously, the reactions to an abortion (whether natural or induced) are diverse and specific to each woman, but psychological follow-up should be offered to all.
However, several studies show that abortion is not a long-term psychological risk factor.
The emotional distress of the woman is often maximum before the abortion then decreases significantly between the period before the abortion and that immediately following it.10.