Instrumental abortion - Causes, symptoms and treatment. MF.

The operation of artificial abortion is performed under thorough and complete anesthesia. Before the operation of artificial abortion for determining the size, shape and position of the uterus, it is necessary to make a vaginal examination.

A patient after emptying the rectum and bladder is placed on a gynecological chair, as for a gynecological operation. Hair on the external genitalia should be shaved, the skin is treated with 70% ethyl alcohol and 1% iodine alcohol solution.

The vagina is opened with mirrors, cotton balls clean it from the discharge. The mucous membrane of the vagina and cervix are wiped with 70% ethyl alcohol and 1% solution of iodine alcohol. The Doyen or Muzo forceps grab the front lip of the cervix. Thoroughly and slowly carry out local anesthesia with 1-2% lidocaine solution, especially when treating the cervical canal. The action of dicaine is easy to notice by increasing the diameter of the external throat, by the way the instrument easily moves along the neck channel and penetrates into the uterine cavity. Then, the uterine cavity is examined by the uterine probe, its length and transverse dimensions are clarified and the channel of the neck begins to expand, beginning with the introduction of small-diameter dilators.

At 6-7-week pregnancy, it is quite enough to treat the cervical canal, as already mentioned, with lidocaine and you can start the operation. At 8-9 weeks of pregnancy, it is necessary to expand the cervical canal, inserting successively the extensions of Gegar to expander No. 10-11;at 10-12-week pregnancy - to № 12-13;and in some women - up to number 14.When performing expansion of the neck channel, it is necessary that the curvature of the expander coincides with the bending of the uterus, otherwise the uterus can be easily perforated.

After the expansion, a curette is inserted into the uterine cavity, which is felt for the fetal egg, destroys it( Figure a), which is established after the flow of a small amount of water. If the curette can not immediately remove the fetus, it is removed by abortion. Aborttsang into the uterus is inserted closed, in the cavity it is opened, they seize the fruit or part of it and remove it. After the removal of the fetus by the curette, the uterine mucous membrane, and also the membranes of the fetal egg, are systematically scraped off. In this case, it is absolutely not necessary to scrape off until a clearly audible uterine crunch appears. After curettage of the mucous membrane of the uterus and the remains of the fetal egg, there is a feeling of smoothness of the walls of the uterus. Once the uterus is emptied, bleeding stops and bloody foam appears, which is an indication for the end of the operation.

Do not forcefully scrape the mucous membrane of the uterine horns, this can lead to obliteration of the intramural part of the tube.

At a later date, at 13-16 and 18 weeks of pregnancy, according to vital indications, an operation of artificial abortion can also be performed without much difficulty. The key to its successful implementation is a thorough anesthesia. Expansion of the cervical canal, depending on the gestational age, is made by Gegar dilators, including dilators No. 16-18, and sometimes No. 20-22.

In the later stages of pregnancy, in no case should you begin the operation of artificial abortion with destruction of the curette of the fetal egg and curettage, this will inevitably lead to severe uterine bleeding.

Once the dilatation of the cervical canal is complete, a large abortion is injected into the uterine cavity, the fetal membranes are ripped( Figure b), without removing the abortion after the expiration of the water, groping for the most voluminous part of the fetus - the head, wide open abortion, and grasping the latter,hand located on the anterior abdominal wall above the uterine fundus, the operator controls and corrects the abortion movement. Slowly closing abortsang, crush the head, which is easily determined by the allocation of brain tissue from the cervical canal. The head should be removed slowly so that its bones do not injure the uterine tissue in the area of ​​the internal pharynx. Then, one after another, the other parts of the fetus are captured and removed until it is completely removed. Now the same aborttsangom remove the placenta and only then the curette systematically scraped the mucous membrane of the uterus with the remains of the fetal egg. All parts of the fetus should be folded in the tray, so that it is possible in doubtful cases to check whether all the fetal eggs are removed.

Therefore, the main points of the operation of artificial abortion after the preparation of the operating field and pain relief are the following:

1) dilating the cervical canal;

2) removal of the fetus and its membranes by abortion or curettage( with a minor pregnancy);

3) systematic and careful curettage of the mucous membrane of the uterus with the remains of the fetal egg;

4) removing the tools used to perform the operation.