Safe abortion for pregnancy under 13-22 weeks

The article was professionally consulted by Specialist Doctor I Pham Thi Yen - Obstetrician - Obstetrics and Gynecology - Vinmec Hai Phong International General Hospital.

As the pregnancy gets bigger, the abortion will pose more risks to the mother's health. A second-trimester abortion such as a 15-week abortion or a 22-week abortion is much more dangerous than an abortion in the early stages of pregnancy. For a safe abortion with a pregnancy from 13-22 weeks, it is extremely important to choose a medical facility with qualified facilities, qualified and skilled doctors.

For various reasons, if a woman is unable to continue the pregnancy, she may decide to have an abortion. There are two types of abortion:
Surgical abortion: Using transcervical instruments to terminate a pregnancy, including vacuum aspiration, dilation and forceps. Medical abortion also known as medical abortion: Medicine is used to cause spontaneous abortion. "Is a 13-week-old abortion dangerous or not?" is the question of many people. In general, the larger the pregnancy, the more dangerous the abortion. Abortion in the second trimester such as 13-week abortion, 15-week abortion or 22-week abortion, when the fetus is almost complete, the placenta develops and adheres to the mother's uterus, if before When the abortion is not examined carefully, the abortion is performed in poor quality medical facilities, does not follow the technical procedures or arbitrarily terminates the pregnancy at home, there will be a high risk of complications. adverse health effects, especially serious effects on future fertility.
To ensure safety and health after abortion, it is extremely important to choose a medical facility with adequate facilities, qualified and skilled doctors. At medical facilities, depending on the condition of each customer, doctors can choose one of the abortion methods from 13-22 weeks:

Dilatation and grasping method: Use a vacuum suction pump and forceps after the cervix has been prepared with misoprostol. This method applies to the pregnancy from week 13 to the end of week 18. Medical abortion method: Previously, abortion in the second trimester of pregnancy required surgical techniques. However, according to the current regimen, in facilities with qualified facilities (provincial hospitals and above), drugs can be used to terminate an abortion from 13 to 22 weeks of age. Misoprostol can be used alone or in combination with misoprostol and mifepristone.

2.1. Indications and contraindications
This method is indicated for pregnancy from the 13th to the 22nd week, equivalent to 52mm biparietal diameter. Before the procedure, the client will have a full body examination, gynecological examination, take medical history, perform fetal ultrasound to determine gestational age and perform some necessary paraclinical tests. Medical abortion will not be performed when the client has:
Adrenal gland disease, Cardiovascular disease Severe or moderate anemia Long-term systemic corticosteroid therapy Has surgical scarring on the uterine body Allergy to mifepriston or misoprostol Medical abortion at 13-22 weeks of gestation is relatively contraindicated in patients with acute genital tract infections, genital malformations, or previous surgical scars in the lower uterine segment. These cases need to be treated before medical abortion or performed at provincial and central obstetrics and gynecology hospitals to ensure safety.

2.2. Steps to take
Before the procedure, the client will be consulted about the risks, possible complications, the procedure, methods of self-monitoring and self-care after the abortion, signs and symptoms. It is necessary to re-examine and advise on safe methods of contraception to prevent another abortion. Customers must sign a voluntary commitment to abortion, if under 18 years old, must have a commitment form from the guardian.
During the abortion process, the client's body temperature, pulse, and blood pressure will be monitored every 4 hours, at the beginning of uterine contractions, every 2 hours. For clients to take pain relievers, check the vagina before each medication use.
2.3. Monitoring after pregnancy
Customers will be monitored for vaginal bleeding, uterine contractions within 4 hours after delivery. Before leaving the hospital, customers will be prescribed antibiotics, post-procedure counseling and appointment for follow-up examination.

This method is indicated for pregnancy from the 13th to the 18th week. Contraindications are:
Old surgical scars on the uterine body Having acute medical diseases or acute genital tract infections Allergic to misoprostol Consider with caution before performing with patients with uterine malformations, uterine fibroids, old surgical scars and lower uterine segments,...
Before the procedure, the doctor will conduct the procedure. Full body examination, gynecological examination, taking history to rule out contraindications, ultrasound to determine gestational age and ordering some tests such as complete blood count, blood group, basic coagulation, .. .Customers are also consulted about the risks, possible complications after abortion, self-monitoring methods and post-abortion care, signs of needing to go to a medical facility for re-examination. Just like a medical abortion, the client must make a voluntary commitment to have an abortion.

After the procedure, monitor body temperature, pulse, blood pressure, vaginal bleeding, uterine contractions every 30 minutes for 1-2 hours. Prescribe antibiotics, post-procedure counseling, make an appointment for a follow-up visit before letting the client go home.
Possible complications when performing dilation and clamping are shock, cervical tear, uterine perforation, bleeding, stillbirth, blood stasis in the uterus, infection,... Depending on each case , the doctor will handle according to the appropriate regimen.
Doctor Pham Thi Yen has 11 years of experience in examination and treatment in the field of Obstetrics and Gynecology. Doctor with strengths and deep understanding in:
Examination and consultation of normal pregnancies, pathological pregnancies, high-risk pregnancies Examination and treatment of gynecological diseases: cervicitis, cervical ectropion Surgery Laparoscopic surgery for gynecological diseases: ectopic pregnancy, uterine tumor, ovarian tumor Surgery for breast, vulvar, vaginal, cervical tumors Obstetric surgery: cesarean section, examination and treatment of endocrine disorders in women of all ages: puberty, reproductive age; perimenopausal age.