Curettage

In general terms, abortion (curettage) refers to taking tissue from inside the uterus. Very often it is applied to end the pregnancy in the uterus. Apart from that, it can also be applied for diagnostic purposes or biopsy. In this case, this process is called 'probe curettage'.

Abortion with the aim of ending unwanted pregnancies is limited to '10 weeks from the last menstrual period' according to the law. This is called "legal eviction or curettage." According to the law, this procedure is authorized only by obstetricians in our country.

The procedure performed remains hidden between the doctor and his patient. If the expectant mother has a serious illness and pregnancy poses a serious risk to her, or if she is using drugs that are harmful for her pregnancy but she must use, 'therapeutic curettage' is applied to the patient. A medical board report is required for this procedure, where more than one doctor's approval is required.

If it is determined that the baby has no severe disability or heartbeat during pregnancy follow-up, therapeutic curettage is applied.

How is abortion done?

Before starting the procedure, the size of the pregnancy and its location in the uterus are determined by ultrasound.

General or local anesthesia can be preferred during abortion. If general anesthesia is to be applied, the patient should not eat or drink anything 4 hours before the procedure. If the patient is the first abortion experience or has delivered by cesarean before, we recommend abortion with general anesthesia. However, if the patient has had more than one abortion or had a normal birth, they can have an abortion with local anesthesia. Local anesthesia is the application of narcotic drugs to the cervix area of the patient. General anesthesia is the application of narcotic drugs to the vascular access from the patient's arm by an anesthesiologist.

Before starting the procedure, a careful gynecological examination is carried out. If general anesthesia is preferred, an instrument called "speculum" is placed before the cervix can be seen after the patient is put to sleep. After the vagina and cervix are cleaned with an antiseptic solution, the "tinulum" is pulled by holding the tool named as a single tooth and the uterus is leveled. If local anesthesia is preferred, medication is injected into the cervix at this stage.

In necessary cases, the cervix is widened with the tools called “spark plug” in pregnancies that have not given birth or have an advanced pregnancy week. Then, the uterine cavity is reached by easily entering through the cervix, which is expanded with sterile cannulas in plastic structure. A special injector is placed at the tip of the cannula, creating a vacuum effect. Tissues in the uterus are removed by providing negative pressure with this special syringe.

At the end of the procedure, the tin is removed, the vagina is cleaned again with antiseptic solution and the speculum is removed. With the help of transvaginal ultrasound, it should be checked whether any parts remain in the uterus.

The abortion procedure takes 5-15 minutes on average. After 15 minutes with local anesthesia, if general anesthesia is applied, 30-40 minutes later, the patient is sent home. The patient is recommended antibiotics, pain-relieving medications when needed. Suggestions should be followed carefully. The uterus is checked 1 week after the procedure.

What are the risks of abortion?

Legal abortion limits, ie the risks experienced in abortions applied until the 10th gestational week, are generally closely related to the experience of the obstetrician performing the procedure. Although abortion is not a common occurrence, as a result of which abortion is a surgical procedure, the patient may face various risks.

Infection:

The environment in which the procedure is performed should be sterile. At the same time, the infection may develop as a result of the patient's failure to follow the rules that should be followed after abortion (not using antibiotics, not showering in the foot, entering the pool or tub, early sexual intercourse after abortion). The patient's vaginal bleeding may be increased, pain and fever may be observed.

Continuation of pregnancy:

Especially in abortions performed more than 5 weeks before, it is frequently observed (pregnancy is monitored by ultrasound control of the patient 1 week later). Due to the very small gestational sac, it may develop as a result of inadequate processing.

Atony:

Excessive bleeding may be encountered during abortions performed in advanced gestational weeks. It develops due to the inability of the uterine muscles to contract well. Abortion within the boundaries of legal evacuation is not very common.

Parts remaining:

The patient expresses that after the procedure there is more bleeding than normal menstrual bleeding. It can be monitored and intervened on ultrasound performed 1 week after abortion.

Uterus puncture or intestinal injury:

It is more likely to be seen in large gestational weeks. Uterus perforation may also be accompanied by bowel injury. It is followed in small punctures and expected to close spontaneously. In large punctures, the operation can be planned by evaluating the patient's clinical picture.

Asherman's syndrome (Adhesion):

It develops as a result of excessive curettage of the inner layer of the uterus wall. Abortion, even though 4-6 weeks have passed since Ankara, the patient cannot have menstruation, and then he or she cannot see their menstruation very little or not at all. It is important as it can lead to infertility.

Things to consider after an abortion:

Be sure to use your antibiotics and pain medication recommended by your doctor!

If you have blood incompatibility with your partner (Rh incompatibility), you should hit the anti-D Ig dispute needle in the first 72 hours after an abortion!

You may have a small amount of slightly pinkish bleeding. Sometimes these bleeding may also include a clot. But don't worry, this is normal. If your bleeding amount is too big and red, contact your doctor right away ..!

Op. Sibel Malkoç, MD

Gynecology and Obstetrics Specialist

Dr. Sibel Malkoç attended many domestic and international training seminars and congresses during 25 years of specialised physician service.

Pregnancy follow-up, urinary incontinence surgery and laser treatments, genital aesthetic surgery and laser applications and vaginismus treatment are of special interest.

It serves its patients especially in surgical and laser-assisted Vagina aesthetics.

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