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Doctor's Orders
February 09, 2013 COMMENT comment
     
Doctor's Orders
By Purva Bhatia
 
 
When contacted for their inputs for this article, all the gynaecologists had several sordid tales of various patients (mostly young, unmarried girls) who came to them after having botched up abortions by quacks, or contraceptive and emergency contraceptive pill abuse. "Just recently, I had this case of a young girl who went for an abortion to an uncertified clinic. She was suffering from excruciating pain; we found that she had had an incomplete abortion," shares Dr Sadhna Kala, head of the gynaecology department at Moolchand Women's Hospital, Delhi. "Such cases are very common," she adds.

There is almost negligible awareness of the pros and cons
of prevention of pregnancy as well as the termination procedures, say doctors. Whether you are pro-choice or pro-life, it is important to know about the different abortion procedures.

Depending on how old the foetus is, there are several types of legal procedures available in India. Non-surgical procedures are suitable in the first trimester, after which surgical means are required. Whichever method – medical or surgical – one goes for, consulting a certified doctor is an absolute must, stresses Dr Vimal Grover, senior consultant, Obs and Gynae, Fortis La Femme. Unmarried women who worry about the 'stigma' attached should know that the MTP Act requires for the patient's identity to be kept private. You are allotted a number the minute you check in.

Up to seven weeks of pregnancy can be terminated medically. This involves the use of two drugs, mifepristone and misoprostol. The drugs induce vaginal bleeding and uterine cramping which lead to abortion. Abortion generally occurs within 72 hours of the first dose. Although available over the counter in India, the pills should not be taken without medical supervision as it could lead to severe complications, says Dr Kala. "Since the drugs are easily available, people tend to take it lightly and think it is easy and safe. But that is not true. You will need to go for an ultrasound and follow up about two weeks after the abortion to make sure the procedure was successful," she adds.

In the first trimester or up to 14 weeks of pregnancy, abortion can be performed by suction evacuation, usually done under ultrasound guidance, and curettage or cervical dilatation and evacuation of uterus, or menstrual aspiration.

Abortion up to 16 to 20 weeks (second trimester) of pregnancy can be done by medical methods like ethacridine lactate and prostaglandin. A surgical method like hysterotomy, aspirotomy and hysterectomy is followed in case medical abortion fails or is contraindicated. The actual procedure takes only about 15–20 minutes, but one has to stay in the hospital for four to five hours.

RISKS INVOLVED
Any one of the abovementioned procedures can fail and have side effects on the woman's body. The physical side effects vary from woman to woman. The common side effects of abortion include pain, bleeding, infection, increased chances of infertility and a sense of guilt, says Dr Grover. In many cases, women undergoing abortion suffer from immediate complications like heavy bleeding or severe pain. "If a woman has severe pain after an abortion, she should contact the facility that provided the abortion immediately. If you are experiencing foul-smelling discharge from your vagina, do contact the doctor to avoid complications," she says.

There are some complications that might take time to develop and may not be apparent for days or months. Risks and complications include:

Early Complications:
*
Perforation of the uterus, injury to the intestines with dilation and evacuation
* Hemorrhage or excessive blood loss (more chances in advanced pregnancies)
* Allergic reaction to drugs
* Painful menstruation
* Infection if asepsis not maintained properly
* Incomplete abortion
* Sometimes failure of abortion: 2 to 3 per cent chances with medical abortion and also with surgical abortion if ultrasound is not used during procedure.

Late Complications:
*
Asherman's Syndrome: Intrauterine adhesions if too much of endometrium is scraped
* Pelvic infection leading to infertility
* Increased risk of breast cancer
* Future miscarriages
* Adherent placenta (placenta accreta) in subsequent pregnancies
* If perforation had gone unrecognised, it remains a weak area and there are increased chances of uterine rupture in labour in subsequent pregnancies

COSTS
Medical abortion up to seven weeks can cost from Rs 2,500 to Rs 4,000. Suction evacuation done under anesthesia can cost approximately Rs 16,000 to Rs 20,000. Second-trimester abortion, which requires hospitalisation for up to 24 weeks, can cost approximately Rs 30,000.

It is an absolute must to ensure that the abortion is conducted under the supervision of a trained gynecologist in a reputed clinic or hospital. An unsafe abortion could cost anything from infertility to death.

EMERGENCY CONTRACEPTIVE PILLS
PROS & CONS:

PROS:
*
Highly effective, failure rate just 1–2%
* Reduces chances of ovarian cancer
* Can be the last resort to avoid unwanted pregnancy

CONS:
*
Nausea, vomiting, dizziness, diarrhea
* Allergic reactions like rash and breathing problems
* Small chance of failure and ectopic pregnancy
* Excessive menstrual bleeding
* Bleeding between monthly menstrual cycles
* Pain during sex

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