From Big Medical Encyclopedia

ABORTION ARTIFICIAL (abortus artificalis) — deliberate abortion in terms up to 28 weeks.

And. and. can be legal, medical, or criminal.

Abortion artificial as social problem

Social importance And. and. is defined by the fact that it infringes on interests not only women and her families, but also the state.

And. and. as the method of disposal of undesirable pregnancy was known in an extreme antiquity and is widespread in many countries. By the legislation of Ancient Greece of Rome life of a fruit was not protected and abortion was not punished. Was considered by Plodoizgnaniye as an immoral act and it was punished only in cases when it was made in the mercenary purposes or on other low motives.

Hippocrates considered a plodoizgnaniye as an immoral act unworthy the doctor. In the oath, to-ruyu doctors of school of Hippocrates accepted, it is told: «... I will not hand to any woman of an abortal pessary».

Later, when the Roman Empire began to need soldiers for occupation of others lands and increase in number of slaves, the woman and persons promoting production And. and., were strictly punished.

The Christian concept claiming that destruction of a fruit deprives of its grace of future baptism also, therefore, is a grave sin, was a basis for qualification And. the item in the Middle Ages as the serious crime similar to murder of the relative. Honor iod with influence of church in 16 century in all European countries (England, 1524; Germany, 1533; France, 1562) production of abortion was punished by the death penalty, edges afterwards was replaced with a hard labor and imprisonment. Such situation remained in many countries up to the first half of 20 century.

In the capitalist countries, in addition to medical indications, women force to resort to And. and. hl. obr. severe social conditions: low living standards and material neediness of many categories of workers, especially women; discrimination in compensation; an unsoluble problem of providing workers with housing in the capitalist countries, accommodation in rooms unfit for human habitation, slums; full or partial unemployment; uncertainty in tomorrow.

Bourgeois medical statistics in every possible way shade actual reasons of big prevalence And. and.

In fight with And. and. the bourgeois states use only prohibitive measures. The general for the majority of the countries is evolution from extremely severe punishments in the past towards their mitigation.

In England And. and. it is resolved according to medical indications and also if pregnancy was caused by rape. In Austria since 1937. Abortion artificial is allowed according to medical indications, and his doctor is punished for illegal production by imprisonment. In Belgium along with punishment for illegally made And. and. sale of contraceptives is not allowed. In Germany and in France And. and. it is allowed only according to medical indications. Under the law of 1963 in France indications to And. and. are expanded and they included medico-social indications. In Sweden under the law of 1938. And. and. it is resolved according to medical indications, and under the law of 1946 — also on medico-social. In the USA of the federal law about And. and. is not present; in different states there are laws: in 31 state And. and. it is allowed according to medical indications; in 6 — according to the conclusion of doctors without special restrictions; in 6 states And. and. it is prohibited. In Japan under the law of 1948. And. and. it is resolved according to medical and social indications. In developing countries (India, Pakistan, etc.) And. and. it is prohibited, but in connection with rapid growth of the population in them measures for decrease in birth rate, and the basic by providing the population with effective contraceptives are taken.

Because in many capitalist countries And. and. it is allowed only according to medical indications, and social are not taken into account, the large number of criminal abortions takes place there.

Long-term experience of the countries applying only repressive measures and fight with And. and., demonstrates that severe measures without original improvement of social and economic living conditions of workers achieved the goal anywhere and never and were insolvent. These measures lead only to criminal abortions with high mortality.

In many socialist countries And. and. it is resolved according to medical and social indications. Along with it and them the governmental activities sent to a pas gradual elimination are held And. and.: providing mothers and children with the free help, improvement of zhilshchny and living conditions; the established «family» extra charges to a salary depending on number of children in a family; on pregnancy and childbirth women are granted prenatal and postnatal leave.

In pre-revolutionary Russia And. and. it was prohibited, however, in spite of the fact that the legislation strictly punished the woman and promoting it, number A. l. annually increased. In St. Petersburg, according to L. G. Lichkus (1913), A. and. made 20% of number of childbirth. Mortality of women from criminal abortions was very high.

The question was discussed at pirogovsky congresses of doctors (1889, 1893, 1904) about And. and. At the XII pirogovsky congress in 1913 the question of cancellation of prohibition was raised And. the item to protect health of women from harmful influence of underground abortions.

In RSFSR punishments for production And. and. were actually cancelled in the very first days after Great October socialist revolution.

To protect health of women from harm of criminal abortions, the Soviet government in November, 1920 legalized cancellation of punishment for carrying out And. and. However it did not mean their justification the Soviet state. Considering And. and. as the social evil, the Soviet government carried out work against And. and. by propaganda among the working women, at the same time widely carrying out the principles of protection of motherhood and an infancy.

Legalization And. and. considerably reduced mortality from abortion (from 4% to 0,28%). Further as a result of growth of welfare of the Soviet people and for the purpose of increase in birth rate the resolution of the CEC ISNKSSSR «About prohibition of abortions, increase in financial support to women in labor, establishment of the state help multi-family, expansion of network of maternity homes, children's day nursery and kindergartens, strengthening of criminal penalty for non-payment of the alimony and about some changes in the divorce law» was accepted on June 27, 1936.

And. and. were resolved only according to medical indications. The persons breaking the law were brought to trial.

For protection of motherhood and the childhood the Decree of Presidium of the Supreme Council of the USSR from 8.VI had great value. 1944. «About increase in the state help to pregnant women, having many children and lonely mothers, strengthening of protection of motherhood and the childhood, about establishment of an honorary title „Mother heroine” and establishment of the award „Maternal Glory” and the medal „Medal of Motherhood”». Measures for improvement of material conditions, expansion of network ro efficient houses, a day nursery promoted encouragement of motherhood.

However practice showed that prohibitive measures for fight with And. and. do not give the expected results and lead to growth of the criminal abortions made by ignorant people in unfavorable sanitary conditions that causes big percent of complications and high mortality.

Considering the increased cultural level of the people and for the purpose of decrease in extra sick-lists And. and., the Presidium of the Supreme Council of the USSR issued on November 23, 1955 the Decree «About Cancellation of Prohibition of Abortions». According to this Decree operation of abortion was allowed according to medical and social indications only in medical institutions. Criminal liability for criminal remained And. and.

The reasons of prevalence of artificial abortions

the Decision of the woman on abortion can be caused by many reasons. Interdependence of a condition of living conditions and indicators of birth rate is established: frequency of the birth of the second children is more in the families living in certain apartments. Most often resort to abortion in connection with a disease, family disorders, a possession of many children; to criminal And. and. the women hiding pregnancy resort, as a rule.

The major actions directed to the prevention of abortions artificial, their gradual reduction up to complete elimination are the general social and economic transformations to the USSR which eliminated exploitation of the person by the person, the social inequality between men and women which liberated women. Systematic growth of material well-being of workers also leads to reduction of number A. and. Also sanitary and educational work on an explanation of harm and danger is of great importance And. and. for health of women; acquaintance of women with the legislation on protection of motherhood and the childhood, on fight against criminal abortions and criminal liability for them.

In «Bases of the legislation of USSR and federal republics about the marriage and a family» approved by the Supreme Council of the USSR in 1968 it is told about encouragement of motherhood. This document protects interests of mother and child, labor, housing, pension and other rights of female mothers and the equal rights and duties of parents — the father and mother — are fixed in education of children.

According to the decision of the XXIV congress of the CPSU in the 9th the fifth anniversary the development plan for the national economy provided increase in financial support to the families having children; privileges to the working female mothers extend: child allowances in families where the average income on each family member does not exceed 50 rubles a month are entered; for all working women leave allowance on pregnancy and childbirth at a rate of full earnings irrespective of the seniority is established.

Further reduction And. and. it will be provided by a bigger encouragement of motherhood, increase in welfare of workers, improvement of activity of institutions of protection of motherhood and the childhood, educational, explanatory, sanitary and educational work among broad masses of workers and the recommendation of modern highly effective contraceptives.

Abortion in the medical relation.

Medical And. and. it is made in specialized department at a multi-field hospital or a maternity home in the direction of clinic for women or the gynecologist of district clinic.

Indications to medical And. and. can be social or medical. Social indications are defined, as a rule, by the woman; according to these indications it can be made only early And. and. (in the first 12 weeks).

Medical indications to And. items arise when pregnancy and childbirth threaten health and life of the woman: diseases of c. the N of page who are followed by mental disorders, organic heart diseases, blood vessels, a liver, kidneys, malignant new growths, open forms of a pulmonary tuberculosis, a thyrocardiac craw, not giving in to treatment toxicoses of pregnancy, etc.; according to these indications And. and. it can be made also in terms over 12 weeks.

Contraindications to medical And. and. — duration of gestation more than 12 weeks and a time term less month after previous And. and. Acute and chronic inflammatory diseases of female generative organs, erosion of a neck of uterus, acute infectious diseases (quinsy, flu, pneumonia and t. and.) serve as relative contraindications to carrying out And. and.; it is more reasonable to carry out it after the corresponding course of treatment.

The vast majority of medical abortions is made under a local anesthesia. According to specially stipulated indications (lability of mentality, the increased painful sensitivity and so forth) the general anesthesia can be applied (an intravenous short-term anesthesia Epontolum, Sombrevinum, etc.). In rare instances at And. and. according to medical indications, especially in late terms, there can be a need for an anesthesia with muscle relaxants, the managed breath and so forth.

For performance medical And. and. use bullet nippers, Hegar's dilators, curettes, etc. (see. Obstetric and gynecologic tools ).

Early medical abortion is made by expansion of the cervical channel with the subsequent removal of fetal egg and a mucous membrane of a uterus. And. and. make without control of sight that creates certain difficulties and dangers of this operation.

Before operation make vaginal examonation for determination of size and position of a uterus. Then the vagina is opened mirrors, processed alcohol and 5% spirit of iodine. The front lip of a neck of uterus is taken bullet nippers and reduced. Determine by sounding the sizes of a cavity of the uterus and the direction of the cervical channel which then is broadened with Hegar's dilators, as a rule, to 11 — the 12th number. After expansion of the channel separate and delete fetal egg from a cavity of the uterus with a sharp curette. The scraping should be made extremely carefully, remembering possible danger of injury of a friable edematous uterus by tools. Operation is considered finished when all parts of fetal egg are removed from a cavity of the uterus, the uterus is well reduced, there is no bleeding.

Medical abortion can be carried out by means of devices for a vacuum ekskokhleatsii (see. Vacuum ekskokhleation ). The first stages of operation at the same time (up to expansion of the cervical channel) same, as at a tool way. After expansion of the channel to its bottom enter a tube of a vacuum aspirator into a cavity of the uterus, then during 5 — 8 sec. create depression to 0,5 — 0,6 atm.

The method vacuum ekskokhleatsii has advantages before method of a scraping: demands smaller expansion of the cervical channel; enter less tools into a cavity of the uterus that reduces number a complication; considerably (almost twice) blood loss decreases during operation; duration of operation is reduced to 2 — 3 min.; the muscular layer of a wall of a uterus is less injured; an operation vacuum ekskokhleatsii is undergone by women much easier.

After operation A. and. the woman is in a hospital under observation of medical staff. It is necessary to watch the general condition, body temperature, dynamics of reduction of a uterus and allocations of a pas of a genital tract. If And. and. passed without complications, the woman is written out from a hospital in 72 hours. Before an extract vaginal examonation is made. After an extract the woman shall be under observation of the doctor of clinic for women to the first normal periods.

Late medical abortion is made by various methods depending on duration of gestation, the general state of health of the woman, the obstetric anamnesis.

Conservative method consists in artificial initiation of reduction of a uterus (initiation of patrimonial activity) by administration of oestrogenic hormones and drugs of tonomotorny action (see. Childbirth ).

Surgical methods:

1. Vulval Cesarean section is applied at duration of gestation of 16 — 20 weeks when according to medical indications urgent abortion is required (a severe form of toxicosis of pregnancy, an idiopathic hypertensia, more sharply cardiovascular insufficiency, etc.) at unprepared patrimonial ways. Contraindications: placental presentation, earlier undergone operations of Cesarean section, existence of new growths of generative organs, cervical pregnancy. Technology of operation — see. Cesarean section .

2. Bryushnostenochny small Cesarean section is most often applied when simultaneous sterilization is for health reasons shown to the woman. Technology of operation — cm. Cesarean section.

3. Intraamnionalny introduction of hypertonic salt solutions for the purpose of abortion in late terms in a crust. time is applied only by some specialists. In aseptic conditions a needle with mandrin enter into a cavity of amnion through an abdominal wall, vaults of the vagina of a pla the cervical channel; to zata mandrin is extracted, remove 120 — 200 ml of amniotic waters and enter 20% solution of sodium chloride 40 — 50 ml smaller, than it is released an amniotic fluid. Abortion is done within the first days.

Complications of medical abortion can arise both during operation, and in the postoperative period; their frequency in many respects depends on term, at Krom is made And. and., and from a method of operation. Complications And. the items executed in time 9 — 12 weeks meet by 2,2 times more often than at the term of 6 — 8 weeks. Use of a method vacuum ekskokhleatsii reduces number of complications during And. and. Perforation of a uterus and an internal injury tools in time And. and. are observed in 0,01 — 0,3% of all And. items and depending on a damage rate demand conservative operational treatment of a pla (see. Uterus ).

Bleeding can arise after medical And. and. at hypotonia of a uterus as a result of the rests of fetal egg in a cavity of the uterus which exfoliated from its wall and at an atony of a uterus. Big blood loss can lead to very serious effects, up to death of the patient. For a stop of bleeding delete the remains of fetal egg (a repeated scraping) from a cavity of the uterus, transfuse blood, appoint the haemo static and reducing a uterus means.

At medical And. and. infectious complications meet seldom (a metritis, an endometritis). At spread of an infection out of limits of internal generative organs can be observed pelviperitonitis (see) or peritonitis (see).

Placental polyp (see) develops, as a rule, from the pieces of a fleecy cover which remained in a cavity of the uterus, sprouts edges elements of connecting fabric. It is shown by the repeating uterine bleedings amplifying in days of periods. Treatment of a placental polyp consists in a careful scraping of a mucous membrane of a uterus.

Aggravation hron. inflammations of internal generative organs note approximately in 1/2 all And. and.

One of serious consequences And. and. secondary infertility is St.). Frustration of a menstrual cycle after postponed And. items meet in 6 — 10% of cases.

The heavy complication of childbirth is observed 4 times more often at the women who transferred And. and.; to their thicket hysterorrheses in labor are observed.

Abortion criminal

the women who are not married from desire to hide pregnancy in most cases resort To criminal abortion. More than a half of criminal abortions is carried out in late terms that regarding cases speaks to a neuva rennostyo women in the fact of pregnancy or instability of marital status.

Criminal abortion is made, as a rule, by persons low-skill and without due observance of rules of an asepsis and antiseptics. It generally also defines a large number of the complications accompanying criminal abortion: metritis, endometritis, sepsis, ruptures of patrimonial ways, bleeding etc.

As a rule, only criminal abortions with complications are registered. At suspicion on criminal abortion the woman shall be hospitalized irrespective of her general state. Tactics of treatment at complications of criminal abortion same, as well as at complications of medical.

It is necessary to inform on each case of criminal abortion investigating authorities.

The problem of the prevention of criminal abortions costs in close interrelation with the further growth of material well-being of the population and improvement of sanitary education.

Abortion in the medicolegal relation

And. and. matters object of examination when it is criminal.

For illegal production by the doctor A. and. criminal liability is provided; punishment amplifies if criminal And. and. it is made by the person who does not have the higher medical education and also if And. and. it is made repeatedly or involves the death of the victim or other heavy effects (Art. 116 of UK RSFSR). The woman at whom pregnancy was interrupted is not subject to punishment.

At criminal abortion mechanical, chemical, thermal and medicamentous means are used. Court. - medical examination should establish: the fact of existence of pregnancy and its term, proofs of the done spontaneous or artificial abortion, its prescription, a way of a plodoizgnaniye, emergence of complications and a cause of death.

At court. - a medical research of generative organs of a corpse of the woman in connection with criminal abortion department of soft tissues in the field of a pubis, a cut of haunch bones at the level of locking openings and removal of the cut site of a pubic joint is recommended. The urethra, a bladder, a vagina cut on their left side wall and examine on site. Then take bodies of a small pelvis. The neck of uterus is cut on the left sidewall. Enter a stupid branch of scissors into a cavity of the uterus and cut the left sidewall it to the left pipe, a bottom — to the right pipe. Examine a mucous membrane of a uterus, a bag of waters, the placental platform. At the same time damages, traces of influence of various solutions can be found. The ovary is cut on length, pipes and a wide sheaf — cross. Parts direct them to judicial and chemical, histologic, bacteriological, cytologic, biochemical researches.

Diagnosis of existence of pregnancy is made by the general rules of obstetrics. Signs of an event And. and.: opening of a neck of uterus, change of provision of its mucous stopper, placental detachment and bleeding, existence of cells of chorion in allocations from a neck of uterus and scrapings from her cavity Hormonal diagnosis of the broken pregnancy is based on identification of a chorial gonadotrophin.

Duration of gestation is determined by the sizes of a fruit (its length), a uterus and a yellow body. Fibers of chorion up to three months of pregnancy consist of a connective tissue basis, cubic epithelial cells covered with an outside syncytial layer. At big durations of gestation the cytotrophoblast perishes.

The secret of a mammary gland in the first 3 months of pregnancy always contains a small amount of fatty balls, epithelial cells of the average size (alveolar). The cytologic picture of a secret of a mammary gland at abortion differs in existence in it of neutrophils and a basophilia of epithelial cells. In a secret of a mammary gland of a corpse these inclusions remain within a day after death, and then cells of a secret break up.

The way of a plodoizgnaniye (at an exception of the conditions able to entail spontaneous abortion) is determined by existence of bruises, their morphological features (localization, a form, the sizes, properties of edges, etc.), to a condition of a mucous stopper of a neck of uterus (its movement), reactive changes of a mucous membrane of a uterus under the influence of various chemical substances. Experts shall consider results of inspection of the scene and the evidence.

The prescription of abortion, i.e. time which passed from the moment of production of abortion before survey of the woman or a research of her corpse is determined by a cytologic picture of the separated vagina, a cut reflects duration of gestation within 5 — 6 days, and then signs of a puerperal period. Duration of allocation of a chorial gonadotrophin (Galli-Maynini and Ashgeym's reaction — Tsondeka) is established by a research of urine which is allocated the ambassador A. and. within 10 — 14 days.

At a research of a corpse the prescription of abortion is determined by degree of manifestation of inflammatory reaction of a mucous membrane of a uterus taking into account and others court. - medical and investigative data.

The histologic research reveals the inflammatory changes in scrapings from a cavity of the uterus after criminal abortion depending on character of chemical substance, its concentration and duration of action. The plethora of tissues of uterus without infiltration on border with sites of a necrosis of her mucous membrane demonstrates short-term intrauterine influence of chemical solution; in several hours or days the histochemical picture of a wall of a uterus reflects inflammatory process of various intensity — from catarral, serous to is purulent - necrotic.

On section bruises of generative organs and signs begun can be found And. and.: a considerable plethora of internals and a hyperpermeability of vessels, lack of a reactive inflammation in a mucous membrane of a uterus (after influence of chemical solutions), existence in tissues of a uterus, its contents of various chemical substances. Bystry approach of death on site of incident is observed, as a rule, from an air embolism and shock. Also acute loss of blood at bruises, poisonings, sepsis, etc. happens a cause of death at criminal abortion. If there is a suspicion that abortal means were applied, opening is made by the rules established for postmortem examination of bodies of poisoned.

Complications and their causal relationship with And. and. are defined at survey of the woman: inflammatory processes of appendages, uterus, perimetric cellulose, etc.

At suspicion on criminal abortion the medical staff is obliged («The instruction of Prosecutor's office of the USSR, the National Commissariat of health care of the USSR No. 202-3 from 25. XI. 1940 about carrying out fight against criminal abortion») in details to write down in the history of a disease the anamnesis and data of an objective research (survey of external genitals, a vagina and a neck of uterus by means of mirrors, etc.), and also to keep material evidences of commission of criminal abortion (the foreign bodys taken from a vagina or a uterus of the patient; notes, recipes, etc.). In a case history the data reported to medical staff by the persons which brought the patient to medical institution are surely entered.

Bibliography: Beloshapko P. A. Influence of abortion on the subsequent childbirth, Akush. and ginek., No. 10, page 21, 1940; Volkov A. G. Morphological changes of a fruit and placenta at intraovulyarny introduction of hypertonic salt solution of sodium chloride, Vopr. okhr. mat. also it is put., t. 14, No. 8, page 74, 1969; Volkova L. S. Immunobiological relationship of organisms of mother and fruit, page 160, M., 1970; I. F Zhordania. Textbook of obstetrics, page 526, M., 1964; Malinovsky M. S. Operational obstetrics, page 420, M., 1955; Nikonchik O. K. The principles of the organization of fight against abortions in the Soviet Union, in book: Aktualn. vopr. akush. and ginek., under the editorship of A. V. Bartels, the p. 2, page 91, M., 1967; Persianinov L. S. and Avtyukovich S. F. A role of clinic for women in fight against abortions, in book: Clinic for women, under the editorship of L. S. Persianinov, page 206, Minsk, 1966: The Raman R. M. Operations of abortion on medical indications, Mnogotomn. the management on akush. and ginek., under the editorship of L. S. Persianinov, t. 6, book 1, page 29, M., 1961; Haskin S. G. Abortion and its complications, L., 1967.

And. and. as social problem: Bakradze D. K. Legal analysis of the legislation of some countries of the world on abortion. Works of Nauch. - issled. in-that fiziol, and patol. women, t. 3, page 453, Tbilisi, 1967, bibliogr.; Vasilevsky L. M. Abortion as social phenomenon, Dnipropetrovsk, 1927; Intrauterine contraceptives, physiological and clinical aspects, the lane with English, it is gray. tekhn. dokl. WHO, No. 397, Geneva, 1969; Questions of demography, a research, a problem, methods, under the editorship of A. G. Volkov, M., 1970; Studying of opinions on the size of a family, under the editorship of A. G. Volkov and L. E. Darsky. M, 1971; Katkova I. P. Birth rate in young families. M, 1971; Clinical aspects of oral use of gestogen, the lane with English, it is gray. tekhn. dokl. WHO, No. 326, Geneva, 1967; Smiths V. K. Zavisimost of the average saved-up chislennost of abortions from age and distribution of abortions, in book: Sots. - a gigabyte. researches, under the editorship of Yu. P. Lisitsyna, page 170, M., 1970; about N with, Studying of abortion as social and hygienic problem, in the same place, page 160; Levi M. F. Abortion and fight against it, M. — L., 1937; Methods of demographic researches, the lane with in., under the editorship of L. E. Darsky, M., 1969; Birth rate and its factors, the lane with in., under the editorship of A. G. Volkov, M., 1968; Factors of birth rate, under the editorship of A. G. Volkov, M., 1971; Abortion in the United States, ed. by M. S. Calderone, N. Y., 1958.

And.i. in the medicolegal relation: Dozortseva G. L. Functional diagnosis in obstetrics and gynecology on the basis of cytologic researches, Minsk. 1952, bibliogr.; Zaytsevo E. I. Znacheniye of a cytologic picture of the vulval criminal abortion separated at diagnosis of prescription, Court. - medical examination, t. 7. N «4, page 25, 1965; Some questions of pathology of early stages of ontogenesis of the person, under the editorship of A. P. Dyban, Lviv, 1951; Hizhnyakovak. I. Medicolegal value of microscopic examination of women's milk. Court. - medical examination, t. 1, No. 1, page 29, 1958; it. The cytology of a secret of a mammary gland is normal also at some diseases, page 214, M., 1965, bibliogr.; Marchand et Delecour M. Valeur medico-legale des frottis vaginaux, Ann. Med. leg., t. 2, p. 155, 1952.

V. K. Kuznetsov, Yu. P. Lisitsyn, D. G. Oppengeym (sots.); O. K. Nikonchik (academician), K. I. Hizhnyakova (court.).